Active management of 3rd stage of labour is needed for all the following EXCEPT
Ans. d (Delivery of first baby of twins) (Ref. Textbook of Obstetrics D.C. Dutta 6th/pg. 142)Accidental administration of ergometrine or methergin during delivery of first baby in undiagnosed twins produce grave danger to the unborn 2nd baby caused by asphyxia due to tetanic uterine contractions.MANAGEMENT OF THE THIRD STAGE OF LABORThe third stage of labor begins following the delivery of the baby and ends with the delivery of the placenta.Signs of spontaneous placental separation include an apparent lengthening of the umbilical cord, a gush of vaginal bleeding, and a change in shape of the uterus from discoid to globular along with a rise in fundal height.Active management of the third stage of labor, which involves prompt umbilical cord clamping and cutting, administration of an oxytocic agent, and gentle umbilical cord traction, reduces maternal blood loss and the frequency of postpartum hemorrhage, and lessens the risk that the third stage will be prolonged.# Cord clamping is part of management of 2nd stage of labour.# Cord traction should be used only against fundally applied counter-traction to lessen the potential for uterine inversion and catastrophic hemorrhage. If at any time heavy bleeding occurs during the third stage of labor or if the placenta is not delivered within 30 minutes of the birth, the placenta should be manually removed.# General anesthesia may be required for women who have no regional anesthesia, and curettage may be necessary if the placenta does not readily separate from the uterine wall.# Manual removal is accomplished by developing a cleavage plane with the intrauterine hand between the maternal surface of the placenta and the uterine wall, while simultaneously fixing the uterus with the abdominal hand, and progressively peeling the placenta free.# If any portion of the placenta or the membranes is missing, the uterine cavity should be manually explored. Some advocate routine exploration of the uterine cavity to reduce the risk of infection and bleeding from retained placental fragments. In most women, especially those without regional anesthesia, the benefit of manual exploration is outweighed by the discomfort it causes, as well as the increased risk for uterine infection.# The uterus should be frequently palpated following delivery of the placenta to ensure that it remains well contracted. Oxytocin, 10 to 20 U administered intramuscularly or as a dilute intravenous solution, has been demonstrated to decrease the incidence of postpartum hemorrhage secondary to uterine atony. The birth canal, including the cervix,vagina, and perineum should be inspected for lacerations requiring repair.
Rh incompatibility
Diabetic mother
Prolonged pregnancy
Delivery of first baby of twins
Miscellaneous (Gynae)