The document discusses complications that can occur during the third stage of labour, which include postpartum haemorrhage, retention of placenta, uterine inversion, obstetric shock, and pulmonary embolism. Postpartum haemorrhage is defined as bleeding over 500cc after delivery and can be caused by uterine atony, trauma, retained tissues, or coagulation disorders. Retention of placenta may occur if the placenta is not fully separated or adhered to the uterus. Uterine inversion involves the uterus turning inside out, and can be caused by fundal pressure or a relaxed uterus. Obstetric shock is low blood pressure caused by blood loss, trauma, air embol
Similar a Complications of 3rd Stage of Labour: Postpartum Haemorrhage, Retention of Placenta, Uterine Inversion, Obstetric Shock and Pulmonary Embolism
Similar a Complications of 3rd Stage of Labour: Postpartum Haemorrhage, Retention of Placenta, Uterine Inversion, Obstetric Shock and Pulmonary Embolism (20)
4. Bleeding from genital tract more than
500cc after the delivery of fetus
Types
Primary-Haemorrhage occurs within
24hrs following the birth of the baby
-Third Stage Bleeding
-True Postpartum Haemorrhage
Secondary-Haemorrhage occurs
beyond 24hrs and within puerperium
7. Management
-Third Stage Bleeding
Massage the uterus
Inj Methergin 0.2 mg IV
Oxytocin drip with crystalloid solution
Bladder catheterization
Antibiotics
Express placenta by Controlled cord
traction or by Manual removal under
general anaesthesia
8. -True Postpartum Haemorrhage
Same as third stage bleeding plus
Inj Misoprostol 1mg per rectum
Bimanual compression of
uterus
Tight uterine packing
Balloon tamponade
Ligation of uterine artery
Hysterectomy
10. Management
IV Fluids
Blood transfusion
Antibiotics
Removal of retained parts
11. Complications of PPH
Shock
Maternal death
Acute renal failure
Sheehan’s syndrome
Puerperal sepsis
12. RETENTION OF
PLACENTA
Causes
1.
2.
Retained seperated placenta
Atony of uterus
Contraction ring
Premature attempts to deliver
placenta before it is seperated
Retained non-seperated
placenta
Simple adherance- Due to
uterine atony
Morbid adherance- Placenta
15. The body of uterus is partially or
completely turned inside out.
Types
First degree- Dimpling of fundus which
still remains above the level of internal
os
Second degree- Fundus passes
through cervix but lies inside the
vagina
Third degree(Complete)- Endometrium
is visible outside the vulva
16. Causes
1.
Iatrogenic
Pulling the cord when the uterus is
atonic
specially when combined
with fundal pressure
2. Spontaneous
Sharp rise of intra abdominal pressure
when the uterus is lax
17. Management
Replacement of uterus
-Manual replacement
-Hydrostatic replacement
-Surgical replacement
Antibiotics to control sepsis
21. Management
Ensure patent airway & give 100% Oxygen
Control active bleeding
IV Fluids- Crystalloids, Colloids, Blood
IV Sodium bicarbonate (For acidosis)
Antibiotics (For sepsis)
Others- Steroids, Morphine, Ranitidine
Monitor
BP, ECG, Pulse oximetry, Urine output,
Serum electrolytes, CVP, ABG
22. PULMONARY
EMBOLISM
Emboli can be thrombus, amniotic fluid or
air
Clinical features
Sudden chest discomfort
Air hunger
Hypotension
Haemorrhage (due to DIC)
Collapse
Management
Similar to shock