Evaluation of complications during third stage of labour among women delivering at tertiary care center


  • Tanya Agrawal Department of Obstetrics and Gynaecology, People's College of Medical Sciences and Research Center, Bhopal, Madhya Pradesh, India
  • Ruchi Kalra Department of Obstetrics and Gynaecology, People's College of Medical Sciences and Research Center, Bhopal, Madhya Pradesh, India
  • Aabha Suryavanshi Department of Obstetrics and Gynaecology, People's College of Medical Sciences and Research Center, Bhopal, Madhya Pradesh, India




Perineal tears, PPH, Third stage complications


Background: The common complications occurring during third stage of labor are PPH Retained Placenta, Morbid adherent placenta- placenta accreta, placenta increta, percreta, perineal tears, uterine inversion increasing the maternal morbidity and mortality. The objective of the present study was to evaluate percentage and spectrum of obstetrics complication occurring during third stage of labor.

Methods: An observational study was done at Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Center, Bhopal from January 2016 to December 2017. All women delivering vaginally including instrumental deliveries were included. The medio-lateral episiotomy was given to all primigravida and for multigravida decision was case based as big size babies, instrumental deliveries, rigid perineum. Active management of third stage of labor was practiced.

Results: 899 women delivered vaginally during the study period of 2 years (Jan -Dec 2016 Jan -Dec 2017). Among these 6.45% (58 women) had various complications during third stage of labor . 55% were primigravida. Complications which were observed to occur during third stage of labor were perineal tear 4% (37/899 deliveries). Atonic PPH occurred in 0.5% (9/899 deliveries) Traumatic PPH was in 1.44% (13/899 deliveries and 0.3% cases had retained placenta. Associated condition in perineal tear cases were 92% had big size babies 5% cases were preterm labor and in 3% cases ventouse application was done.

Conclusions: Common complications were 1st and 2nd degree perineal tears occurred in 4% deliveries and traumatic PPH were in 1.44% of cases.


AICOG Manual of Operative Obstetrics and postparturtum hemorrhage. In Birth injuries to lower birth canal Patel B, Shah A, Jani S. First Edition. Jaypee Brothers Medical Publishers; 2017:97-112.

National Health portal, India. Available at: https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/postpartum-haemorrhage

Estimates of Maternal Mortality Ratios in India and its States A Pilot Study; Institute for Research in Medical Statistics. Indian Council of Medical Research. July 2003.

SOGC clinical Practice Guideline. Active Management of the third stage of labour: Prevention and Treatment of Postpartum Hemorrhage. J Obstet Gynaecol Can. 2009;31(10):980-93.

Patel MM, Jain M. A study on active management of third stage of labor as per WHO Guidelines: efficacy and complications. Int J Reprod Contracept Obstet Gynecol. 2016Jan;5(1):80-3.

Maughan KL, Heim SW, Galazka SS. Preventing postpartum hemorrhage: managing the third stage of labor. Am Fam Physician. 2006;73(6):1025-8.

Ott J, Gritsch E, Pils S, Kratschmar S, Promberger R, Seemann R, et al. A retrospective study on perineal lacerations in vaginal delivery and the individual performance of experienced mifwives. BMC pregnancy and childbirth. 2015 Dec;15(1):270.

Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth. 2013:13:59.

Suto M, Takehara K, Misago C, Matsui M. Prevalence of Perineal Lacerations in Women Giving Birth at Midwife-Led Birth Centers in Japan: A Retrospective Descriptive Study. J Midwifery Womens Health. 2015 Jul-Aug;60(4):419-27. doi 10.1111/jmwh.12324

Schmitz T, Alberti C, Andriss B, Moutafoff C, Oury JF, Sibony O. Identification of women at high risk for severe perineal lacerations. Eur J Obstet Gynaecol Repro Biol. 2014 Nov;182:11-5.

Hsieh WC, Liang CC, Wu D, Chang SD, Chueh HY, Chao AS. Prevalence and contributing factors of severe perineal damage following episiotomy-assisted vaginal delivery. Taiwan J Obstet Gynecol. 2014 Dec 1;53(4):481-5.

Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2017 Jun;6:CD006672.doi 10.1002/14651858.CD006672.pub3

Ngwenya S. Postpartum hemorrhage: incidence, risk factors, and outcomes in a low-resource setting. International journal of women's health. 2016;8:647.

WHO 2012 Recommendations for the Prevention and treatment of Postpartum Hemorrhage. Available at http://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf;jsessionid=866F8B2F71B917B9A9CE922D484CDA9B?sequence=1.Assessed on 6th April 2018

WHO guidelines for the mangement of Post-partum Haemorrhage and Retained Placenta. 2009.

NHS Clinical Guidelines: Postpartum Hemorrhage. Registration number o4234, June 2015.

WHO Recommendations: Intrapartum care for a positive child birth experience. Web annex. Evidence base. Geneva :World Health Organization ;2018(WHO/RHR/18.04)Licence :CCBY-NCSA3.0 IGO

Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva, World Health Organization ,2007.

NHS Clinical Guidelines: Management of retained Placenta. Registration number o4245, July 2015.

Intrapartum care. Care for healthy women and their babies during childbirth. National Institute for Health and Clinical Excellence, 2007. Available at http;//www.nice.org.uk/nicemedia/live/11837/36280/36280.pdf

Urner F, Zimmermann R, Krafft A. Manual removal of the placenta after vaginal delivery: an unsolved problem in obstetrics. J Preg. 2014;2014.






Original Research Articles