physiology and management of third stage of labour

OBSTETRICS & GYNAECOLOGICAL NURSING
physiology and management of third stage of labour-introduction
labour
stages of labor
physiology
management of third stage of labour.

1. Physiological process Normal labour: spontaneous in onset, at term, vertex presentation, natural termination without any complications affecting health of mother &/or newborn Three stages of labour Labour

2. First stage : onset of true labour pains to full dilatation of cervix Second stage: full dilatation of cervix to expulsion of fetus from birth canal Third stage: after expulsion of fetus to expulsion of placenta & membranes (afterbirths) Stages of labour

3. PRANATI PATRA PHYSIOLOGY AND MANAGEMENT OF THIRD STAGE OF LABOUR

4. After expulsion of fetus to expulsion of placenta & membranes (afterbirths) Duration :15 min. Placental separation Placental expulsion Third stage: events

5. Separation of placenta is brought about by contraction and retraction. Reduces the size of placental area. Placenta begins to tear off the uterine wall. At the area of separation a clot forms. Placental separation

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7. Contraction & retraction of Upper Uterine Segment Placenta forced to lie in LUS/upper vagina Voluntary contraction of abdominal muscles Expulsion of placenta Expulsion of placenta

8. Effective retraction of uterine muscles : Living ligatures Thrombosis of torn sinuses Myotamponade : apposition of walls of the uterus Mechanisms to control bleeding

9. MANAGEMENT

10. Constant watch. A hand is placed over the fundus Look for 3 classic signs of placental separation Expectant management

11. 3. Change in shape of uterine fundus from discoid to globular with elevation of fundal height

12. Modified Brandt Andrews method Left hand: palmar surface of fingers placed above pubic symphysis . Body of uterus pushed upwards & backwards Right hand: cord traction in downward & backward direction Uterus feels hard, contracted CCT

13. Massage the uterus Examination of placenta ,membranes, cord Inspect vulva, vagina & perineum Expectant management

14. Examination of placenta ,membranes

15. Examination of membranes, cord

16. Most crucial Life threatening complications PPH(postpartum haemorrhage) Retained placenta Inversion of uterus Pulmonary embolism Third stage

17. Care for at least an hour after delivery. The mother should receive cleansing body wash,mouth wash and perineal care. She should be encouraged to empty bladder and bedpan offered. Blood pressure , pulse,uterine contaction ,and bleeding should be checked every 15mts. CARE OF NEW BORN AND MOTHER

18. The baby’s general wellbeing and security of the cord clamp needs to be checked. as the baby will chill after birth thoroughly dry and wrap the baby. Mothers intended to breastfeed may be encouraged. Early breastfeeding causes a reflex release of oxytocin from the posterior pituitary and stimulates the uterus to contract. CARE OF NEW BORN AND MOTHER

19. Labor is said to be normal if all are present except: At term Breech presentation Spontaneous in onset Healthy mother & neonate after delivery MCQ1

20. Labor is said to be normal if all are present except: At term Breech presentation Spontaneous in onset Healthy mother & neonate after delivery MCQ1

21. Regarding the third stage of labor, following is not true: Most crucial stage of labor Duration is 15 minutes Uterine inversion is most common complication AMTSL is routine in all MCQ2

22. Regarding the third stage of labor, following is not true: Most crucial stage of labor Duration is 15 minutes Uterine inversion is most common complication AMTSL is routine in all MCQ2

23. The uterotonic of choice for prophylaxis of PPH in third stage of labor is Syntometrine Oxytocin Misoprostol carboprost MCQ3

24. The uterotonic of choice for prophylaxis of PPH in third stage of labor is Syntometrine Oxytocin Misoprostol carboprost MCQ3

25. All are true in relation to AMTSL except: 10 IU of Oxytocin , IM Uterine massage Reduces the duration of third stage Perform in only high risk cases MCQ4

26. All are true in relation to AMTSL except: 10 IU of Oxytocin , IM Uterine massage Reduces the duration of third stage Perform in only high risk cases MCQ4

27. Complications during third stage of labor are all except PPH Chronic Uterine inversion Retained placenta Amniotic fluid embolism MCQ5

28. Complications during third stage of labor are all except PPH Chronic Uterine inversion Retained placenta Amniotic fluid embolism MCQ5

29. The most frequently observed method of placental separation : Marginal separation Central separation None both MCQ6

30. The most frequently observed method of placental separation : Marginal separation Central separation None both MCQ6

31. The most important method to control uterine bleeding following delivery Myotamponade Thrombosis Contraction& retraction of uterine muscle none MCQ7

32. The most important method to control uterine bleeding following delivery Myotamponade Thrombosis Contraction& retraction of uterine muscle none MCQ7

33. Following are true regarding misoprostol, except Low cost Easy storage Administered rectally Drug of choice for AMTSL MCQ8

34. Following are true regarding misoprostol, except Low cost Easy storage Administered rectally Drug of choice for AMTSL MCQ8

35. Following is true regarding Oxytocin Given as IV bolus dose Thermolabile Contraindicated in cardiac patient Causes hypertension MCQ9

36. Following is true regarding Oxytocin Given as IV bolus dose Thermolabile Contraindicated in cardiac patient Causes hypertension MCQ9

37. Prevention of PPH, all are true except Treatment of anemia in antenatal period Practice AMTSL in all Home delivery in high risk cases In forceps delivery, explore uterovaginal canal MCQ10

38. Prevention of PPH, all are true except Treatment of anaemia in antenatal period Practice AMTSL in all Home delivery in high risk cases In forceps delivery, explore uterovaginal canal MCQ10

39. CONCLUSION The third stage of labour commences with the completed delivery of the fetus and ends with the completed delivery of the placenta and its attached membranes. The  third stage  of labour begins once your baby is born, and ends when you deliver the placenta and the empty bag of waters attached to the placenta (membranes). It's normal for there to be some bleeding during this stage of labour.

40. Shirish  S  Sheth, “ Essential  of Obstetrics ” , 1stEdition, Chapter13, Antenatal  Care,Jaypee  Brothers Medical Publishers, New Delhi,2004, page no.: 102 - 107. Maya Devi  Subedi, “ Manual  of Midwifery A ” , 1stEdition, Chapter  11,  AntenatalAdvice , Books and Stationers, 2005, page no.: 157 - 165. •Kamala  Shova   Napit, “ Manual  of Midwifery B ” , 1stEdition, Chapter 4,Management of First Stage of  Labour,published  by Makalu Books and Stationers,2005, page no.: 41 to 64. BIBLIOGRAPHY

41. Miles C Benamin ‘text book of obstetric and gynaecology ’ 2 nd edition page no ; 249-254 Dutta Dc ‘text book of obstetric & gynaecology ‘ 3 rd edition page no – 139-143 BIBLIOGRAPHY

42. WRITE DOWN HOW TO MANAGE THE THIRD STAGE OF LABOUR ? ASSIGNMENT