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Active Management of The Third Stage of Labour

Postpartum hemorrhage is the leading cause of maternal death worldwide and usually occurs within 4 hours of delivery. It is defined as excessive bleeding within the first 24 hours after childbirth. The main causes are uterine atony, retained placenta or blood clots, vaginal or uterine tearing, and coagulation disorders. The preferred prevention method is administration of oxytocin after delivery, though alternatives like carbetocin, ergonovine, and misoprostol may be used if oxytocin is unavailable. Delaying cord clamping for at least 60 seconds is recommended for premature infants but risks of jaundice in full-term infants require consideration. Surgical techniques should only be used for intract

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Genio Rachmadana
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136 views

Active Management of The Third Stage of Labour

Postpartum hemorrhage is the leading cause of maternal death worldwide and usually occurs within 4 hours of delivery. It is defined as excessive bleeding within the first 24 hours after childbirth. The main causes are uterine atony, retained placenta or blood clots, vaginal or uterine tearing, and coagulation disorders. The preferred prevention method is administration of oxytocin after delivery, though alternatives like carbetocin, ergonovine, and misoprostol may be used if oxytocin is unavailable. Delaying cord clamping for at least 60 seconds is recommended for premature infants but risks of jaundice in full-term infants require consideration. Surgical techniques should only be used for intract

Uploaded by

Genio Rachmadana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Active Management of

the third stage of labour

Post Partum Hemorrahage

Is the leading cause of maternal death worldwide

The majority of these death occurs within 4 hours of delivery, which


indicates that they are a consequence of the third stage of labour.

Definition

Excesive bleeding that occurs in the first 24 hours after delivery

Etiology

4 T:

Tone: uterine atony, distended bladder

Tissue: retained placenta and clot

Trauma: vaginal, cervical, or uterine injury

Thrombin: coagulopathy (pre-existing or acquired)

Prevention of PPH

Oxytocin (10 IU), administered intramuscularly, is the preferred medication and


route for the prevention of PPH in low-risk vaginal deliveries. Care providers
should administer this medication after delivery of the anterior shoulder

Intravenous infusion of oxytocin (20 to 40 IU in 1000 mL, 150 mL (per hour) is


an acceptable alternative for AMTSL

An IV bolus of oxytocin, 5 to 10 IU (given over 1 to 2 minutes), can be used for


PPH prevention after vaginal birth but is not recommended at this time with
elective Caesarean section

Carbetocin, 100 g given as an IV bolus over 1 minute, should be used instead


of continuous oxytocin infusion in elective Caesarean section for the
prevention of PPH and to decrease the need for therapeutic uterotonics

For women delivering vaginally with 1 risk factor for PPH, carbetocin 100 g IM
decreases the need for uterine massage to prevent PPH when compared with
continuous infusion of oxytocin

Ergonovine, 0.2 mg IM, and misoprostol, 600 to 800 g given by the


oral, sublingual, or rectal route, may be offered as alternatives in
vaginal deliveries when oxytocin is not available

Whenever possible, delaying cord clamping by at least 60 seconds is


preferred to clamping earlier in premature newborns (< 37 weeks
gestation) since there is less intraventricular hemorrhage and less
need for transfusion in those with late clamping

For term newborns, the possible increased risk of neonatal jaundice


requiring phototherapy must be weighed against the physiological
benefit of greater hemoglobin and iron levels up to 6 months of age
conferred by delayed cord clamping

Intraumbilical cord injection of misoprostol (800 g) or oxytocin (10 to


30 IU) can be considered as an alternative intervention before manual
removal of the placenta

Uterine tamponade can be an efficient and effective intervention to


temporarily control active PPH due to uterine atony that has not
responded to medical therapy

Surgical techniques such as ligation of the internal iliac artery,


compression sutures, and hysterectomy should be used for the
management of intractable PPH unresponsive to medical therapy

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