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Third Stage of LaborAka: Stage Three of Labor, Active Management of the Third Stage of Labor

Complications: Most Unpredictable and Dangerous Stage
1. Retained Placenta (1-2% Incidence)
2. Primary Postpartum Hemorrhage (3-4% Incidence)
3. Uterine Inversion
Management
1. Active Management
  1. See Postpartum Hemorrhage
  2. Early Pitocin
    1. Pitocin given at anterior shoulder delivery
      1. Contrast with Pitocin after placenta delivery
    2. Pitocin dose
      1. Pitocin 10 Units IM or
      2. Pitocin 20 units in 500 cc NS given as IV bolus
    3. Benefits
      1. Lower Incidence Postpartum Hemorrhage
      2. Lower Incidence Retained Placenta
    4. Risks
      1. No increased risk of Retained Placenta
      2. Risks compromise of undiagnosed second twin
        
        However, prenatal ultrasound makes unlikely
  3. References
    1. Prendiville (2000) Cochrane Database Syst Rev
    2. Khan (1997) Am J Obstet Gynecol 177:770
2. Controlled cord traction to deliver placenta
3. Uterine massage after delivery of placenta
Management: Oxytocin alternatives not recommended
1. Carbetocin (extended release Oxytocin)
  1. No benefit over standard Oxytocin
2. Misoprostel (Cytotec)
  1. Less effective, with more side effects than Oxytocin
3. References
  1. Maughan (2006) Am Fam Physician 73:1025

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.