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General preventive measures

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Traditionally, the third stage of labor is defined as that time between the delivery of the baby and delivery of the placenta. Separation of the placenta from the uterine wall results from a combination of capillary hemorrhage and uterine muscle contraction. The length of the third stage of labor, and its subsequent complications, depends on a combination of the length of time it takes for placental separation and the ability of the uterine muscle to contract. Preventive clinical management of the third stage of labor varies from the purely expectant to an active approach, or some variation thereof. . | Section III General preventive measures 11 ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR W. Prendiville and M. O Connell THE EVIDENCE Traditionally the third stage of labor is defined as that time between the delivery of the baby and delivery of the placenta. Separation of the placenta from the uterine wall results from a combination of capillary hemorrhage and uterine muscle contraction. The length of the third stage of labor and its subsequent complications depends on a combination of the length of time it takes for placental separation and the ability of the uterine muscle to contract. Preventive clinical management of the third stage of labor varies from the purely expectant to an active approach or some variation thereof. The expectant pure physiological approach involves waiting for clinical signs of placental separation alteration of the form and size of the uterus descent and lengthening of the umbilical cord and blood loss and allowing the placenta to deliver either unaided using gravity or with the aid of nipple stimulation as described in most maternity books1 2. In contrast the full active approach involves administration of an oxytocic agent early umbilical cord clamping and division and controlled cord traction for delivery of the umbilical cord3-6. In daily practice the term active management does not mean the same thing to all health-care professionals. Marked variation in practice is seen. A recent survey of management of the third stage of labor in 14 European countries confirmed this variation7. Whereas all units professed to practice active management of the third stage of labor prophylactic uterotonics were infrequently employed in units in Austria and Denmark. Controlled cord traction was almost universally used in Ireland and the UK but in less than 50 of units in the other 12 countries surveyed. Policies with respect to clamping and cutting the umbilical cord also varied widely with most practitioners clamping and cutting immediately. .