9.) Conduct of 3rd stage of labour , credo manoeuver , inspection of placenta , membranes , soft tissue of birth canal

Question 1

What is the 3rd stage of labour ?

Answer 1

This refers to the period from the birth of the baby until the delivery of the placenta.

Question 2

How long does the 3rd stage of labour last approximately ?

Answer 2

5-30 mins

Question 3

What are the signs of placental separation ?

Answer 3

• The uterus becomes globular and firm.
• A sudden gush of blood.
• The uterus rises in the abdomen as the placenta passes down into the lower uterine segment and vagina its bulk pushes the uterus upwards.
• The umbilical cord becomes lengthened.

Question 4

how long does it take to deliver the placenta ?

Answer 4

3-5 mins if the patient is given “Methergine” IM due to stronger uterine contractions , otherwise if not given it can take up to 30-50mins

(used to treat excessive bleeding)

Question 5

Contraindication for the usage of “Methergine” ?

Answer 5

it is contraindicated in woman who have hypertension as it can cause a sudden increase in BP.

Question 6

What is controlled cord traction ?

Answer 6

Pull the umbilical cord gently and push behind the symphysis , if the placenta is still attached you will have traction backwards of the cord (back inside)

Question 7

What is fundal pressure (Krede maneuver)

Answer 7

This involves placing one hand on top of the uterine fundus and squeezing it between the thumb and other fingers whilst gently pulling the umbilical cord to help placental separation and delivery.

Question 8

What is the normal size and weight of the placenta ?

Answer 8

22cm in diameter 2cm thick , 0.7kg , placenta membrane very thin and large surface

Question 9

Name a few placental attachment abnormalities ?

Answer 9

Placenta previa :

Low lying ( Vaginal delivery possible)

Marginal : Edge of placenta reaches the cervical os

Complete and partial these usually require a C- Section

Question 10

What is placenta accreta and the types?

Answer 10

Placenta attaches to deeply to the uterine wall.

• Increta , invades the uterine muscle.

-Percreta , Penetrates through the uterine wall and may involve other organs.

Question 11

Name a structural anomaly of the placenta ?

Answer 11

Placenta fenestrata , placenta has a hole or missing tissue.

Question 12

if the placenta is not delivered completely then what is the risk for the woman?

Answer 12

Postpartum haemorrhage.

Question 13

Name the umbilical cord insertion anomaly ?

Answer 13

Insert velamentrosa , umbilical cord attaches to the membranes , with vessels exposed and prone to rupture.

Question 14

If no methods are working to deliver the placenta then what do we do ?

Answer 14

Introduce your hand with a sterile glove while the external hand is on the fundus , if still not working then use curettage to scrape it off if still not working then uterine suction and lastly D and C dilation and curettage ( surgery)