INTRODULTION

kabot
Twind
Aaviously
staqe in moot eHucial stage
uneventu iot and aL cord
sBage ean loCoMe abnomal wituin a minute coit
dinas tHOWs
tue
corsLquanS
management
ue pin ciple. ndying
aMe to
stteict
vigitanc and managemert
quidins stiety in pHacNae 30 as to pravent te
eomplcotiows he tund
stage kabot ConsiotA

two phoses. 7it phape is He plaenta

and DLcond phae i9 Huat
Separation tue
plaental examination
ADVAN AGES
minimige blodd om in e wind oage
appom atey to One

"o hoten dunatior Huind Aage to

hat
" Rdu CUA matenynal anemia:

blood tanaguain

DISADVAN (AG ES
. it incHIased incidence ah et
etaound peaana and
CoN)equ nt incuand inadan af manual Hemoval.

51EPS OF MANAGEMENf
fuo metaodo management ae CuHKntig in

practtae

d Achue Nanagmet
2· Expictant Managmnt
 54EME MANAGeMENT of THiRD 5A4E ASUR
Expactan
hanagiment Active aaagemnt
Delvery ot He baby Iyection oxgtocin 1ouni ts IH or
ablut miDDpHopto Goo uq oralg
oR înj metuangine o2 mg IM to
Oclayd corLd elampingy the. motuh oittin one. ninute
(90-120 5ec)
a bith af tue

camp divide and ugate Delayed cond clamping

Hue CoHd (a0- (20 Sed

clamp duvide and duqte Hue

wait d watch
quand e fundus
wait joh Depurhio
plaanta
" Cathe tetuge tu bladdY Contolled tord tract'on

Plaant paratd avai ling jiot wteine

contach'or·
J
Wait joh spontunous tue wte w

Upulsio
oita He a kareaging
with
immadiatuy ttun dliveng
inute
pla anta to
door wtenine Conracho w.
bearinq J

Caragud Lxaminahyn at
kuplautn fo its canmplatenn.
Amitd Axpulsion Cxaminaton
-fta ct to xcu de. ang
injumy aud to apain ha,
Poot partum vigikan a:
t
"Palpatiorn
15 minutes 2 h to 2nts
te in hatd
"Eotimoate Lorm.
Conolled cord
racton " NewboHn are
kup tbabg dy
and sKin t 6kin Lontact oitth
COve baby and
no tue. Snhao a
oitin hout.
bvaottudeg

pla anta and

membanes imgped vuwa

vagina and penin um.

AC1VE NANAGCMEN

undonly'ng pinuple in act'vo

to
4 minuteo
excite.
pouengud utrine (ontkacfom wttin

panntenal not

sepo matiorn the plo cnta , bt also podua cut

wtentne.
onthacfonb Rolong paration
PADCCDURES
Snjector orgtocir 10 uns TM orc minopostol bo049
motuun

melengine o- 2 mg IM gven
within 1 minute koalg e pla arta
in expuctd deivetud soon follo cosng divery
7 tue plaanta io not daivend, theagteh
Contollucd
dlehad foutit Hue cokd
Lond tHachion ttennique carping
wterws Hema cantractd.
te
mio tiedo in a
adg
tratior mignt happen
Rabon HOo1 ohould not be paniclt but
Cornducte conventional atg
txpctanc
Actie manageunt containdy a vatue
to devtope postporetum humonage
ig Anamia, bydramnian
and pheviows * PPH
toins mulipanus
ot

in casoyot
olth home dalieny Metuangint onowid not
pa dampoi'a:
 car diac OveHload aand
fon 7 phecipitating
and aggravahon af bloood
taulune fommin
penun edampoia in Raten

Amioto plaanta (a) controlls d

CeRd tractio dsliang palmar sungace He

in pla ad pprorimatuy
junction and
uppet Louoeh utetin gment
uteus pushd upwad and
bac kwatd towatds unbilliCws Qhile
uand otady tension is given in dooniard
and koackwahd dihu ch'on hodirg until
clamp
pola anta outoide intoitws.

thus m one an wteine Luvah'on bauutates

Lxpuloion plaanta. e pro adure is to
uten w io hahd an ontactd
adaptud
() fundal Prusue pushc dowgrd
and Oackuwand
ahind
and Hue im
rant
P r e u must be aian
hn ttu comes hard it ty not
ondg mane it hand prenune
oitudrawn Hue pla anta
tue to manaratd
prurn patune tus
traehen
Kucued
iwstanas.
 totn wch in not
to pxo bltr glovud
hand sho uld be. intodud an d plaata
gropeed and
wmawagud to stimutae uteHÌne
ue wteeus
Contachos and o make
facibtates expulolor rataind clotA

and tod .
Examinationn of te pla centa membHanes

e plaanto tray and istuewashedl

blood
Hunning tup wath to
Hemove.

out n
and ctot
and anomolies e matnal
Complittn
with deeilua

cotgtedovv ate plaud in cloos pprximaon

4he
and
noi cats mimrg cotylucdon
numbn
cut an insprctud
two
Bmbilu cal
tuee
ot alood vunds. Natmaly
are

aHdHis and umbilli cas veini An ova

the Chon'on tortn vens
in
magin tue p (ndicateo
unnirj up to te
sUe Untuiate

-Vuwoa vagina
and penneum igpucted
and nupained ,ib ang
wound outund.
Ovty ttue vulva
ptaud
 ExPECANÍ MANAG EMENÍ

managemnt , plaantal spanah'on and

alowc to bee
descot int Hhe
vagino
spontanously Minimal amintance may
may be gren
tadies needed

"Comtant watch mandataMY Qnd tue patieut

alone .
Should not
pooith'on
daveed in te lateal
donsal pooihon to note
she Sholo Changd to
ocparason and o
Reaturus of pla cantal
amount blo d Lo
Hue

"A hand plaad Ovet fundus

He Dupanaho^ t pea unta
() o ucognige
(b) To note Hue otate af utu°ne achiviys contrachon
and Helaxaton

dutect , Hougn Hare

upping the
an Avidnu Hue utHW).
invetoior
Disire to
Qith tue
be

Dparated i t a mintA
(ndend. Placunta
tte

to 6ao
watigd
minuts.
apclan can be extendd
0me imtihuhos,no touch
nands cmplagud.
 is xpected to expl ue pla anta witin 20
min utw witt ud

.Expulsion plaunta : ovdy

inty tue
t plaunt al spamator ardd ita ds unt inty
pahent in askd
Rowtr gmment are conginmd,
to down simultantowg with the
nandnin0
Hat Kaised inra abdominal pD he
tten adquate to cpl tue plaanta If He patheut
Can Nait up to 1o min
Huene i no .An D0on as Hue pla anta
pameo wioug tue intoi tus it ia
hands and twiotd hound and Hound with
genta
Haction Hhe mmbHans are stripprd
intact Gentlems pahtna and Cahe anl phe
huquisit tu membYa ns.
pontanouy oH i9 not

pNocth caole. oteawe

undden anestsa,
nmetuooo to Lwd to
anyn
kpedite expusion