"Active management of third stage of labour" includes all of the following steps, except ?
WHO definition of PPH - Blood loss of 500 ml or more following vaginal delivery or blood loss 1000 ml or more following a caesarean section. Third stage of labor includes the period from delivery of the baby to delivery of placenta and membranes. Active management of third stage of labor for prevention of postpaum hemorrhage (PPH) includes: Intramuscular oxytocin 10 U given at the delivery of anterior shoulder. Controlled cord traction to deliver the placenta. Uterine massage holding the fundus of uterus after delivery of placenta. Recently, delayed cord clamping has be advocated for all deliveries to make sure the fetus gets maximum blood from the placenta (except cases like R. isoimmunisation and fetal distress, see table below). The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, 2017 January repo, makes the following recommendations regarding the timing of umbilical cord clamping after bih: In term infants, delayed umbilical cord clamping increases hemoglobin levels at bih and improves iron stores in the first several months of life, which may have a orable effect on developmental outcomes. Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after bih. There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician-gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice. Delayed umbilical cord clamping does not increase the risk of postpaum hemorrhage. (Students to Please note the last point: This is the reason why 'early cord clamping' is not a pa of AMTSL)
Controlled cord traction
Uterine massage
Oxytocin
Methergine
Obstetrics