1. THIRD STAGE
DEFINITION
• From expulsion of the foetus to delivery
of the placenta, cord and membranes
DURATION
• Primigravida – 15 minutes
• Multigravida – 5 minutes
• Generally – not > 30 minutes
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2. PLACENTA SEPARATION
Two Methods
1. Schultz method
- placenta separate from centre
2. Matthew Duncan
- placenta separate from the peripheral
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3. Schultz method
Beginning of 3drstage Placenta in lower segment End of 3rd stage
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4. Matthew Duncan
Upper segment
Trickling
of blood
Placenta separate from Upper segment contracted
Beginning of 3rd stage
the peripheral Placenta separated
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5. MECHANISM OF PLACENTA SEPARATION
• Once the child is delivered,
– the uterine muscle contracts
– placenta sheared from the uterine wall
– pushing it into the lower uterine segment or
upper part of the vagina
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6. SIGNS OF PLACENTA SEPARATION
1. Lengthening of the cord
2. Trickling (gush) of blood
3. Uterus - becomes hard
- mobile from side to side
- height rises to the level of
umbilicus
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7. LENGTHENING OF THE CORD
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8. TRICKLING OF BLOOD
Trickling
of blood
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9. RISING OF THE FUNDAL HEIGHT
umbilicus
Beginning of 3rd stage placenta at lower segment end of 3rd stage
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10. MANAGEMENT
• Delivery of the placenta is done by
“CONTROLLED CORD TRACTION” method
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11. CONTROLLED CORD TRACTION
• Signs of placenta separation must be present
before doing CCT (to prevent uterine inversion)
• Position – supine position
• Left hand – rested on the
abdomen on the
uterine fundus
• Right hand – cord traction is
applied
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13. LENGTHENING OF THE CORD
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14. CONTROLLED CORD TRACTION
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15. MANAGEMENT
• Check placenta to see if any cotyledons
are missing
• Check membranes to see whether they
are complete or incomplete
• Check tears of the genital tract
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16. CHECKING PLACENTA COTYLEDONS
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17. MISSING PLACENTA
COTYLEDONS
Missing cotyledons
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18. CHECKING FOETAL SURFACE OF
THE PLACENTA
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19. CHECKING THE MEMBRANES
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20. BATTLEDORE PLACENTA
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