Another component of third stage requiring
consideration with respect to physiologic management is
the duration. There is some debate regarding the
maximum duration of a normal third stage. Third stage
usually lasts from 5-15 min, but may last up to an hour.4
After 30 minutes duration, there is an increase in the
rates of postpartum hemorrhage.60 Research has borne
out the association between prolonged third stage and
complications. It has been suggested that the most
important aspect of third stage management is
minimizing its duration, and that how this is
accomplished is secondary. For example, in two trials
demonstrating active management to be the superior
approach, 26% and 16.4% of women in the physiologic
groups had third stages exceeding 30 minutes
(compared to 2.9% and 3.3% of women in the active
management groups).22,26 In another trial, which
demonstrated no benefit to active management, third
stage duration was less than 20 minutes in 93% of the
physiologically managed and 95% of the actively
managed groups respectively.23
Another component of third stage requiringconsideration with respect to physiologic management isthe duration. There is some debate regarding themaximum duration of a normal third stage. Third stageusually lasts from 5-15 min, but may last up to an hour.4After 30 minutes duration, there is an increase in therates of postpartum hemorrhage.60 Research has borneout the association between prolonged third stage andcomplications. It has been suggested that the mostimportant aspect of third stage management isminimizing its duration, and that how this isaccomplished is secondary. For example, in two trialsdemonstrating active management to be the superiorapproach, 26% and 16.4% of women in the physiologicgroups had third stages exceeding 30 minutes(compared to 2.9% and 3.3% of women in the activemanagement groups).22,26 In another trial, whichdemonstrated no benefit to active management, thirdstage duration was less than 20 minutes in 93% of thephysiologically managed and 95% of the activelymanaged groups respectively.23
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