23. Stages of delivery. Management of the third and fourth stage

Question 1

what are the Signs of placental separation?

Answer 1

1. Fresh show of blood from the vagina
2. The umbilical cord lengthens outside the vagina
3. The fundus of the uterus rises up
4. The uterus becomes firm and globular

Question 2

the placenta should be examined for?

Answer 2

to ensure it’s complete removal (no missing cotyledons) and to detect placental abnormalities

Question 3

what is controlled cord traction (CCT)?

Answer 3

delivering the placenta by gentle traction of the umbilical cord and counter-pressure on the uterus between the symphysis and fundus to prevent descent of the uterus into the pelvis.

Question 4

after delivery of the placenta

Answer 4

1. check for any uterine bleeding- Perform fundal massage to help the uterus contract down and ↓ the bleeding. Oxytocin may be added to the IV infusion after the baby has been delivered.
2. Inspect for any lacerations or extensions of episiotomy that may need to be repaired

Question 5

1st degree perineal laceration

Answer 5

Laceration involving the vaginal epithelium or perineal skin

Question 6

2nd degree perineal laceration

Answer 6

Laceration extending into the subepithelial tissue of the vagina or perineum, +/- involvement of the muscles of the perineal body

Question 7

3rd degree perineal laceration

Answer 7

Laceration involving the anal sphincter

Question 8

4th degree perineal laceration

Answer 8

Laceration involving the rectal mucosa

Question 9

what occurs in the 4th stage of labor

Answer 9

an hour immediately following delivery and the first 4 hours postpartum require close observation of the patient to prevent postpartum hemorrhage (PPH)

Question 10

what is monitored closely during the 4th stage of labor?

Answer 10

BP
HR
uterine tone