WordNet

perform (a play), especially on a stage; "we are going to stage `Othello" (同)present, represent
a section or portion of a journey or course; "then we embarked on the second stage of our Caribbean cruise" (同)leg
a small platform on a microscope where the specimen is mounted for examination (同)microscope stage
a large platform on which people can stand and can be seen by an audience; "he clambered up onto the stage and got the actors to help him into the box"
any scene regarded as a setting for exhibiting or doing something; "All the worlds a stage"--Shakespeare; "it set the stage for peaceful negotiations"
the theater as a profession (usually `the stage'
plan, organize, and carry out (an event); "the neighboring tribe staged an invasion" (同)arrange
in the third place; "third we must consider unemployment" (同)thirdly
following the second position in an ordering or series; "a distant third"; "he answered the first question willingly, the second reluctantly, and the third with resentment"
the musical interval between one note and another three notes away from it; "a simple harmony written in major thirds"
coming next after the second and just before the fourth in position (同)3rd, tertiary
work hard; "She was digging away at her math homework"; "Lexicographers drudge all day long" (同)labour, toil, fag, travail, grind, drudge, dig, moil
undergo the efforts of childbirth (同)labour
productive work (especially physical work done for wages); "his labor did not require a great deal of skill" (同)labour, toil
a social class comprising those who do manual labor or work for wages; "there is a shortage of skilled labor in this field" (同)labour, working_class, proletariat
attend a dance or a party without a female companion
adult male deer

PrepTutorEJDIC

(劇場・ホールなどの)『舞台』・on stage 舞台上で・《無冠詞》・off stage 舞台の陰で《無冠詞》：ステージ;演壇;《the~》演劇;俳優業,演劇(舞台)の仕事 / (事件・活動などの)『舞台』,場所 / (発達などの)『段階』,時期 / (駅馬車などの止まる)駅,宿場;休憩地;(旅行における休憩地間の)旅程,行程 / =stagecoach / (多段ロケットの)段 / 〈劇〉‘を'『上演する』,〈試合など〉‘を'公開する / (特に劇的に)…‘を'実行する,やってのける
《所有・所属》…『の』,…のものである,…に属する・《材料・要素》…『でできた』,から成る・《部分》…『の』[『中の』] ・《数量・単位・種類を表す名詞に付いて》…の・《原因・動機》…『で』,のために(because of) ・《主格関係》…『の』,による,によって・《目的格関係》…『を』,の・《同格関係》…『という』・《関係・関連》…『についての』[『の』],の点で・《抽象名詞などと共に》…の[性質をもつ] ・《『It is』+『形』+『of』+『名』+『to』 doの形で,ofの後の名詞を意味上の主語として》・《分離》…『から』・《起原・出所》…『から』[『の』](out of) ・《『名』+『of』+『a』(『an』)+『名』の形で》…のような・《『名』+『of』+『mine』(『yours, his』など独立所有格)の形で》…の…・《時》(1)《副詞句を作って》…に《形容詞句を作って》…の・《時刻》《米》…前(to,《米》before)
《the ~》『第3番目の』,3番目の / 3分の1の / 《the ~》『第3』,3番目[のもの],(月の)『3日』 / 〈C〉『3分の1』 / 〈C〉(音楽で)3度[音程] / 〈U〉(自動車などの)サード(第3速)[ギア] / 第3に,3番目に
雄ジカ / 《米話》(社交的な集まりに)婦人を同伴しない男 / 男性用の,男性のみ出席する,男性向けの / 女性を同謀しないで

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/13 17:11:35」(JST)

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Placental expulsion (also called afterbirth) occurs when the placenta comes out of the birth canal after childbirth. The period from just after the baby is expelled until just after the placenta is expelled is called the third stage of labor.

The third stage of labor can be managed actively with several standard procedures, or it could be managed expectantly (also known as physiological management or passive management), the latter allowing the placenta to be expelled without medical assistance.

Although uncommon, in some cultures the placenta is kept and consumed by the mother over the weeks following the birth. This practice is termed placentophagy.

Physiology

It begins as a physiological separation from the wall of the uterus. The placenta is usually expelled within 15–30 minutes of the baby being born.

Maternal blood loss is limited by contraction of the uterus following birth of the placenta. Normal blood loss is less than 600 mL.

Active management

Methods of active management include umbilical cord clamping, stimulation of uterine contraction and cord traction.

