Third stage of labour

Overview Of Third stage of labour

The third stage of labor refers to the final phase of childbirth, occurring after the baby is born and before the placenta is expelled from the uterus. This stage typically lasts between 5 to 30 minutes but can sometimes take longer. During this stage, the uterus continues to contract to detach and expel the placenta and any remaining membranes from the uterus. The expulsion of the placenta is crucial to prevent complications such as postpartum hemorrhage, an excessive loss of blood. The third stage begins immediately after the baby is delivered and ends when the placenta, along with the umbilical cord and membranes, is fully expelled. It is essential for the uterus to contract effectively during this stage to prevent bleeding and support the body's recovery from childbirth.

Causes of Third stage of labour

• The third stage of labor is a natural part of the childbirth process, following the birth of the baby. Several physiological mechanisms contribute to the progression of this stage: - Placental separation: After the baby is delivered, the placenta, which has been providing nourishment to the baby during pregnancy, detaches from the uterine wall. This detachment is typically caused by uterine contractions that constrict the blood vessels at the site of the placenta, causing it to separate and begin its passage from the uterus. - Uterine contractions: Contractions of the uterus continue after the baby is born, aiding in the separation and expulsion of the placenta. These contractions also help compress blood vessels in the uterus to reduce the risk of postpartum hemorrhage. - Hormonal changes: The hormone oxytocin, released during labor and after birth, plays a significant role in stimulating uterine contractions that help expel the placenta and minimize bleeding.

Risk Factors of Third stage of labour

• Several factors can affect the third stage of labor, and certain conditions may increase the risk of complications during this phase: - Placenta previa: This is a condition where the placenta covers the cervix, which can complicate the delivery of the placenta and increase the risk of excessive bleeding. - Retained placenta: If part or all of the placenta remains attached to the uterine wall after delivery, it can cause prolonged bleeding and may require medical intervention, such as manual removal of the placenta. - Multiple pregnancies: Women carrying twins or higher-order multiples may have an increased risk of retained placenta, as the uterus has been stretched more than in a singleton pregnancy. - Uterine atony: When the uterus fails to contract effectively after birth, it can lead to excessive bleeding (postpartum hemorrhage). Uterine atony is more likely to occur in cases of over-distension (as with a large baby or multiple pregnancies) or after prolonged labor. - Previous cesarean section: A history of cesarean delivery can increase the risk of complications in the third stage, including uterine rupture or placenta accreta (where the placenta grows too deeply into the uterine wall). - Advanced maternal age: Women over the age of 35 may face higher risks of complications during childbirth, including issues with placental delivery. - Pre-existing medical conditions: Conditions like hypertension or clotting disorders can increase the likelihood of complications during the third stage of labor.

Prevention of Third stage of labour

• Although the third stage of labor is typically a natural process, certain preventive measures can reduce the risk of complications: - Active management of the third stage: Administering oxytocin immediately after birth and using controlled cord traction can help reduce the risk of postpartum hemorrhage and facilitate the safe expulsion of the placenta. - Early identification of complications: Monitoring for signs of uterine atony, retained placenta, and excessive bleeding can help identify potential complications early, enabling timely interventions. - Routine prenatal care: Attending regular prenatal check-ups and managing risk factors, such as high blood pressure, diabetes, or a history of previous cesarean sections, can reduce the risk of complications during the third stage. - Hydration and nutrition: Ensuring adequate hydration and nutrition during labor may improve uterine function and support optimal postpartum recovery. - Postpartum care: Immediate postpartum care, including uterine massage, monitoring of blood loss, and encouraging breastfeeding, can help the uterus contract properly and minimize bleeding.

Prognosis of Third stage of labour

• The prognosis after the third stage of labor is generally good for most women, especially with proper management. The uterus should contract effectively, expelling the placenta and minimizing blood loss. However, certain complications can affect the outcome: - Successful placental expulsion: In the majority of cases, the placenta is expelled successfully, and the bleeding stops naturally with appropriate uterine contraction. Most women experience minimal discomfort during the third stage. - Postpartum hemorrhage: If the uterus does not contract effectively or if there is retained placenta, there may be excessive bleeding. With prompt medical intervention, such as uterotonic medications or surgical procedures, the prognosis can remain favorable. - Retained placenta: If part of the placenta is retained in the uterus, it can lead to infection or further bleeding, requiring additional treatment. Prompt removal of retained tissue is crucial to avoid complications. - Infection: If the uterus is not properly emptied of placenta or other tissues, there is an increased risk of infection. With appropriate antibiotics and care, most infections can be managed successfully.

Complications of Third stage of labour

• Several complications may arise during or after the third stage of labor, including: - Postpartum hemorrhage: Excessive bleeding after placental expulsion is one of the most common complications of the third stage of labor. It can result from uterine atony (failure of the uterus to contract), trauma to the birth canal, or retained placenta. - Retained placenta: This occurs when parts of the placenta remain attached to the uterine wall, leading to prolonged bleeding and an increased risk of infection. It may require surgical removal. - Infection: If the uterus is not properly emptied after delivery or if the delivery was complicated, there is a risk of infection, such as endometritis (infection of the uterine lining), which can cause fever, pain, and prolonged bleeding. - Uterine rupture: In rare cases, the uterus may rupture, particularly in women with a previous cesarean section or other uterine surgery. This is a medical emergency that requires immediate surgical intervention. - Thromboembolism: The risk of blood clots may increase after childbirth, and severe postpartum hemorrhage can complicate this further. Women may be at risk of developing deep vein thrombosis (DVT) or pulmonary embolism (PE).

Related Diseases of Third stage of labour

• Conditions related to the third stage of labor include: - Postpartum hemorrhage: A leading complication, often resulting from uterine atony or retained placenta, which can be life-threatening if not managed promptly. - Endometritis: An infection of the uterine lining that can occur if the uterus is not fully emptied or becomes infected after delivery. - Placenta accreta: A condition where the placenta grows too deeply into the uterine wall, complicating the delivery and potentially requiring surgical intervention. - Cervical or vaginal lacerations: Tears in the birth canal during delivery that can lead to excessive bleeding or infection if not properly treated.

Treatment of Third stage of labour

Treatment during the third stage of labor primarily focuses on ensuring the placenta is expelled safely and addressing any complications that may arise: - **Active management of the third stage**: This approach involves the administration of oxytocin (a hormone that stimulates uterine contractions) immediately after birth to help expel the placenta, reduce bleeding, and prevent postpartum hemorrhage. Controlled cord traction may also be used to assist with placental delivery. - **Passive management**: In some cases, if the placenta is expected to deliver naturally without complications, passive management may be chosen, allowing the placenta to be expelled without the use of medication or active intervention. Close monitoring is still necessary. - **Manual removal of the placenta**: If the placenta is not expelled within a reasonable timeframe or if part of it remains in the uterus (retained placenta), manual removal may be necessary. This involves a healthcare provider inserting their hand into the uterus to remove the remaining tissue. - **Blood transfusion**: If excessive bleeding occurs during or after the third stage, a blood transfusion may be required to replace lost blood and maintain blood volume. - **Surgical intervention**: In severe cases, surgical procedures such as a dilation and curettage (D&C) or a hysterectomy (removal of the uterus) may be necessary to treat complications such as severe bleeding or uterine rupture.