A Clinical Audit: Intrapartum Care in Third Stage of Labor

ABSTRACT

Introduction: The third stage of labor is the time from the birth of the baby to the expulsion of the placenta and membranes.Management is normally categorized into two types; active management and physiological management. Active managementof the third stage involves a package of care comprising the following components Routine use of uterotonic drugs, deferredclamping, and cutting of the cord controlled cord traction after signs of separation of the placenta. Most common complicationsof the third stage of labor are postpartum hemorrhage and retained placenta.Aims and Objectives: The present clinical audit aims to improve the care of healthy women and their babies during the thirdstage of child and to review the practices regarding the third stage of labor and to develop and implement action plan regardingmanagement strategies.Materials And Methodology: The audit was carried out on 218 pregnant women admitted in Rajarajeswari Medical Collegeand Hospital from April 2018 to September 2018. The inclusion criteria, exclusion criteria, and data collection on the excel sheetwere based on the National Institute for Health and Care Excellence (NICE) guidelines.Results: Among 218 cases, vaginal blood loss was recorded in 181 (83%) cases whereas the color, respiration, and generalcondition were recorded in all 218 cases. In all 218 cases, active management of the third stage was carried out, and decisionregarding the same was recorded. The time of cord clamping was recorded in only 6% of the cases. The management ofpostpartum hemorrhage and retained placenta met audit standard in all 218 cases.Conclusion and Recommendations: The present clinical audit suggests that there is a need to follow specific guidelines andtreatment strategies to avert the complications. Recording of vaginal blood loss in all cases, instructions for the compulsoryrecording of the cord clamping time following the birth of a baby and continue to follow the remaining steps according to theNICE guidelines to reduce the complications of the third stage of labor.