Birth of placenta and membranes

Question 1

What is third stage of labour

Answer 1

the period that commences the birth of baby and ends with the complete expulsion of the placenta and membranes and the control of haemorrhage

Question 2

3 mechanisms to control bleeding

Answer 2

• effective retraction of uterine muscles
• thrombosis of torn sinuses
• apposition of walls of the uterus

Question 3

Type of separation - (Shiny) Schultze

Answer 3

• majority
• separaion starts at the centre of the placenta and this part descends first
• fetal surface (shiny side) appears at the vulva with the membranes trailing behind
• retroplacental clot obtained within the inverted sac: minimal blood loss

Question 4

Type of separation - (Dirty) Duncan

Answer 4

• separation starts at the lower edge
• placenta slips down sideways and maternal surface appears at the vulva
• accompanied b some bleeding because blood from the placental site escapes immediately
• slower separation because not aided by retroplacental clot: bleeding likely to be more profuse

Question 5

Signs of placental separation

Answer 5

• bleeding
• lengthening of umbilical cord
• uterus becomes more round, globular and firm

Question 6

Active Management

Answer 6

• use of uterotonic drugs
• deferred cord clamping
• controlled cord traction after signs of separation of the placenta

Question 7

Physiological management

Answer 7

• no use of uterotonic drugs
• no clamping of cord until pulsation has stopped
• delivery of placenta by maternal effort

Question 8

Controlled cord traction

Answer 8

• oxytocic must have been given and allowed time to act
• uterus must be contracted
• counter traction must be applied
• traction on cord before signs of separation may interfere with the normal process

Question 9

Early Cord Clamping

Answer 9

• within 1 minute of birth and before pulsation deceases
• may reduce volume of blood returning to fetus by 125ml
• nay increase likelihood of veto maternal transfusion
• umbilical vessels may contain quantity of clotted blood - ideal medium for bacterial growth

Question 10

Optimal Cord Clamping

Answer 10

-higher haemoglobin concentrations, a decreased risk of iron deficiency and greater vascularity stability in babies, ?increased jaundice