INTRODUCTION

As a part my Class room teaching presentation, I got a topic from Obstetrics and
Gynaecological Nursing –II specialty; in that I got a topic “COMPLICATIONS OF
THIRD STAGE OF LABOR”. So, I want to take the class about this topic to my dear
IV year B Sc nursing students and I want give more information regarding the topic.
 BACK GROUND INFORMATION:

Name of the student: Mr. Ajay D

Class/ Year: II Year M Sc Nursing
Subject: Obstetrics and Gynaecological Nursing-II
Topic: Complications of third stage of labor
Group: IV year B Sc Nursing
Venue: IV year B Sc Nursing class room
Time: 60 minutes
Date of teaching:15/09/2024
Methods of teaching: Teaching cum discussion and demonstration
AV Aids: Black board, leaflets, pamphlets and chart.
Previous knowledge
level of the students: Students have the less knowledge about the topic
 GENERAL OBJECTIVES:

By the end of the class room presentation; students will gain and improve their knowledge
regarding the topic of “COMPLICATIONS OF THIRD STAGE OF LABOR”.

SPECIFIC OBJECTIVES:
By the end of the class room presentation; the students will be able to:
 Define obstructed labor.
 Explain about incidence of obstructed labor.
 Describe the causes of obstructed labor.
 Explain about morbid anatomical changes.
 Explain the effects of obstructed labor.
 Explain the clinical features of obstructed labor.
 Describe the prevention of obstructed labor.
 Explain the treatment of obstructed labor.
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1 2 min Self SELF INTRODUCTION :- L P Students know
Introduction myself
I am Mr. Ajay D, from II year M.Sc
P
Nursing Stusent {Obstetrics and I

Gynaecological Nursing}. As a part of T

my Class room presentation. I got a topic S

from Obstetrics and Gynaecological

Nursing –II Speciality; the topic is T

“COMPLICATIONS OF THIED STAGE

OF LABOR”. So, I want to take class E

room presentation of this topic to 4th year

B sc Nursing students. N

G
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INTRODUCTION:
Of all the stages of labor, third stage is
the most crucial one for the mother. Fatal
complications may appear unexpectedly in an
otherwise uneventful first or second stage.
The following are the important
complications:
(1) Postpartum hemorrhage,
(2) Retention of placenta,
(3) Shock—hemorrhagic or nonhemorrhagic,
(4) Pulmonary embolism either by amniotic
fluid or by air,
(5) Uterine inversion (rare)

I.POSTPARTUM
HEMORRHAGE:
DEFINITION:
 Quantitative definition is arbitrary
and is related to the amount of blood
loss in excess of 500 mL following
birth of the baby (WHO). It may be
useful for statistical purposes. As the
effect of the blood loss is important
rather than the amount of blood lost.
 The clinical definition, which is more
practical states, “any amount of
bleeding from or into the genital tract
following birth of the baby up to the
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end of the puerperium, which
adversely affects the general
condition of the patient evidenced by
rise in pulse rate and falling blood
pressure is called postpartum
hemorrhage”.

 The average blood loss following

vaginal delivery, cesarean delivery
and cesarean hysterectomy is 500
mL, 1000 mL and 1500 mL
respectively.
 Depending upon the amount of blood
loss, PPH can be
♦ Minor (< 1L),
♦ Major (> 1L) or
♦ Severe (> 2L).

INCIDENCE:
The incidence widely varies mainly
because of lack of uniformity in the
criteria used in definition. The incidence
is about 4–6% of all deliveries.

TYPES:
 Primary
 Secondary
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Primary: Hemorrhage occurs within 24
hours following the birth of the baby. In
the majority, hemorrhage occurs within
two hours following delivery.
These are of two types:
 Third stage hemorrhage—Bleeding
occurs before expulsion of placenta.
 True postpartum hemorrhage—
Bleeding occurs subsequent to
expulsion of placenta (majority).

Secondary: Hemorrhage occurs beyond

24 hours and within puerperium, also
called delayed or late puerperal
hemorrhage.

A. PRIMARY POSTPARTUM
HEMORRHAGE:
CAUSES:
Four basic pathologies are expressed
as the four Ts’ (RCOG): Tone (atonicity),
Tissue (retained bits, blood clots),
Trauma (genital tract injury) and
Thrombin (coagulopathy).
♦ Atonic ♦ Traumatic ♦ Retained tissues
♦ Blood coagulopathy (Thrombin).
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 Atonic uterus (80%): Atonicity of
the uterus is the commonest cause of
postpartum hemorrhage. With the
separation of the placenta, the uterine
sinuses, which are torn, cannot be
compressed effectively due to
imperfect contraction and retraction
of the uterine musculature and
bleeding continues. The following are
the conditions, which often interfere
with the retraction of the uterus as a
whole and of the placental site in
particular.
 Grand multipara
 Overdistension of the uterus as in
multiple pregnancy,
 Anesthesia: Depth of anesthesia and
the anesthetic agents (ether,
halothane) may cause atonicity.
 Initiation or augmentation of delivery
by oxytocin:
 Malformation of the uterus:
 Uterine fibroid causes imperfect
retraction mechanically.
 Mismanaged third stage of labor:
This includes—
 Too rapid delivery of the baby
 preventing the uterine wall to
adapt to the diminishing
contents,
 Premature attempt to deliver
the placenta before it is
separated,
 Kneading and fiddling the
uterus,
 Pulling the cord. All these
produce irregular uterine
contractions leading to partial
separation of placenta and
hemorrhage,
 Manual separation of the
placenta increases blood loss
during cesarean delivery.
 Placenta: Morbidly adherent (accreta,
percreta), partially or completely
separated and/or retained
(constriction ring uterus p. 486)
cause PPH.
 Precipitate labor
 Other causes of atonic hemorrhage
are: Obesity (BMI > 35), Previous
PPH, Age (>40 yrs), Drugs: Use of
tocolytic drugs (ritodrine), MgSO4 ,
Nifedipine.
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