Class 1 Flashcards
What are two other names for postpartum?
Puerperium or Postnatal Period
What is the medical definition of postpartum?
After birth until 6 weeks, when the organs become non pregnant. A well known midwife considers the postpartum period to last as long as your baby is in diapers and you are up in the night.
What is one of the most detrimental aspects of postpartum?
Isolation. Education and relationship are important factors of the postpartum time.
When does the 3rd stage of delivery start?
Upon the completion of the birth of the baby and ends with the birth of the placenta
What is the time from for the 3rd stage of labor?
As early as 3 minutes and up to an hour later. The earlier the placenta comes, the more toned the uterus.
What are the 2 sub stages of the third stage?
Placental Separation and Placental Expulsion
What brings on the third stage?
contractions
What is the anatomy and physiology of the 3rd stage?
Pushing contractions that last 2-3 minutes. The next may occur 3-5 minutes later. Contractions continue every 4-5 minutes until the placenta detaches and is expelled.
What are the competing hormones of the 3rd stage?
Oxytocin Increase (breastfeeding and nearness of the baby increase this); and Adrenalin decrease (keep the mother warm)
What are the normal signs of placental separation?
Gush of blood, cord lengthens, change in shape of uterus, change in position of uterus
What is the Shultz mechanism?
The fetal side of the placenta and the bag surrounding it. Most of the time the placenta comes out with this side presenting.
What is the Duncan Mechanism
This is more messy, the mother’s side comes out first. There is often the presentation of more blood.
What is one of the biggest issues for postpartum women in the hospital?
cord clamping. Most hospitals try to do this as soon as possible.
How long have most studies shown that it is good to allow the cord to pulse?
1-3 minutes
What are reasons for cutting the cord before the placenta is delivered?
Cord wrapped around the baby; 3rd stage hemorrhage; monozygotic twin birth that keeps the second baby from descending; extensive NRP methods
What is the HYpovolemia, Hypervolemia controversy?
The idea that the baby will get too little blood from cutting the cord too soon, or too much blood if it is left too long.
What are methods to aids in delivering the placenta?
Tincture of Angelica; squal position and toilet delivery; empty bladder; sterile glove and follow up vaginal wall; active management
What is the placental deliver and inspection?
Check for pieces of the placenta missing; check for 2 arteries and one cord; as the placenta comes out, the caregiver twirls it so the membranes come out.
What needs to happen after the placenta is delivered?
Immediate Uterine Massage, Examine the Placenta
Battle Door
placenta side insertion; if you are pulling on this cord it is more likely to snap
Velamentous Cord Insertion
Trunkal arteries, that should be protected by the Wharton’s Jelly int he cord, are exposed.
Placenta with a Succenturiate Lobe
an extra love that grows to the side; can sometimes have no veins, just attached to the wall, and can come out with the chorion.
Parenchyma
meaty part of the maternal side
Cotelydons
any subdivision of the maternal side of the placenta
What are placental customs in the US?
Throw it away; planting it; placental encapsulation; placental art
What does the newborn need in the third stage?
Kept next to mom (non-separation) dried and warm (Best way through mother’s body temp); put to the breast.
What are the three types of invasive placenta?
Placenta Accreta, Placenta Increta, Placenta Percreta
Placenta Accreta
The placenta grows into the uterine wall
Placenta Increta
The placenta grows into the uterine muscle
Placenta Percreta
The placenta grows entirely through the uterine wall
Uterine Inversion
Occurs when the entire uterus turns inside out and protrudes through the cervical os (incomplete), into the vagina (complete), or beyond the vulva (prolapsed).
What is the result of Uterine inversion?
Usually life threatening hemorrhage and shock. More common in multigravidae or cord traction done without fundal pressure.
Retained placenta
Placenta that has not separated and shows no visible sign of hemorrhage. The woman can start bleeding heavily a few days later.
Third stage hemorrhage
Most common cause is due to the mismanagement of the third stage. It is due to partial separation of the placenta.
