3rd Stage of Labour & Early Postnatal Care (W/S 10 & 11) Flashcards
What is the 3rd stage of labour?
From the birth of the baby until delivery of the
placenta and membranes.
What are the 2 phases of the 3rd stage of labour?
Separation and expulsion of the placenta (and membranes)
Describe separation of the placenta.
Separation of the placenta – a retroplacental clot forms as the vessels supplying the placenta and umbilical cord constrict.
Contraction of the uterus and a reduction in the surface area of the uterine cavity aids in the separation of the placenta from the uterine wall. Placenta then drops into lower segment.
Describe explusion of the placenta and membranes.
Further uterine contractions force the placenta into the vagina, where it can then be expelled by maternal effort or by the assistance of the attending health professional.
What are the living ligatures and what is their role in the 3rd stage?
The vessels supplying the placental bed traverse a latticework of crisscrossing muscle bundles that occlude and kink-off the blood vessels as they contract and retract following expulsion of the placenta. This arrangement of muscle bundles has been referred to as the “living ligatures” or “physiologic sutures” of the uterus.
What are the two types of separation?
Schultz (Shiny Schultz) and Matthews Duncan (Dirty Duncan)
What are the two approaches for third stage management?
Active - hands on
Physiological - hands off, aka expectant mgt
What is meant by physiological third stage?
The birth of the placenta and membranes are expelled by maternal effort only and without using uterotonic agents or controlled cord traction.
“It means that you wait for the placenta to be delivered naturally.
After your baby’s birth, your midwife will delay clamping the umbilical cord to allow oxygenated blood to pulse from the placenta to your baby.
Your uterus will contract, and the placenta will peel away from the wall of your uterus. The placenta will then drop down into your vagina, ready for you to push it out.”
What role does the midwife play in a physiological third stage? (5)
- Don’t clamp or cut the cord
- Wait for the woman to feel for the next contraction
- Encourage her to ‘follow her body’ as she feels the urge to bear down
- Once the placenta is out clamp and cut the cord
- Check fundus and lochia
What are the pros of physiological third stage? (3)
- Natural balance
- Delayed cord clamping more likely
- Empowering the woman
What are the cons of physiological third stage?
- Requires an effective endogenous oxytocin release. Does the setting support physiology? Could be an issue where skin to skin does not occur, there is fiddling, stress and fear, prescribed timeframes, bright lights, lots of talking, etc.
(Are midwives experienced in the management of physiological third stage? Still expectations on time which does not promote physiology - 1hr)
What is meant by active third stage?
Consists of interventions designed to facilitate the delivery of the placenta by increasing uterine contractions and to prevent primary postpartum
haemorrhage (PPH) by averting uterine atony (lack of tone).
The usual components include administration of uterotonic agents, controlled cord traction and uterine massage after birth of the placenta, as appropriate.
What are the steps taken by the midwife during an actively managed third stage? (5)
- Give Syntometrine 1 amp or Syntocinon 10iu after birth of the anterior shoulder (top of buttocks or outer thigh)
- Clamp and cut the cord.
- Wait for signs of separation of the placenta:
- hand on the fundus to feel for contraction; fundus becomes hard and narrow (cricket ball)
- trickle of blood vaginally
- lengthening of the cord - Guard the uterus by placing hand above symphysis pubis
- Apply traction to the cord down towards the sacrum
- When placenta is seen at introitus lift cord upwards.
- As widest diameter of placenta fills the vaginal entrance place hand below to catch placenta.
- If membranes are trailing turn the placenta continually until membranes fall out.
- Check fundus and lochia
NOTE: Never get woman to push while you pull. Most you can do is ask her to cough but only while you’re holding it, not pulling.
What are the two schools of thought about when to administer the oxytocic?
1. WAIT Wait until the cord stops pulsating. Clamp and cut the cord Give the OCYTOCIC Wait for signs of separation Deliver the placenta by CCT
2. OXYTOCIC FIRST Give the OXYTOCIC Wait until the cord stops pulsating Clamp and cut the cord Wait for signs of separation Deliver the placenta by CCT
How are cord blood gases taken?
- Use heparinised tubes (so blood doesn’t clot)
- Put the cord on a flat surface
- Take arterial blood first
- Remove needle and cap the syringe
- Take venous blood next and cap syringe
- If not analysed immediately put on ice.
