By Dr.M.D.Mazumdar, MD
The third stage of labor starts at the end of the Second Stage after the baby has been delivered.
As soon as the baby is delivered, there is a temporary lull in the uterine contractions.
The uterus contracts to become a firm globular organ reaching upto the mother's umbilicus. Pressure on it causes pain but it is not otherwise painful.
Through the vagina, the cervical opening or os is seen to become partially closed. The baby's umbilical cord is seen snaking out of the os towards the vaginal opening.
An injection of a drug called ergometrine is usually given just after the baby is delivered to stimulate the uterus to contract better. This helps to prevent any excess bleeding.
Uterine contractions start again after about 5 - 10 minutes. The contractions are strong and powerful and show charateristics similar to those in the second stage - they contract and relax alternately. Pain is lesser than in the second stage.
Placental separation from the uterine wall is indicated by a gush of fresh bleeding from the os. The umbilical cord also seems to become longer.
The placenta may be delivered by the woman herself by bearing down during the uterine contractions. But usually, controlled traction or pull is applied on the cord by the obstetrician and the placenta pulled out slowly. This allows the placent to be delivered faster and decrease the amount of bleeding.
Once the placenta is out , it is examined carefully to see that all parts including the membranes are completely out and there are no bits left behind in the uterus. Retained placental bits may cause heavy bleeding or infection later on.
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The principle of management of this stage is to prevent complications during delivery of the placenta and the membranes.
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