What are the components of active management of the third stage of labour?

1. Routine uterotonic - oxytocin (e.g. 5 IU IV or 10 IU IM) soon after delivery of the baby
2. Delayed cord clamping (e.g. ~2 minutes after birth, unless contraindicated)
3. Controlled cord traction to deliver the placenta (with counter-traction on the uterus)
4. Uterine massage after delivery of the placenta to ensure the uterus is contracted

Clinical relevance. Active management (uterotonic, delayed cord clamping, controlled cord traction, uterine massage) reduces postpartum haemorrhage.

More Detail

Active management of the third stage

Active management is a package of interventions that reduces postpartum haemorrhage.

The components

1. Routine prophylactic uterotonic - oxytocin (5 IU IV slowly, or 10 IU IM) soon after delivery of the baby - causes the uterus to contract (the key step in preventing atony).
2. Delayed cord clamping - clamp and cut the cord at ~2 minutes (allows placental transfusion, reducing neonatal/infant iron deficiency) - unless the baby needs resuscitation, the mother is bleeding, or she is Rhesus isoimmunised.
3. Controlled cord traction (CCT) - deliver the placenta by steady traction on the cord with counter-traction (guarding) on the uterus (after signs of separation), to reduce the risk of cord avulsion/uterine inversion.
4. Uterine massage - after the placenta is delivered, massage the fundus to ensure the uterus is well contracted.

Benefit

• Active management reduces the incidence and severity of postpartum haemorrhage compared with physiological management.