Postpartum hemorrhage is a significant cause of maternal morbidity and mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Expectant or physiologic management of the third stage of labor has been compared with active management in several studies. Active management involves administration of uterotonic medication after the delivery of the baby, early cord clamping and cutting, and controlled traction of the umbilical cord while awaiting placental separation and delivery. Good evidence shows that active management of the third stage of labor provides a better balance of benefits and harms and should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin, ergot alkaloids, and prostaglandins have been compared, as have timing and route of administration of these uterotonic medications. Oxytocin is the uterotonic agent of choice; it can be administered as 10 units intramuscularly or as 20 units diluted in 500 mL normal saline as an intravenous bolus, and can safely and effectively be given to the mother with the delivery of the baby or after the delivery of the placenta.
The third stage of labor is the time from the delivery of the infant until delivery of the maternal placenta.1 The natural course of this final stage of childbirth involves cessation of umbilical cord pulsation, separation of the placenta from the uterine wall, and passage of the placenta through the birth canal. Volume of blood loss depends on how long it takes the placenta to separate from the uterine wall and how effectively the uterine muscle contracts in the immediate postpartum period.
Postpartum hemorrhage is a significant cause of maternal morbidity and mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Expectant or physiologic management of the third stage of labor has been compared with active management in several studies. Active management involves administration of uterotonic medication after the delivery of the baby, early cord clamping and cutting, and controlled traction of the umbilical cord while awaiting placental separation and delivery. Good evidence shows that active management of the third stage of labor provides a better balance of benefits and harms and should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin, ergot alkaloids, and prostaglandins have been compared, as have timing and route of administration of these uterotonic medications. Oxytocin is the uterotonic agent of choice; it can be administered as 10 units intramuscularly or as 20 units diluted in 500 mL normal saline as an intravenous bolus, and can safely and effectively be given to the mother with the delivery of the baby or after the delivery of the placenta.ระยะที่สามของแรงงานเป็นเวลาจากส่งเด็กทารกจนกระทั่งยุติ pulsation สะดือ แยกของรกจากผนังมดลูก และกาลรกผ่านคลองเกิดเกี่ยวข้องกับการส่ง placenta.1 แม่ดำเนินนี้ขั้นตอนสุดท้ายของการคลอดธรรมชาติ ปริมาณการสูญเสียเลือดขึ้นอยู่กับระยะก็รกแยกจากผนังมดลูกและสัญญาอย่างไรกล้ามเนื้อมดลูกในระยะหลังคลอดทันที
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