Management of 3rd Stage of Labour: A Comparison of Different Methods

Abstract

Introduction: The third stage of labor is the period following the completed delivery of the newborn until the completed delivery of the placenta and the membranes. Post partum hemorrhage (PPH) is the blood loss of greater than 500 ml following vaginal deliveries or 1000ml following cesarean section and is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. Even after the introduction various methods in the management of third stage of labour, the incidence of PPH is on the rise; the cause of which is still not clear. This study was done to assess all the methods in management of third stage of labour and find out the effects of each method so we can apply it in our daily practice. Materials and Method: After obtaining permission from the ethics committee of the institution, this study was carried out in the Obstetrics and Gynaecology department of Dhiraj Hospital, Pipariya. 200 low risk patients, who fit in the study criteria, were selected and randomly divided into 4 groups by chit method for the management of third stage of labour. Group A included patients who received expectant management, Group B patients received Inj. Oxytocin 10 IU IM at the time of delivery of the anterior shoulder of the baby, Group C patients received Inj. Oxytocin 10 IU IM after the delivery of the baby and Group D patients received Inj. Oxytocin (10 IU diluted in 20 ml NS) in the umbilical vein after clamping the umbilical cord. Data was collected and analysed and results were made. XI Results: All the groups were comparable in terms of factors like age, parity, booking status, hemoglobin level at the time of admission and fetal weight. We observed that there was an increase in the mean post delivery pulse rate in Group A (p – 0.0001) and Group D (p – 0.024). There was no statistical difference in the mean pre and post delivery blood pressure in any groups ( p > 0.05). All the groups were comparable in terms of duration of second stage of labour. The duration of third stage of labour was significantly more in Group A compared with all other groups (p – 0.0001). The PPBL was also significantly more with Group A compared with all other groups (p - < 0.05) and all the other groups were comparable. Total incidence of PPH was 8 in 200 patients (4 %), of which 6 (75 %) were from Group A and 2 (25 %) from Group D. All patients with PPH had to be given blood transfusion. The incidence of retained placenta was 4 in 200 deliveries (2 %) of which 3 (75 %) were from Group A and 1 (25 %) from Group B. Conclusion: We found out that the best method in the management of third stage of labour was Inj. Oxytocin 10 IU IM after the delivery of the baby; but in the hands of a skilled obstetrician who is aware of the complications, Inj. Oxytocin 10 IU IM at the time of delivery of the anterior shoulder of the baby may be equally effective.