Downloaded 118 times
Uploaded byDolisha Warbi
THIRD STAGE OF LABOUR AND ITS MANAGEMENT.pdf
The third stage of labor involves the separation and expulsion of the placenta following the birth of the baby and typically lasts 5 to 30 minutes. Management strategies include expectant (passive) management and active management, the latter involving prophylactic oxytocin to reduce complications such as postpartum hemorrhage. Complications may include postpartum hemorrhage, retained placenta, and inversion of the uterus.
More Related Content
Similar to THIRD STAGE OF LABOUR AND ITS MANAGEMENT.pdf
THIRD STAGE OF LABOUR AND ITS MANAGEMENT.pdf
- 1. THIRD STAGE OFLABOUR By - DOLISHA WARBI
- 2. INTRODUCTION: LABOUR: A series ofevents that take place on genital organs in an effort to expel the viable product of conception out of the worm through the vagina into the outer world. 4 STAGES OF LABOUR: Stage 1 – Dilatation of the cervix (0 – 10cm). a) Early phase – Latent (0-3cm). b) Active phase (4-7cm). c) Transitional phase (8-10cm). Stage 2 - Begin with complete cervical dilation, an end with the birth of the baby. Stage 3 – Begin with the birth of the baby and end with the delivery of the placenta and its membrane. Stage 4 – Recovery phase start after the delivery of the placenta and last for 2 hours of birth.
- 3. 3RD STAGE OFLABOUR:
- 4. DEFINITION: • The thirdstage of labor lasts from the birth of the baby until the placenta is expelled. It is known as the placental stage of labor. • 3rd stage is that separation and expulsion of the placenta and membranes are also involves the control of bleeding. DURATION: • Primigravida – 15 minutes. • Multigravida – 5 minutes. • Normally it should be delivered between 5 – 30 minutes times frame.
- 5. EVENTS: 1) Placental separation. 2)Descend of placenta. 3) Expulsion of placenta. PLACENTAL SEPARATION: Before separation – Per abdomen - Uterus become discoid in shape, firm when feel and non ballotable. Fundal heart rate slightly below the umbilicus. Per vaginum – There may be a slight trickling of blood. Length of the umbilical cord are visible from outside, remain static.
- 6. After separation – Perabdomen – Uterus become globular, firm and ballotable. Fundal height is slightly raised. Suprapubic bulging. Per vaginum – Slight gush of vagina bleeding. Permanent lengthening of the cord. DESCENT OF THE PLACENTA: § Sudden trickles or gush of blood. § Lengthening of the umbilical cord. § Change in the shape of the uterus to globular. § Change in the position of the uterus. Above the umbilicus.
- 7. EXPULSION OF THEPLACENTA: 1) The Schultz Mechanisms. 2) Mathew Duncan Mechanisms. The Schultz Mechanisms. ØPlacenta separates in the center and folds in on itself as it descends into the lower part of the uterus 80%. ØFetal surface appear at vulva with membrane’s trailing behind. ØMinimal visible blood loss as placenta is erupted from the uterus. ØRetro placental clot contained within membranes (inverted sac).
- 8. Mathew Duncan Mechanisms. •Separation start at the lower edge of Placenta lateral border, separate 20%. • Maternal surfaces appear fast at Volva, usually accompanied by more bleeding from placental site due to slower separation and no retro placental clot.
- 9. SIGNS OF SEPARATIONAND DESCENT: • Lengthening of the umbilical cord outside. • The uterus become firm and globular (descent). • The uterus rises in the abdomen. • A gush of blood is present due to separation. CONTROL OF BLEEDING: qNormal blood flow through placenta site is 500 - 800 ml/min. 10 - 15% of cardiac output. qStrong contraction/retractions of uterus constrict blood vessel by interlacing muscle fibers in myometrium (living ligature). qPressure exerted on Placental site by wall of contracted uterus. qBlood clotting mechanism (Sinuses and torn vessel).
- 10. MANAGEMENT: EXPECTNAT MANAGEMENT /PASSIVE MANAGEMENT ACTIVE MANAGEMENT
- 11. EXPECTNAT MANAGEMENT /PASSIVE MANAGEMENT: ØThis is done 15 to 20 minutes. ØCourt clams after delivery of placenta. ØNo prophylactic Oxytocin. ØNo control cord traction. ØUpright / kneeling / squatting position best easy to observed blood loss. ØHand off just checked uterus contracted and observed PV. ØWait and watch for sign of separation and descent. ØMother expelled placenta when she feel the contraction and placenta in vagina.
- 12. ACTIVE MANAGEMENT: • Accordingto the World Health Organization. Active Management of 3rd stage of labor takes about 5 to 10 minutes. • This is used to reduce the length of 3rd stage and incidence of postpartum hemorrhage. • It include the use of prophylactic oxytocin drugs and early clamping and coating of cord and control cord tractions. • It include 4 components; 1) Used of uterotonics - Oxytocin (Pitocin) – 10unit /IM OR Misoprostol 600mg / orally. 2) Delayed cord clamping – 1-3 min; 80-100ml of blood and iron can be transferred from placenta to the baby during this time. 3) CCT (control cord traction) – under the presence of a professional midwife. Modified Brandt Andrew procedure is used by pulling doenward and backward direction. 4) Post Partum Vigilance – from 15min – 2hr monitor the tonicity and the nature of contraction.
- 14. OTHER MANAGEMENT: • Guardthe uterus to keep yourself and anyone else from messaging it prior to placental separation. • Do not massage the uterus before placental separation except when partial separation has occurred by natural process and excessive breeding evidence. • Do not pull on the umbilical cord before the placenta separate, or ever with an uncontracted uterus. • Wait for the natural process to occur and do not interfere.
- 15. COMPLEXTION OF THIRDSTAGE: • Continuing evaluation. • Ensure that the uterus is well contracted. • Slight laceration are usually required immediately. • The vulva and perineum are gently cleaned. • Mother’s blood pressure pulse and temperature should be taken. • Once the mother is comfortable, the placenta and membrane is the next priority.
- 16. EXAMINATION OF PLACENTAAND ITS MEMBRANE: • Infraction that are recent or old. • Localize calcification. • Lobes. • Blood vessel. • Insertion of the cord. • Umbilical vessel. • Cord length. • Weight of Placenta.
- 17. COMPLICATION OF 3RDSTAGE: • Postpartum hemorrhage. • Hematoma formation. • Retained Placenta. • Inversion of uterus. • Shock.
- 18.