Third Stage of Labor- What does NICE recommend?
According to NICE guidelines - ‘Advise the woman to have active management of the third stage, because it is associated with a lower risk of a postpartum haemorrhage and/or blood
transfusion.’
Recordings in third stage of labor-
General physical condition- shown by her colour, respiration and her own report of how she feels
Vaginal blood loss
Management of third stage of Labor- Can be -
1. Active or
2.Physiological
Compared with physiological management, active management shortens the third stage of labor.
Active Management
Physiological Management
Vomiting and Nausea
100 in 1000
50 in 1000
Bleeding > 1000 mL
13 in 1000
29 in 1000
Blood Transfusion
14 in 1000
40 in 1000
Differences between active and Physiological Management of Third Stage of Labor
Active management of Third stage of Labor includes -
1. Administer 10 IU of oxytocin by intramuscular injection with the birth of the anterior shoulder or immediately after the birth of the baby and before the cord is clamped and cut.
2. After administering oxytocin, clamp and cut the cord- Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about integrity of the cord, or well being of the baby ( e.g heart rate below 60 bpm AND not getting faster) .
Clamp the cord before 5 minutes.
3. After cutting the cord, use controlled cord traction- only after administration of oxytocin and signs of separation of the placenta.
Record the timing of cord clamping in both active and physiological management.
- If there is haemorrhage or if the placenta is not delivered within 1 hour of the birth of the baby- Advise a change from physiological to active management.
- Do not use either umbilical oxytocin infusion or prostaglandin routinely in the
third stage of labour.
What is a prolonged Third stage of Labor ?
If it is not completed within-
30 minutes of the birth with active management or
within 60 minutes of the birth with physiological management
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