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Intrapartum Care > The Third Stage of Labour > Flashcards

The Third Stage of Labour Flashcards

1
Q

NICE defines the 3rd stage of labour as the time from ? to ?

A

from the birth of baby to expulsion of placenta and membranes

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2
Q

by the beginning of the 3rd stage, the placental site has reduced in size by ?

A

75%

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3
Q

what are the 3 phases in the separation and expulsion of the placenta?

A

latent: uterus is contracting and retracting but placenta hasn’t yet sheared off
detachment: contraction and retraction continues, uterine wall thickens
expulsion: placenta fully away from uterine site, uterine wall much thicker, retroplacenta clot

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4
Q

the retroplacental clot:

A

aids in separation

formed by blood seeping between the septa of the spongy layer of the uterus and the placental surface

(blood comes from vessels becoming congesting and bursting after compression of placenta)

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5
Q

retraction of oblique muscle fibres form ?

A

living ligatures

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6
Q

living ligatures constrict blood vessels so…

A

blood does not drain back into the maternal system

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7
Q

what are the 2 methods that a placenta separates from the maternal wall?

A

schultze method

matthew duncan method

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8
Q

the schultze method of placental seperation:

A

separatation starts in the centre of the placenta and this descends first

retroplacental clot forms

fetal surface appears first at vulva and membranes trail behind

associated with less blood loss (quicker separation)

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9
Q

how common is the schultze method of placental separation?

A

occurs in 80% of cases

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10
Q

matthew duncan method of placental separation:

A

separation begins at lower edge of placenta

placenta slips down sidewards and materal surface appears first at vulva

associated with longer duration, increased blood loss and ragged membranes

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11
Q

how common is the matthew duncan method of placental separation?

A

occurs in 20% of cases

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12
Q

what is the average blood flow through the placental site?

A

500-800ml per minute

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13
Q

what are the 4 vital mechanisms that control bleeding after placental expulsion?

A

empty uterus fully contracts and walls close in (apposition)

myometrium continues to contract and forms ‘living ligatures’

blood clotting begins at site of placental attachment and becomes covered with fibrin mesh

skin to skin will increase oxytocin levels (further contraction of uterus)

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14
Q

what percent of the fibrin mesh that covers the placenta is fibrinogen?

A

10%

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15
Q

what are the 2 main approaches to the third stage of labour?

A

physiological

active management

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16
Q

the physiological third stage of labour involves a package of care including…

A

no routine use of uterotonic drugs

no clamping of cord until pulsation has stopped

delivery of placenta by maternal effort

17
Q

the active management of the third stage of labour involves a package of care including…

A

routine use of uterotonic drugs

optimal clamping and cutting of cord

controlled cord traction after signs of separation

18
Q

when a woman is wanting a physiological first stage of labour it is important to…

A

keep her in a upright position (e.g. over bag in toilet)

encourage woman to empty bladder

put baby to breast (oxytocin producing environment)

19
Q

when a woman is wanting a physiological first stage of labour it is important NOT to…

A

administer an oxytocic (unless heavy bleeding)

palpate uterus (‘fundus fiddling’ - causes spasms)

touch cord or apply cord traction

clamp cord

20
Q

the first stage in the active management of the 3rd stage of labour:

A

give a prophylactic uterotonic after birth or birth of anterior shoulder

21
Q

what are the 2 most common prophylactic uterotonic drugs given?

A

syntocinon - oxytocin (given IM)

syntometrine - oxytocin and ergometrine (given IM), can cause vomiting and hypertension but lasts a lot longer

22
Q

the second stage in the active management of the 3rd stage of labour:

A

optimal cord clamping:

cord should not be clamped or cut until more than a minute has passed from birth

expands neonatal blood volume by 20-50% (decreases anaemia)

reduces the chances of a sudden drop in neonatal blood pressure

23
Q

the third stage in the active management of the 3rd stage of labour:

A

CCT/controlled cord traction:

woman should be in sitting/semi-recumbent position and signs of separation are observed (fresh blood loss)

dominant hand to apply downward traction until placenta visible

non-dominant hand pushing uterus upwards ‘guarding’

once visible, upward traction to follow curve of carus

24
Q

lotus birth:

A

birthing both baby and placenta and keeping them attached until cord falls off on its own

this can take 3 to 10 days

25
Q

a prolonged third stage of labour would be diagnosed if…

A

not completed within 30 minutes with active management

not completed with 60 minutes with physiological management

(NICE guidelines)

26
Q

it is estimated separation of the placenta occurs within…

A

3 minutes

27
Q

midwives examine placenta to check it is complete:

A

circle type shape

iron/blood odour

bright red and patches of dark red in colour, shouldn’t be signs of calcification

maternal side: retroplacental clot, shouldn’t be cotyledons missing

fetal side: 2 membranes and 3 vessels in cord (AVA), centrally inserted cord

28
Q

average length of umbilical cord:

A

50-60cms

29
Q

succenturiate lobe:

A

abnormality in placenta

occurs in 1.7% of pregnancies

two sites attached to uterus (increases chance of not coming away, increased blood loss and chances of infection)

more common as maternal age increases and IVF pregnancies

30
Q

bipartite placenta:

A

abnormality

placenta separated in two but joined by vessels in between

very rare

high risk of increased blood loss

31
Q

velamentous umbilical cord insertion:

A

abnormality

cord inserted in edge of the placenta

fetal blood vessels unprotected and exposed

risk of fetal blood loss due to chances of damage to vessels

can be picked up on scan

Intrapartum Care (15 decks)

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