[CG] Post partum haemorrhage: prediction and prevention


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Third Stage of Labour - Active Management

The third stage of labour is the time from the birth of the baby to the expulsion of the placenta and membranes.

Active management of the third stage involves a package of care comprising the following components in order to reduce the incidence of Post Partum Haemorrhage.

  • routine use of uterotonic drugs
  • delayed clamping and cutting of the cord
  • controlled cord traction after signs of separation of the placenta ( gush of blood, lengthening of cord, rising of fundus).

Physiological management of the third stage involves the following components

  • no routine use of uterotonic drugs
  • no clamping of the cord until pulsation has stopped ( unless clinical concerns re mother or baby)
  • delivery of the placenta by maternal effort

This policy is for active management of the third stage.

The PPH prophylaxis risk assessment should be carried out to identify patients at particular risk of PPH. This risk assessment should be carried out on admission to labour ward and following each vaginal assessment, as the risk of PPH can change during the labour process. The score should be documented with the vaginal examination findings and used to make a clinical plan for the patient to reduce the risk of PPH.

Postpartum Haemorrhage Vigilance (PPV): PPH prophylaxis risk assessment form

Active management of third stage of labour: A) vaginal delivery (flowchart)

Active management of third stage of labour: B) caesarean section (flowchart)

Clinicians should consider the use of intravenous tranexamic acid (1g IV), in addition to other uterotonic agents required, at caesarean section to reduce blood loss in women with 1 major risk factor or >3 minor risk factors for PPH.

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Last reviewed: 25 October 2017

Next review: 01 October 2022

Author(s): Dr Julie Murphy, Consultant Obstetrician RAH

Approved By: Obstetrics Clinical Governance Group