Abnormalities of the third stage of labour

1. Big picture

The third stage of labour begins after delivery of the baby and ends with delivery of the placenta and membranes. It is usually short, but it is one of the most dangerous moments in obstetrics because severe haemorrhage can develop rapidly.

For the oral exam, the examiner wants to hear three things immediately:

1. Recognize third-stage abnormality early

   • Placenta not delivered.
   • Excessive bleeding.
   • Uterus not contracting.
   • Shock or collapse.
   • Inverted uterus.

2. Think of the “4 Ts” of postpartum haemorrhage

   • Tone: uterine atony.
   • Tissue: retained placenta or membranes.
   • Trauma: genital tract tears, uterine rupture, inversion.
   • Thrombin: coagulopathy.

3. Treat maternal life threat first

   • Airway, Breathing, Circulation.
   • Call for help.
   • Uterine massage + oxytocin.
   • Large-bore IV access, fluids, blood products.
   • Remove retained tissue or repair trauma.
   • Escalate early if bleeding continues.

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