6.1.2  Complications occurring during the third stage of labour

Study Session 11 of this Module will tell you in detail about postpartum haemorrhage and atonic uterus; the other terms in Box 6.1 are covered in this study session.

Women who give birth unattended by a skilled healthcare provider (like you) are more likely to experience complications at all stages of labour, including the third stage. These complications are listed in Box 6.1 below. They can arise even in a delivery where the placenta was implanted in a good position in the top two-thirds of the uterus, labour was not prolonged and the birth was normal. In such cases, while a normal and spontaneous delivery of the placenta during the third stage might be expected, complications can still arise unpredictably. You should always be prepared for the unexpected emergency.

Box 6.1  Common complications of third stage of labour

All these complications are much more likely to occur if the third stage is not properly managed, using the AMTSL approach.

Retained placenta

The placenta remains inside the uterus for longer than 30 minutes after delivery of the baby, usually due to one or more of the following:

  • Uterine contractions may be inadequate to expel the placenta
  • The cervix might have retracted too fast and partially closed, trapping the placenta in the uterus
  • The bladder may be full and obstructing placental delivery.

Excessive bleeding (PPH)

PPH is the loss of more than 500 ml of blood following delivery of the baby. Most bleeding comes from where the placenta was attached to the uterus, and is bright or dark blood and usually thick. PPH occurs when the uterus fails to contract well, usually due to:

  • Partially separated placenta (it remains partly attached to the uterine wall
  • Completely separated placenta, but retained inside the uterus
  • Atonic uterus; the muscular wall of the uterus could not contract powerfully enough to arrest the natural bleeding which occurs when the placenta separates.

Uterine inversion

The uterus is pulled ‘inside out’ as the baby or the placenta is delivered, and partly emerges through the vagina.

6.1.1  Natural processes during the third stage

6.2  Active management of third stage of labour (AMTSL)