If the cord does not retract when pressure is applied, the placenta has separated (Figure 8.1). To facilitate expulsion from the vagina if it seems to be going slowly after the separation, apply moderate pressure to the uterine fundus, directed toward the vagina. Placental separation: press down on the abdomen just above the pubic bone. Heart rate, blood pressure, the amount of blood loss, while waiting for the placenta to deliver and after placental expulsion (every 15 minutes for the first hour, then every 30 minutes for the next hour) as the risk of PPH persists.In addition, massage the uterus to help uterine retraction. Be sure that the placenta is complete before administering oxytocin. Uterine exploration to remove any placental fragments will be more difficult after injecting oxytocin. However, this is less effective in preventing PPH. If oxytocin has not been given prior to placental delivery, it should be administered after the placenta has been completely delivered. Administration of oxytocin after placental delivery If these conditions are not met, oxytocin should be administered after placental expulsion. For this reason, the birth attendant who administers oxytocin immediately after birth must be able to perform manual removal of the placenta, should it be necessary. within 3 minutes), a risk of retained placenta. When oxytocin is used prior to placental delivery, there is, in theory, and especially if the injection is not done immediately (i.e. Then, after clamping and cutting the cord, deliver the placenta with controlled cord traction (during a contraction with counter pressure to the uterus, with a hand placed on the abdomen). Uncontrolled traction on the cord (i.e., done without a contraction or counterpressure) is contra-indicated, as it can cause tearing of the placenta and, afterwards, retention of placental fragments with risk of bleeding and infection. Administration of 5 or 10 IU oxytocin slow IV or IM immediately after the birth (after the birth of the last infant in a multiple pregnancy) AND before delivery of the placenta accelerates separation of the placenta, facilitates its delivery and helps prevent PPH. 8.1.2 Routine prevention of postpartum haemorrhage Active management of third stage of labourĪctive management of third stage of labour consists in the administration of oxytocin before placental expulsion, followed by controlled cord traction then uterine massage to help retraction of the uterus.Īfter the birth, palpate the mother's abdomen to be sure she is not carrying twins. After that, the placenta should be removed manually (Chapter 9, Section 9.2). In the absence of PPH, a maximum delay of 30 to 45 minutes is tolerated for the expulsion of the placenta. The blood loss accompanying delivery of the placenta should not exceed 500 ml.When the entire placenta has reached the vagina, the uterus retracts and forms a hard ball above the pubic bone. On abdominal palpation the uterine fundus can be felt ascending and then descending again, corresponding to the migration/descent of the placenta. Then, contractions resume, the placenta separates spontaneously.Watch the mother carefully, however, for signs of PPH, which can occur at any time. Use this time to take care of the neonate.
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