Obstetrics and gynecology. Management of the third stage of labor (most important)

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Obstetrics and gynecology. Management of the third stage of labor (most important)

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16. Management of the third stage of labor

The afterbirth period (the third period of childbirth) begins from the moment the fetus is born and ends with the birth of the placenta. Usually the placenta separates on its own within 5-20 minutes after the birth of the fetus. You can not try to isolate the placenta before separation of the placenta. The succession period is characterized by the appearance of successive contractions, which lead to the gradual separation of the placenta from the walls of the uterus. Separation of the placenta from the walls of the uterus can occur in two ways - from the center (central separation of the placenta) and from the peripheral parts of the placenta (marginal separation of the placenta).

Signs of placenta separation. Before checking contact signs, you need to check non-contact signs:

1) the umbilical cord lengthens (positive Alfeld sign);

2) the umbilical cord is retracted with a deep breath (Dovzhenko's sign);

3) the bottom of the uterus takes on a rounded shape, becomes denser to the touch and rises above and to the right of the navel (Schroeder's sign);

4) bloody discharge from the genital tract appears;

5) the outer segment of the umbilical cord is lengthened;

6) when pressing with the edge of the palm on the abdominal wall slightly above the pubis, the umbilical cord does not retract into the vagina, but, on the contrary, goes out even more.

Bleeding in the afterbirth period, may occur as a result of a violation of the separation of the placenta and the discharge of the placenta.

Violation of the process of separation of the placenta. It may be associated with weakness of labor activity, with dense attachment and true accreta of the placenta.

Violation of the discharge of the placenta occurs with spasm of the internal pharynx, hypotonicity of the uterus.

If blood loss remains within the normal range, it is necessary to monitor the condition of the woman in labor and administer uterotonics for another 30-40 minutes.

If the blood loss is pathological, then it is necessary:

1) clarify the condition of the woman;

2) to compensate for blood loss:

a) in case of blood loss of 400-500 ml, enter gelatinol,

saline, intravenous oxytocin;

b) with a blood loss of more than 500 ml, hemodynamic disorders occur, it is necessary to transfuse blood.

If there are no signs of separation of the placenta, it is necessary:

1) assess the general condition of the woman in labor and the amount of blood loss;

2) give intravenous anesthesia and start or continue the introduction of uterotonics, having previously performed an external massage of the uterus;

3) proceed with the operation of manual separation of the placenta and removal of the placenta.

Manual separation of the placenta and separation of the placenta is performed in the absence of signs of separation of the placenta within 30 minutes after anesthesia.

Inspection of the placenta. The placenta is examined for the presence of all its lobules and the membranes are examined. If broken vessels are present, there may be additional lobules that remain in the uterine cavity. In cases of pathological changes, the placenta is sent for histological examination.

Author: Ivanov A.I.

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