Active management of third stage

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An injection of Syntocinon (or sometimes Syntometrine, a mixture of oxytocin and er- gometrine) is given to the mother as the baby is being born to speed up the separation of the placenta and hasten its arrival. The injection is also given to reduce the chance of haemorrhage after the birth.

When is it necessary?

• Poor obstetric history (for example previous post-partum haemorrhage, incoordinate uterine contractions).
• Low haemoglobin levels in the blood (anaemia) which could mean delay in blood clotting.
• Following a Caesarean section.

How is it done?

• The Syntocinon (or Syntometrine) can be given either by injection usually into the mother's thigh after the baby is born, or if a drip line is in place, through the drip directly into a vein.
• The cord is clamped and cut immediately after the baby is born.
• The cord is pulled to encourage early separation and delivery of the placenta.

Effects on the mother
Advantages:

	1.	The third stage of labour can be completed rapidly.
	2.	There will be less bleeding immediately after the birth.

Disadvantages:

	1.	The delivery of the placenta must be completed before the uterus, under the influence of large amounts of oxytocin, contracts sufficiently to trap the placenta behind the closing cervix. Once the injection is given, the placenta must be delivered within 10 minutes to prevent this happening.
	2.	Excessive pulling on the cord in an attempt to deliver the placenta can cause the cord to break.
	3.	If the placenta does become trapped in the uterus, then a manual removal under general anaesthetic will be needed. The doctor uses his hand to scrape the placenta off the uterine wall and bring it out through the vagina. This will usually be done under a spinal or general anaesthetic but if no anaesthetist is available could be done with the mother using the nitrous oxide and oxygen mask to relieve the pain from the procedure.
	4.	If there is an undiagnosed twin present, giving Syntocinon may cause the second twin to be caught inside the uterus. A Caesarean section or general anaesthetic may be needed to deliver the baby.
	5.	High levels of artificial oxytocin may cause reduced sensitivity to natural levels of oxytocin released in response to sucking by the baby, and lead to difficulties with the let-down reflex and establishment of lactation in the fist days post-partum.