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

1. Introduction to Management of Variations from Normal in the Third Stage of Labor

Definition: The third stage of labor is the time from the complete delivery of the baby to the complete delivery of the seccundines (placenta, cord and membranes)

Goal To achieve the safe conclusion of the third stage of labor when problems with the safe passage of the placenta occur, to ensure the continued health and wellbeing of the woman during childbirth.

Overview: In the previous section, Birth of the Normal Placenta, you learned how to facilitate and support the normal mechanisms of third stage labor, leading to a benign course of events.

In a limited number of instances, however, a problem may develop even after appropriate preventive and management measures have been followed. This may occur before the placenta is born, or immediately afterward.

These third stage labor problems associated with the placenta may involve
  1. failure of the placenta to separate,


  2. partial separation of the placenta with resultant bleeding,


  3. separation with failure to deliver


  4. delivery with retained fragments of the placenta or membranes and/or


  5. excessive bleeding occuring during or immediately after the placenta is delivered.


In this Section, Birth of the Problem Placenta, you will learn the key concepts, and procedures for safely managing these problems. This will involve:

  1. timely recognition of the problem(s) with a presumptive diagnosis, and


  2. safe management which may include

    1. initital response leading to resolution


    2. consultation with a more experienced clinician


    3. collaboration with and/or referral to an expert obstetric consultant.
The benefit to be obtained will be
  1. prompt resolution of the problem(s)


  2. avoidance of occurances which may lead to increased trauma, unmanageable hemorrhage and/or infection.


  3. a live and healthy mother

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


Back to Menu for Birth of the Problem Placenta  |  Back to beginning of Tutorial 2; Birth of the Placenta  |  Back to Psychomotor Skills for Intrapartum managment


Nurse Midwifery
Modules Home
 |  College
of Nursing
 |  University
of Utah
 |  Eccles
Library