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 177:770-4
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 73:1025-8

Family Practice Notebook

Patients should address specific medical concerns with their physicians.

Although access to this page is not restricted, the information found here is intended for use by medical providers.

This page was written by Scott Moses, MD, last revised on 10/21/2007 and last published on 5/17/2012.

This is one of 5740 pages in the Family Practice Notebook