Management of the third stage of labour: (for the Optimal Intrapartum Care series edited by Mercedes Bonet, Femi Oladapo and Metin Gülmezoglu). (August 2020)

• Record Type: Journal Article
• Authors: Weeks, Andrew D.; Fawcus, Susan
• Is Part Of: Best practice & research. Volume 67(2020)
• Page Start: 65
• Page End: 79
• Publication Date: 2020-08
• Subjects: Postpartum haemorrhage -- Birth -- Oxytocin -- Cord clamping -- Placenta; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2020.03.003
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: The physiology of the third stage of labour is described. Active management reduces the risk of postpartum haemorrhage (PPH), due to the use of a uterotonic agent. Intramuscular Oxytocin 10 IU has the highest efficacy and lowest side effect profile, although ergometrine, carbetocin and misoprostol are also effective. The appropriate uterotonic in different settings such as home birth by unskilled attendants and at caesarean section is discussed. For the latter, there is less consensus on the optimal dose/route of oxytocin, this topic remaining on the research agenda. Delayed cord clamping enables transfusion of blood to the neonate and is recommended rather than early clamping. Controlled cord traction should only be performed by skilled birth attendants and confers minimal advantage in preventing retained placenta. The importance of early recognition of PPH, and preparedness, is emphasised. An approach to medical and surgical management of PPH is presented. Highlights: The normal third stage of labour depends on retroplacental myometrial contraction. Routine care includes prophylactic uterotonics and delayed cord clamping (DCC). Unskilled attendants can use misoprostol with DCC but without cord traction. Reducing deaths requires preparedness, simulation training and clear care pathways.