Umbilical cord clamping

Active management routinely involves clamping of the umbilical cord, often within seconds or minutes of birth.

Uterine contraction

Uterine contraction assists in delivering the placenta, and can be induced with medication, usually oxytocin via intramuscular injection. The use of ergometrine, on the other hand, is associated with nausea or vomiting and hypertension.^[1]

Breastfeeding soon after birth and massaging of the top of the uterus (the fundus) also causes uterine contractions.

Cord traction

Controlled cord traction (CCT) consists of pulling on the umbilical cord while applying counter pressure to help deliver the placenta.^[2] It may be uncomfortable for the mother. Its performance requires specific training. Premature cord traction can pull the placenta before it has naturally detached from the uterine wall, resulting in hemorrhage. Controlled cord traction requires the immediate clamping of the umbilical cord.

A Cochrane review came to the results that controlled cord traction does not clearly reduce severe postpartum hemorrhage (defined as blood loss >1000 mL) but overall resulted in a small reduction in postpartum hemorrhage (defined as blood loss >500 mL) and mean blood loss. It did reduce the risk of manual placenta removal. The review concluded that use of controlled cord traction should be recommended if the care provider has the skills to administer it safely.^[2]

Manual placenta removal

Manual placenta removal is the evacuation of the placenta from the uterus by hand.^[3] It is usually carried out under anaesthesia or more rarely, under sedation and analgesia. A hand is inserted through the vagina into the uterine cavity and the placenta is detached from the uterine wall and then removed manually. A placenta that does not separate easily from the uterine surface indicates the presence of placenta accreta.

Efficacy of active management

A Cochrane database study^[1] suggests that blood loss and the risk of postpartum bleeding will be reduced in women offered active management of the third stage of labour. A summary^[4] of the Cochrane study came to the results that active management of the third stage of labour, consisting of controlled cord traction, early cord clamping plus drainage, and a prophylactic oxytocic agent, reduced postpartum haemorrhage by 500 or 1000 mL or greater, as well as related morbidities including mean blood loss, incidences of postpartum haemoglobin becoming less than 9 g/dL, blood transfusion, need for supplemental iron postpartum, and length of third stage of labour. Although active management increased adverse effects such as nausea, vomiting, and headache, women were less likely to be dissatisfied.^[4]

Retained placenta

A retained placenta is a placenta that doesn't undergo expulsion within a normal time limit. Risks of retained placenta include hemorrhage and infection. If the placenta fails to deliver in 30 minutes in a hospital environment, manual extraction may be required if heavy ongoing bleeding occurs, and very rarely a curettage is necessary to ensure that no remnants of the placenta remain (in rare conditions with very adherent placenta, placenta accreta). However, in birth centers and attended home birth environments, it is common for licensed care providers to wait for the placenta's birth up to 2 hours in some instances.

Non-humans

In most mammalian species, the mother bites through the cord and consumes the placenta, primarily for the benefit of prostaglandin on the uterus after birth. This is known as placentophagy. However, it has been observed in zoology that chimpanzees apply themselves to nurturing their offspring, and keep the fetus, cord, and placenta intact until the cord dries and detaches the next day.

The placenta exists in most mammals and some reptiles. It is probably polyphyletic, having arisen separately in evolution rather than being inherited from one distant common ancestor.

Studies on pigs indicate that the duration of placenta expulsion increases significantly with increased duration of farrowing.^[5]

References

^ ^a ^b Prendiville, Walter JP; Elbourne, Diana; McDonald, Susan J; Begley, Cecily M (2000). "Active versus expectant management in the third stage of labour". Reviews (3): CD000007. doi:10.1002/14651858.CD000007. PMID 10908457.
^ ^a ^b Hofmeyr, G Justus; Mshweshwe, Nolundi T; Gülmezoglu, A Metin; Hofmeyr, G Justus (2015). "Controlled cord traction for the third stage of labour". doi:10.1002/14651858.CD008020.pub2.
^ Dehbashi S, Honarvar M, Fardi FH (July 2004). "Manual removal or spontaneous placental delivery and postcesarean endometritis and bleeding". Int J Gynaecol Obstet 86 (1): 12–5. doi:10.1016/j.ijgo.2003.11.001. PMID 15207663.
^ ^a ^b BMJ summary of the Cochrane group metanalysis, at Postpartum Hemorrhage: prevention by David Chelmow.
^ Rens, B.; Van Der Lende, T. (2004). "Parturition in gilts: duration of farrowing, birth intervals and placenta expulsion in relation to maternal, piglet and placental traits". Theriogenology 62 (1–2): 331–352. doi:10.1016/j.theriogenology.2003.10.008. PMID 15159125.

