Active Management of second and third stage of labour

Active Management of second and third stage of labour : we discuss here management of second and third stage of labour.

READ HERE : Management of first stage labour in Pragnancy

Management of second stage of labour

Bearing down is encouraged only in the active phase of the second stage, when the patient feels an urge to bear down.

Monitoring of second stage of labour

• Foetal heart sounds every 10 minutes in the passive phase and every 5 minutes in the active phase.
• Blood pressure and pulse hourly.
• Vaginal examination after an hour.
• Frequency of contractions half hourly. Episiotomy should not be performed routinely.
• It is performed selectively, in cases with prematurity, foetal distress, breech presentation, occipito-posterior position, large baby, twin pregnancy or when a perineal tear is anticipated. It is also performed in all cases of instrumental delivery.
• A medio-lateral episiotomy is performed at 45—60 degrees from the midline directed to the right side, beginning at the vaginal
  fourchette. This is carried out at crowning of the head.

Management of Third stage of labour

Active Management of second and third stage of labour

Management of second and third stage of labour : we discuss here management of second and third stage of labour.Active Management of second and third stage of labour

1. Oxytocin 5 units (or 0.5 mg of ergometrine) is administered intravenously, with the delivery of the anterior shoulder. Clamping
   of the cord should be delayed for 2 minutes.
2. Once the delivery of the baby is completed, an abdominal examination is performed to confirm whether the uterus is well contracted.
3. Next controlled cord traction is applied to deliver the placenta.

• 1, 2 and 3 prevent inversion of the uterus, but the most important step is to make sure that the uterus is well contracted before applying controlled cord traction.
• Strong uterine contractions caused by the oxytocic drug, administered intravenously with the delivery of the anterior shoulder, cause a normal placenta to separate soon after delivery of the baby.
  Therefore, it is not necessary to wait for signs of placental separation.
• The placenta and membranes should be inspected after delivery to confirm that they are complete.
• If the placenta is not delivered with controlled cord traction, manual removal of the placenta is carried out 30 minutes after birth of the baby.
• In developing countries manual removal of the placenta is carried out in the labour ward under intramuscular pethidine. In these circumstances manual removal should be carried out by a medical officer even in a peripheral hospital, because the delay caused by transferring to a specialised unit can result in bleeding, shock and sepsis.
• Manual removal should not be carried out in a peripheral hospital if a plane of cleavage is not found between the placenta and the myometrium, at the beginning of the procedure, as this
  indicates the possibility of morbid adhesion of the placenta. The procedure should be abandoned and the patient should be transferred to a specialized unit as partial removal can result in severe haemorrhage.