In this chapter, definition, physiology and benefits of active management of third stage of labor are explained. Primary postpartum hemorrhage (PPH) is the leading complication. Childbirth is a normal process, occasionally maternal mortality and morbidity is encountered due to problems faced in the third stage of labor. Most often, inadequately trained medical personnel manage these complications. The causes, predisposing factors and management are discussed in a stepwise manner. Atonic PPH is often managed medically with simple uterotonics, but rarely it requires second line prostaglandins. Failure of medical management and morbid patient’s will require various surgical interventions to arrest hemorrhage. Hysterectomy is the treatment of choice when other measures fail. Retained placenta will require manual removal of placenta under general anesthesia. Even though uterine inversion is rare, one should be competent to manage this.