Osce - active management of 3rd stage of labor

Active management of 3rd stage of labor

MMMC

1. ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOUR OSCE BY afiqi fikri

2. The patient is a multigravida who has successively delivered a health baby. case scenario 02

3. Identify the procedure in the pictures Super Plan 01 Lorem ipsum dolor sit amet constecture , do mika do bea beo . Gundul pacul gembelengan . Nyunggi wakul kemplelengan . Lorem ipsum dolor sit amet constecture , do mika do bea beo . Lorem ipsum dolor sit amet constecture , do mika do bea beo . Gundul pacul gembelengan . Nyunggi wakul kemplelengan . Lorem ipsum dolor sit amet constecture , do mika do bea beo . 03

4. Controlled cord traction in the third stage of labor 4

5. State THREE prerequisites for the procedure Lengthening of the cord Fresh gush of recent blood A rise of the uterine fundus 04 The uterus becomes globular in shape and feels firm

6. Describe the correct conduct of the procedure Immediately after the delivery of the baby, palpate the uterus so as to determine it is firm 05 Ensure there is no excessive bleeding (PPH ) Check for signs of separation and ensure the patient has been administered IM oxytocin at delivery of the anterior shoulder of the fetus.

7. CCT - involves traction on the umbilical cord, combined with counter pressure upwards on the uterine body by the other hand placed immediately above the symphysis pubis. The patient is not left till no active bleeding is seen at the introitus . 06 An artery clamp which has seen placed on the umbilical cord close to the vulva is observed for some descent denoting separation (also look for other signs of separation) Then firm continues pressure is given till entire placenta is delivered. The uterus is massaged till it is firm Any perineal tear is the repaired The delivered placenta is checked for completeness

8. State TWO benefits of the procedure in conduct of the third stage. 07 Shortens third stage Less bleeding post partum

9. What further action is taken with regards to the placenta after its delivery? 08 It is checked for completeness , no cotyledons should be missing and the membrane should be complete too Obtain instructions with regards to disposing the placenta (incineration or packaging to be sent back to the m other for cultural reasons)

10. State TWO complications that may occur in improper management of the procedure. 09 Postpartum hemorrhage Uterine inversion

11. References 1 . Pamela M. Spencer. Controlled cord traction in management of third stage of labour.British Medical Journal June 1962, pp 1970 2. Begley CM, Gyte GML, Devane D, McGuire W, Weeks A .Delivering the placenta, expectant or mixed management in the third stage of labour . Cochrane Summary Nov. 2011 available on line http ://summaries.cochrane.org/ CD007412/ delivering- thepl a centa -with-a ctive-expecta nt -or-m ixed -ma na gem e nt-i n-the- th i rd-sta ge-of-1 a bo u r 16

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