3rd stage of labor

Question 1

definition

Answer 1

• period of delivery of baby to the expulsion of the placenta and membranes
• period btw 2nd stage of labor and puerperium

Question 2

Duration

Answer 2

• placenta generally separates within 2 – 10 min but may takes up to half an hr or more to spontaneously separate
• if longer than 30 min, regarded as prolonged

Question 3

management of 3rd stage of labor

Answer 3

• modern tech called controlled cord traction applied

i) synthetic oxytoxin 10iu or syntometrine ( 5iu oxytoxin, 0.5mg ergometrine ) give IM following delivery of shoulder

ii) after delivery of baby, vulva observed for any hemorrhage; attendant’s hand put on abd to feel first contraction and cord should be double clamped appr. 1- 2 min after delivery of baby to compare lengthening of cord

iii) when contraction felt, left hand should be removed suprapubically and the fundus elevated with palm facing towards mother

• simultaneously, right hand grasp cord and exert steady traction to deliver placenta gently

iv) if no bleeding, a further attempt at controlled cord traction should be made after 10 min; if failed, placenta is retained, surgical removal of placenta is performed

Question 4

Apgar score

Answer 4

• usually determined at one and five minutes
• valuation of a newborn infant’s physical status by assigning numerical values ( 0 to 2 ) to each of 5 criteria:

Question 5

conduction

Answer 5

• as the signs of placental separation appear, with gentle traction, with or without counterpressure between the symphysis and fundus to prevent descend of uterus, allows placental delivery
• modern tech called controlled cord traction applied

i) synthetic oxytoxin 10iu or syntometrine ( 5iu oxytoxin, 0.5mg ergometrine ) give IM following delivery of shoulder

ii) after delivery of baby, vulva observed for any hemorrhage; attendant’s hand put on abd to feel first contraction and cord should be double clamped appr. 1- 2 min after delivery of baby to compare lengthening of cord

iii) when contraction felt, left hand should be removed suprapubically and the fundus elevated with palm facing towards mother

• simultaneously, right hand grasp cord and exert steady traction to deliver placenta gently

iv) if no bleeding, a further attempt at controlled cord traction should be made after 10 min; if failed, placenta is retained, surgical removal of placenta is performed

• placenta should be checked to ensure complete removal especially for missing cotyledons or succenturiate lobe and to detect placental abN
• after placental delivery, prevention of excessive postpartum bleeding should be taken care attentively; infusion of dilute solution of oxytoxin or uterine massage may help to cease bleeding
• vulva should be checked for laceration, and suturing needed for major tear

Question 6

signs of placental separation

Answer 6

• fresh show of blood fr vagina
• the umbilical cord lengthens outside vagina
• fundus of uterus rises up, become softer prior to seperation
• the uterus becomes firm and globular