GuidelinesOther guideline
The Third Stage of Labour
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
This stage starts immediately after delivery of the infant & ends with delivery of the placenta. The third stage should be managed actively, as follows:
- Immediately after delivery of the baby, ensure by abdominal palpation that there is no undiagnosed second twin, even if antenatal ultrasound suggests a singleton pregnancy
- If there is no second twin, give oxytocin 10 units IM into the thigh
- Dry & wrap the baby or give it to the mother for skin-to-skin contact
- Delay cord clamping for 1-2 minutes unless there is urgency to resuscitate
- Hold the newborn at the level of the placenta whilst awaiting cord clamping
- Await uterine contraction after about 2-3 minutes, & place the left hand on the woman’s abdomen over the uterus. Do not rub the uterus at this stage
- When the uterus is felt to contract, pull steadily down on the umbilical cord with the dominant hand, & push the uterus upwards with the other hand
- Deliver the placenta by continuous gentle traction on the cord
- Massage the uterus to expel clots & ensure contraction
- Examine the placenta for completeness & any abnormalities