Active management of third stage using controlled
cord traction.
Beischer, N. Mackay, E. Purcal, N. 1989, 2nd
edition. Care of the pregnant woman and her baby, W.B.Saumders/Balliere &
Tindall, Sydney.
1) Administer oxytocic, Syntocinon 10 units IMI or
IVI after the birth of the baby.
2) Await signs of separation.
3) The cord is reclamped near the vulva and
steadied with one hand while the other hand is used to gently push the uterine
fundus upwards. This will indicate if the placenta has separated since the cord
will not follow the upward movement of the uterus. If separation has occurred, a
combined movement is made of downward and backward traction on the cord and
upward displacement of the uterus, provided that the latter is firmly
contracted.
If the placenta does not advance there are usually
only 2 possibilities - it is still attached to the uterus or it has become
trapped in the tightly contracted uterus (unusual if using Syntocinon, usually
only occurs with Ergometrine). In such cases be patient and repeat the procedure
at intervals. Resist the temptation to massage the uterus unless bleeding is
excessive. If the umbilical cord vessels are
congested, remove the clamp and drain the cord blood out. This will reduce the
size of the placenta.
Once the placenta appears at the vulva you can stop
steadying the uterus and gently 'rock' the placenta out taking care not to tear
the membranes. If they begin to tear, the placenta should be rotated to cause a
bunching up of the membranes near the vulva; a wide clamp is then applied and
the membranes eased out with steady traction (pp 252-3).
It is generally recommended to always use an
oxytocic with controlled cord traction, however it can performed without an
oxytocic as long as you await separation and ensure the uterus is firmly
contracted before applying any traction. Hope this helps. Cheers
Jenny
Jennifer Cameron FRCNA FACM
ProMid Professional Midwifery Education Service 0419 528 717
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