Feature ArticlesActive Versus Expectant Management of the Third Stage of Labor and Implementation of a ProtocolBurke, Carol MSN, RNC-OB, C-EFM, APN/CNS, CNMAuthor Information Northwestern Memorial Hospital, Chicago, Illinois. Correspondence: Carol Burke, MSN, RNC-OB, C-EFM, APN/CNS, CNM, Northwestern Memorial Hospital, Prentice Women' Hospital, Prenctice Women's Hospital, 250 East Superior St, Chicago, IL 60611 ([email protected]). For more than 36 additional continuing education articles related to neonatal, go to NursingCenter.com/CE Received February 17, 2010 Accepted May 19, 2010 The Journal of Perinatal & Neonatal Nursing: July/September 2010 - Volume 24 - Issue 3 - p 215-228 doi: 10.1097/JPN.0b013e3181e8ce90 Buy Take the CE Test Metrics Abstract Although the focus at delivery may naturally shift to infant transition, continued maternal vigilance during stage 3 is imperative to accomplish a safe outcome for the mother and her newborn. The third stage of labor is a normal physiological progression of birth that may be compounded by serious complications. The most common complication is postpartum hemorrhage due to uterine atony. Clinicians choose either active management or expectant management for stage 3 to prevent excessive maternal blood loss. Rapid identification and response to a postpartum hemorrhage are critical. A multidisciplinary perinatal team at a large Midwest tertiary center led the transition from an expectant to an active-management protocol within the obstetric service. Outcomes included a decrease in the postpartum hemorrhage rate and decreased usage of additional uterotonic medications during the immediate recovery period. © 2010 Lippincott Williams & Wilkins, Inc.