Abnormal 3rd stage of labor

1. Abnormal third stage
Name: Ahmed Moammed Hassan Eweidah
Seat No. 11
Serial No. 13
Faculty of Medicine, Alexandria University

2. • Definition :
3rd stage of labor: commences with the delivery
of the fetus and ends with delivery of the
placenta and its attached membranes.
• Duration:
- normally 5 to15 minutes.
- 30 minutes have been suggested if there is no
evidence of significant bleeding.

3. Cause of placental separation
• After delivery of the fetus, the uterus retracts
and the placental bed is diminished.
• As the placenta is non elastic and doesn’t
diminish in size , it separates.

4. Uterine retraction AND PLACENTAL
SEPARATION

5. Uterine retraction AND PLACENTAL
SEPARATION

6. Methods of placental separation

7. • Placenta separates in the center and folds on itself
as it descends into the lower part of the uterus as
an inverted umbrella (80%).
Schultze Method
• Fetal surface appears at vulva with membranes
trailing behind.
• Minimal visible blood loss is as retro placental clot
contained within membrane.

8. Duncan Method
• Separation starts at the lower edge of the placenta
(20%) .
• Maternal surface appears first at the vulva.
• Usually accompanied by more bleeding from the
placental site due to slower separation and no
retro placental clot.

9. Third stage abnormalities

10. The placenta is said to be retained when it is
not expelled from the uterus within 30 minutes
after the delivery of the baby .
Normally the placenta is expelled in three stage
- it first separates from the uterine muscle,
then it descends into the lower segment of the
uterus and vagina and then it is expelled
outside. Problems can occur at any of these
stages.
Retained Placenta

11. Epidemiology
The incidence and importance of retained placenta
vary greatly around the world:
In less developed countries, it affects about 0.1% of
deliveries.
In more developed countries, it is more common
(about 3% of vaginal deliveries) but very rarely
associated with mortality. Retained placenta was
identified as the cause of 18% of severe obstetric
hemorrhages in US.

12. 1- Placenta separated but not expelled:
•Failure of the woman to push out the
placenta due to exhaustion or prolonged
labour.
•Closure of the cervix preventing the
placenta from being expelled.
•A constriction ring in the uterus can hold
up the placenta.
Causes of Retained Placenta

13. 2- Simple Adherent Placenta:
• lack of contractions of the uterine muscles (uterine atonicity)
either due to repeated pregnancy, prolonged labor or
overdistension of the uterus during pregnancy, as in twin
pregnancy, it also occurs with a full bladder.
Simple Adherent Placenta is the commonest cause for retention
of placenta.

14. • occurs when the placenta is implanted deeply into the
uterine muscles and thus fails to separate. The placenta can
invade up to different depths in the uterine muscle. In
simple cases, it is only attached firmly to muscle and can be
stripped off by hand. In severe cases , the placenta can
burrow through the full thickness of the muscle. In this case,
the uterus may be needed to be removed ('hysterectomy')
to control the bleeding.
3- Morbid adhesion of the placenta: