Third stage of labor
Definition
- Begins with delivery of the fetus and ends with delivery of the placenta and fetal membranes.
Duration
- Median duration of the third stage of labor is 10 min.
- Of pregnant women 3–5% have a third stage lasting ≥30 min.
Management
- The third stage of labor is usually managed expectantly. Uterine contractions result in cleavage of the placenta between the zona basalis and zona spongiosum.
- The three clinical signs of placental separation include:
1 a sudden gush of blood (“separation bleed”)
2 apparent lengthening of the umbilical cord
3 elevation and contraction of the uterine fundus.
- Placental separation can be encouraged by “controlled cord traction” using either the Brandt–Andrews maneuver (where the uterus is secured and controlled traction is applied to the cord) or the Credé maneuver (where the cord is secured and the uterus elevated). Care should be taken to avoid uterine placental inversion.
Complications
- Postpartum hemorrhage (Figure 68.1).
- Retained placenta is defined as failure of the placenta to deliver within 30 min. If there is excessive bleeding, manual removal may be required earlier. Failed manual removal of the placenta suggests abnormal placentation (see Chapter 56).
