3rd Stage of Labour

Question 1

What does it mean if a blood vessel is tortuous?

Answer 1

It is tense and congested with blood

Question 2

What are the 2 sides of the placenta?

Answer 2

1. Amnion (closest to baby)

2. Chorion (embeds in uterus)

Question 3

What is the umbilical cord made up of?

Answer 3

• Outer layer = amnion
• 2 arteries, 1 vein
• Wharton’s jelly

Question 4

Step 1 of placental separation

Answer 4

Uterus and placental site decrease in size due to contraction and retraction following delivery

Question 5

Step 2 of placental separation

Answer 5

Placenta is elastic and becomes wrinkled, so separates from the uterine wall

Question 6

Step 3 of placental separation

Answer 6

Some foetal blood is pumped back to the baby’s circulation

Question 7

Step 4 of placental separation

Answer 7

Maternal blood in the intervillous spaces is forced back into the spongy layer of the decidua-basalis

Question 8

Step 5 of placental separation

Answer 8

Retraction of the oblique muscle fibres constricts the blood vessels to the placenta

Question 9

Step 6 of placental separation

Answer 9

Tortuous veins rupture to form a retroplacental clot, shearing off the villi of the spongy layer

Question 10

Step 7 of placental separation

Answer 10

Living ligatures (fibres) contract around the torn maternal blood vessels to achieve haemostasis

Question 11

What is haemostasis?

Answer 11

Stopping the flow of blood

Question 12

What are the 2 types of management and how long should they last?

Answer 12

1. Physiological (60 mins)

2. Active (30 mins)

Question 13

Give some signs of placental separation

Answer 13

• Contracted uterus
• Small, fresh blood loss
• Cord lengthening

Question 14

What are the 2 types of placental separation?

Answer 14

1. Shultze (amnion on outside)

2. Matthew Duncan (chorion on outside)

Question 15

What are the differences between the 2 types of placental separation?

Answer 15

Shultze:
Begins centrally, retroplacental clot present, short duration, less blood loss, complete membranes
Duncan:
Begins at border, no clot, longer duration, more bloos loss, ragged membranes

Question 16

What should be advised during physiological management?

Answer 16

Breastfeeding

Question 17

What are the 2 interventions used in active management?

Answer 17

1. Uterotonic drugs

2. CCT

Question 18

What are the 3 types of uterotonic drugs and their doses?

Answer 18

1. Syntocinon (10iu)
2. Ergometrine (500mcg in 1ml)
3. Syntometrine (1ml)

Question 19

What is a contraindication for ergometrine?

Answer 19

High BP/ PET

Question 20

What is a common side effect of syntometrine?

Answer 20

N+V

Question 21

What should be checked on the placenta following its delivery?

Answer 21

• 2 membranes
• Complete (no clots missing)
• Any abnormalities
• 3 umbilical vessels

Question 22

What does the absence of an umbilical artery indicate?

Answer 22

Renal disease in the baby

Question 23

What is calcification?

Answer 23

Hardened areas caused by accumulation of calcium salts

Question 24

When is calcification an issue?

Answer 24

In early pregnancy, as it is a sign that the placenta is ageing early

Question 25

Name 4 placental abnormalities

Answer 25

1. Succenturiate lobe
2. Bipartite placenta
3. Battledore insertion
4. Velamentous insertion

Question 26

What is a succenturiate lobe?

Answer 26

A small extra lobe separate from the chorion that is attached by blood vessels

Question 27

What is a bipartite placenta?

Answer 27

When there are 2 placentas joined by 1 umbilical cord

Question 28

What is a battledore insertion?

Answer 28

The umbilical cord is attached at the very edge of the placenta

Question 29

What is velamentous insertion?

Answer 29

The cord is inserted away from the edge of the placenta in the membranes

Question 30

What are the recommended interventions if 3rd stage is delayed?

Answer 30

• Empty bladder
• Analgesia
• VE
• Synto
• Catheterise/IV access
• ?manual removal