2b amtsl

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Active Management of Third Stage of Labor (AMTSL)

Session 2b

Trainee Handbook Pg 21

Maternal Health DivisionMinistry of Health & Family

WelfareGovernment of India

BEMoC - Presentation 2 (b)

ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)



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Session Objectives

To learn about

Active management of third stage of labour (AMTSL)

Care of the mother immediately after delivery




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What does Active Management of the Third Stage of Labor include?

Administration of uterotonic drug Controlled cord traction Uterine massage




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Active Management of Third Stage of Labor

Uterotonic drugs Enhance contraction of the uterus Facilitate expulsion of the placenta Decrease blood loss and are Given after delivery of baby, after ruling out

presence of another baby




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Uterotonic Drugs

Uterotonic Agent

RouteDosage Action

Onset of action

Duration of action

ContraindicationStorage

(oC)

Oxytocin IM 10 Units 2 - 4 mins 20 minsNever give IV bolus

15 – 30 oC

Misoprostol Oral 600 mcg12 -15 mins

20 -40 mins

NilRoom Temp.




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Controlled Cord Traction (CCT) Technique to assist in expulsion of placenta. Helps to reduce the chances of a retained

placenta and subsequent bleeding i.e. PPH.

How do you perform CCT?

Third Stage of labour (AMTSL)




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Heading???




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Third Stage of Labour (AMTSL)

Controlled Cord Traction (CCT) Ensure that placenta is delivered complete with

all membranes. If the placenta is not delivered after 30 minutes of

delivery - refer the woman to FRU. Give information regarding drugs given, their dose

and time of administration on referral slip. Never apply cord traction (pull) without a

contraction and without applying counter-traction (push) above the pubic symphysis with the other hand.




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Third Stage of Labour (AMTSL)

Uterine massage

Immediately after delivery of the placenta, massage the fundus of the uterus through the woman’s abdomen until it is well contracted.

Helps in contraction of the uterus and thus prevents PPH.

Ensure that the uterus does not become relaxed (soft) after the massage.

Watch for vaginal bleeding.




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Examination of placenta

Examine the placenta and the membranes for completeness




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Retained Placenta

Give information on referral slip regarding If the placenta is not delivered after 30 minutes

of delivery - refer the woman to FRU• drugs given • the dose• time of administration

To be discussed in detail in later slides




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Disposal of Placenta

Disposal of the placenta should be done in a correct, safe and culturally appropriate manner.

Use gloves while handling the placenta. Put the placenta into a leak-proof bag

containing bleach. Incinerate the placenta or bury it at least 10

meters away from a water source in a 2 meter deep pit.




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Uterine Massage

Immediately after delivery of the placenta, massage the fundus of the uterus through the woman’s abdomen until it is well contracted

Helps in contraction of the uterus and thus prevents PPH

Ensure that the uterus does not become relaxed (soft) after the massage

Watch for vaginal bleeding




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Uterine Massage

Massage the uterine fundus in a circular motion with the cupped palm until the uterus is well contracted.

When well contracted, place your fingers behind the fundus and push down in one swift action to expel clots.

Repeat the massage every 15 minutes for the first 2 hours.




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Care of the mother

Examine the perineum, lower vagina and vulva for tears

If present manage as per management of vaginal and perineal tears

Clean the woman and the area beneath her Put a sanitary pad / folded cloth under her

buttocks Pads/ cloths soaked can be counted to

estimate the blood loss




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Fourth Stage of Labor

Fourth stage: First one-hour after delivery of

placenta.

Aim: Observation and care of the mother and newborn

Do not separate mother and the baby, unless essential




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Care of the mother Check every 10 minutes if the uterus is well

contracted and observe for vaginal bleeding If the uterus - not well-contracted / bleeding

is excessive, massage the uterus If bleeding persists – manage as PPH




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Check the following every 10 minutes for the first 30 minutes, then every 15 minutes for next 30 minutes and then every 30 minutes for the next 3 hours:

• General condition

• BP, pulse, temperature

• Uterus, whether well-contracted or not

• Amount of vaginal bleeding Observe the woman for 24 hours




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Encourage the woman to eat and drink, and rest.

Encourage the woman to pass urine. If the woman has difficulty in passing urine, or the bladder is full and she is uncomfortable, help her pass urine by gently pouring water over her vulva.




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Weigh the baby Ask the birth companion to stay with the

mother. Do not leave the mother and the newborn alone. Ask the companion to watch the woman and call for help if any of the following signs appear




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The bleeding increases. The woman feels dizzy The woman has severe headache The woman has visual disturbances The woman has epigastric distress The woman complains of breathlessness The woman complains of increased abdominal

or perineal pain




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Do not discharge the woman before 24 hours after delivery. This is a crucial period for the occurrence and management of PPH. The woman must be kept under observation during this time.




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Key Messages

Active management of 3rd stage of labour. Postpartum care and contraception

counseling Ensure timely referral

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Thank you

2b amtsl

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