Tutorials:
  1. Birth of
    the baby


  2. Birth of
    the placenta


  3. Local anesthesia for vaginal/
    perineal repair


  4. Repair of the Perineum

Tutorial 2: Birth of the Placenta


Birth of the Problem Placenta During Childbirth

7. End Note

The purpose of the tutorial on Birth of the Problem Placenta is to obtain a live and healthy mother even in the event of problems and untoward events during the third stage of labor. This is accomplished through the exercise of knowledge, skill, and judgement whenever there is an
  1. abnormal delay in the spontaneous birth of a complete and intact placenta, and/or

  2. an excessive amount of bleeding during or immediately after the third stage of labor.
A prompt and systematic approach to interventive management is achieved through
  1. knowledge of the anatomy and physiology of the third stage of labor

  2. supportive, and patient, management of normal processes

  3. knowledge of the normal parameters of third stage labor

  4. immediate recognition of deviations from normal when they occur

  5. prompt initiation of interventive management when indicated

  6. timely consultation, and/or collaboration with or referral to, a qualified obstetric physician when indicated.
Interventions by the nurse-midwife may include:

  1. manual removal of the placenta and/or membranes or fragments

  2. bimanual compression of the uterus to stimulate contraction of the uterus.

  3. administration of medication(s) to control excessive bleeding, including intravenous fluids to counteract blood volume loss and avoid shock as indicated.

  4. repair of vaginal/perineal lacerations to control bleeding.

  5. follow-up care to prevent infection, restore blood iron levels and provide adequate rest, fluids and nutrition for full recovery of maternal health and energy.


click on the links below to continue:
  1. Introduction
  2. Events prior to the birth of the placenta
  3. Events immediately after the birth of the placenta
  4. Procedures for management of third stage hemorrhage due to uterine atony
  5. Procedures for manual removal of the placenta and membranes
  6. Clinical Case
  7. End Note


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