UpToDate Contents

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1. 分娩第3期の管理のための子宮収縮薬 uterotonic drugs for management of the third stage of labor
2. 正常な陣痛および分娩の管理 management of normal labor and delivery
3. 経膣分娩後遺残胎盤の診断および管理 diagnosis and management of retained placenta after vaginal birth
4. 正常な陣痛および分娩のメカニズム mechanism of normal labor and delivery
5. 低所得国の妊産婦死亡率の削減へのアプローチ approaches to reduction of maternal mortality in low income countries

English Journal

A randomized controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum hemorrhage.

Priya GP1, Veena P2,3, Chaturvedula L1, Subitha L4.
Archives of gynecology and obstetrics.Arch Gynecol Obstet.2015 Dec;292(6):1231-7. doi: 10.1007/s00404-015-3763-5. Epub 2015 May 20.
PURPOSE: In India, two third of maternal deaths occur in rural areas where there is lack of transportation facilities, lack of refrigeration to store the injectable uterotonic drug such as oxytocin, lack of skilled personnel to administer them and lack of sterile syringes and needles. Hence, this st
PMID 25990482

Tranfusion risk: is "two-step" vaginal delivery a risk for postpartum hemorrhage?

Straface G1, Bassi E1, De Santis M2, Scambia G2, Zanardo V1.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2015 Dec;28(18):2172-5. doi: 10.3109/14767058.2014.980232. Epub 2014 Nov 14.
OBJECTIVE: In the active management strategy of third stage of labor, the optimal timing for clamping the umbilical cord after birth has been a subject of controversy. We want to evaluate if "two-step" delivery is a risk factor for postpartum hemorrhage (PPH), defined as need of transfusion, compari
PMID 25354292

How Long Is Safe? Setting the Cutoff for Uncomplicated Third Stage Length: A Retrospective Case-Control Study.

Shinar S1, Schwartz A1, Maslovitz S1, Many A1.
Birth (Berkeley, Calif.).Birth.2015 Nov 10. doi: 10.1111/birt.12200. [Epub ahead of print]
OBJECTIVE: The aim of our study was to determine the optimal time for manual placental removal in an uncomplicated third stage while taking into consideration the risk for blood transfusion. Risk factors for postpartum blood transfusions were studied.METHODS: Computerized data of all vaginal deliver
PMID 26555024

Japanese Journal

Maternal Death Due to Stroke Associated With Pregnancy-Induced Hypertension

, , , , , , , , , ,on behalf of the Maternal Death Exploratory Committee and the Japan Association of Obstetricians and Gynecologists
Circulation Journal advpub(0), 2015
… Background:The aim of this study was to clarify the clinical features of maternal death due to stroke associated with pregnancy-induced hypertension (PIH) in Japan.Methods and Results:Reported maternal deaths occurring between 2010 and 2012 throughout Japan were analyzed by the Maternal Death Exploratory Committee. … Among a total of 154 reports of maternal death, those due to stroke with (n=12) or without (n=13) PIH were compared. …
NAID 130005073165

メンタル不調からの復職者への適正な仕事配分 : ある製薬企業研究開発部門の事例分析

南雲智映,小沼三智子,梅崎修
社会政策 6(1), 94-106, 2014-09-10
本稿では,製薬会社の研究開発部門におけるメンタルヘルス不調からの職場復帰の成否に影響を与える要因について,復職者の上司および復帰者本人に対し聞き取り調査を行った。同じ会社の同じ部門内での復職事例を比較検討したことが本稿の特徴である。明らかになったことは以下の通りである。第一に復職の成否は(仕事の質が)易しい仕事から,やや難しい仕事を経て,難しい仕事に移行しているかどうかにかかっていた。メンタルヘル …
NAID 110009857400

1970年代後半以降の国際建設業の動態

梶田真
地理科学 69(1), 17-36, 2014-01-28
… This paper examines the geographical dynamics of the international construction industry since the late 1970s, in terms of the validity of Bon's internationalization hypothesis, using the results of the Top International Contractors (TIC) survey by ENR (formerly, Engineering News Records). …
NAID 110009809557

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