The document discusses complications that can occur during the third stage of labour, which include postpartum haemorrhage, retention of placenta, uterine inversion, obstetric shock, and pulmonary embolism. Postpartum haemorrhage is defined as bleeding over 500cc after delivery and can be caused by uterine atony, trauma, retained tissues, or coagulation disorders. Retention of placenta may occur if the placenta is not fully separated or adhered to the uterus. Uterine inversion involves the uterus turning inside out, and can be caused by fundal pressure or a relaxed uterus. Obstetric shock is low blood pressure caused by blood loss, trauma, air embol

1. COMPLICATIONS OF
RD STAGE OF
3
LABOUR
Prashiddha Dhakal
MBBS(KUSMS)

2. COMPLICATIONS OF
3RD STAGE OF
LABOUR
 Postpartum haemorrhage
 Retention of placenta
 Uterine inversion
 Obstetric shock
Pulmonary embolism

3. POSTPARTUM
HAEMORRHAGE

4.  Bleeding from genital tract more than
500cc after the delivery of fetus
 Types
 Primary-Haemorrhage occurs within
24hrs following the birth of the baby
-Third Stage Bleeding
-True Postpartum Haemorrhage
 Secondary-Haemorrhage occurs
beyond 24hrs and within puerperium

5. Primary Postpartum
Haemorrhage
 Causes
1.




Uterine atony
Grand multipara
Overdistension due to multifetal
pregnancy, hydramnios, macrosomic
fetus
Anaesthesia, Tocolytic drugs
Antepartum haemorrhage

6. 2.

3.

Trauma
Vaginal lacerations, Cervical tear, Perineal tear,
Uterine rupture, Episiotomy extension, Genital
tract trauma after instrumental delivery
Retained tissues
Cotyledon, Succenturate lobe, Placenta accreta
4. Coagulation disorders
 Thrombocytopenic purpura, Hypofibrinogenemia

7.  Management






-Third Stage Bleeding
Massage the uterus
Inj Methergin 0.2 mg IV
Oxytocin drip with crystalloid solution
Bladder catheterization
Antibiotics
Express placenta by Controlled cord
traction or by Manual removal under
general anaesthesia

8. -True Postpartum Haemorrhage
Same as third stage bleeding plus
 Inj Misoprostol 1mg per rectum
 Bimanual compression of
uterus
 Tight uterine packing
 Balloon tamponade
 Ligation of uterine artery
 Hysterectomy

9. Secondary Postpartum Haemorrhage
 Causes
 Retained placenta
 Infection
 Subinvolution of uterus & Endometritis
 Choriocarcinoma, CA Cervix
 Fibroid polyp

10.  Management
 IV Fluids
 Blood transfusion
 Antibiotics
 Removal of retained parts

11.  Complications of PPH
 Shock
 Maternal death
 Acute renal failure
 Sheehan’s syndrome
 Puerperal sepsis

12. RETENTION OF
PLACENTA
 Causes
1.



2.


Retained seperated placenta
Atony of uterus
Contraction ring
Premature attempts to deliver
placenta before it is seperated
Retained non-seperated
placenta
Simple adherance- Due to
uterine atony
Morbid adherance- Placenta

13.  Complications
 Haemorrhage
 Shock
 Puerperal sepsis
 Risk of recurrence in next pregnancy

14. INVERSION OF UTERUS

15.  The body of uterus is partially or
completely turned inside out.
 Types
 First degree- Dimpling of fundus which
still remains above the level of internal
os
 Second degree- Fundus passes
through cervix but lies inside the
vagina
 Third degree(Complete)- Endometrium
is visible outside the vulva

16.  Causes
1.
Iatrogenic
Pulling the cord when the uterus is
atonic
specially when combined
with fundal pressure
2. Spontaneous
Sharp rise of intra abdominal pressure
when the uterus is lax

17.  Management
 Replacement of uterus
-Manual replacement
-Hydrostatic replacement
-Surgical replacement
 Antibiotics to control sepsis

18.  Complications
 Haemorrhage
 Shock
 Pulmonary embolism
 Infection and uterine sloughing

19. OBSTETRIC SHOCK
 Causes
1. Hypovolemic Shock
 Postpartum haemorrhage
 Haematoma- Broad ligament/Paravaginal
2. Neurogenic Shock
 Uterine rupture
 Uterine inversion

20. 3. Obstructive Shock
 Air embolism
4. Anaphylactic Shock
 Amniotic fluid embolism
5. Septic Shock
 Prolonged Rupture Of Membranes
 Retained placental tissues
 Manipulation & instrumentation

21.  Management
 Ensure patent airway & give 100% Oxygen
 Control active bleeding
 IV Fluids- Crystalloids, Colloids, Blood
 IV Sodium bicarbonate (For acidosis)
 Antibiotics (For sepsis)
 Others- Steroids, Morphine, Ranitidine
 Monitor
BP, ECG, Pulse oximetry, Urine output,
Serum electrolytes, CVP, ABG

22. PULMONARY
EMBOLISM
 Emboli can be thrombus, amniotic fluid or
air
 Clinical features
 Sudden chest discomfort
 Air hunger
 Hypotension
 Haemorrhage (due to DIC)
 Collapse
 Management
 Similar to shock