Active management of 3rd stage of labour

Active management of 3rd stage of labour

Active management of 3rd stage of labour

THE UNDERLYING PRINCIPLE IN ACTIVE MANAGEMENT =it is to excite powerful uterine contractions following birth of anterior shoulder by parenteral oxytocin which facilitates not only early seperation of placenta but produces effective uterine contractions following its seperation.





ADVANTAGES=
1)to minimise blood loss approximately to 1/5 th
2)shorten duration of 3rd to half

The only disadvantage is slight increase in incidance of retained placenta nd conseqent increased incidance of manual removal.
Accidental administration during delivery of 1st baby in undiagnosed twins produces grave danger to unborn second baby caused by asphyxia due to tetanic contractions of uterus.Thus it is imperative to limit its use in twins only during delivery of second baby.

PROCEDURES=inj. ergometrine 0.25 mg or methergin 0.2 mg is given i.v.following birth of anterior shoulder.If administered prior to this there is chance of imprisonment of shoulder  behind pubic symphysis.This is followed by slow delivery of baby within 2-3 minutes. Placenta expected to be delivered following the delivery of buttocks. If placenta is not delivered instantaneously it should be delivered forthwith by controlled cord traction technique after clamping cord while uterus still remains contracted. He 1st attempt fails another attempt is made after 2-3 minutes failing which another attempt is made at 10 minutes. If still this fails manual removal is to be done.

LIMITATION=It should not be used in cardiac cases or severe pre eclampsia for fear of precipatating cardiac over load in former nd aggravation of bld pressure in latter.
It is certainly of value for cases likely to develope postpartum haemorrhage.