Third and Fourth Stages of Labor Flashcards
definition of 3rd stage? average time?
3rd stage= from expulsion of baby to expulsion of placenta
normal is 5-15 but can be up to 1 hr
mechanism of placental delivery?
- uterine size decreases= placental attachment size decreases
- placenta is squeezed and then blood is forced into the spongy layer of decidua, buckles
- oblique fibers tighten around maternal vessels
- w/contraction vessels burst= thin layer of blood seeps btw decidua and placenta
- placenta begins to separate
- separation usu begins centrally so retroplacental clot forms, increased wt helps strip adherent lateral borders; can also shear asym at lateral border
- placenta falls into lower uterine segment
- expulsion
simple 3 step way the placenta is delivered?
- blood forced into spongy layer
- central separation
- retroplacental clot forms
2 types of separation and presentation?
schultz: baby’s side, smooth; usu occurs w/placenta that is attached higher in fundus; assoc w/more complete shearing and less blood loss
(matthews) duncan: mom’s side; side-separation, more common for lower lying placentas; assoc w/more bleeding
6 sxs of separation?
- separation gush
- lengthening of cord
- change in uterine shape (more globular)
- follow cord up and feel placenta
- see placenta
- modified brand-andrews maneuver: take slack out of cord, press in caudally on uterus, if cord remains the same length then have seapration
when can you wait for placenta w/o intervening?
uterus is firm
no bleeding (frank or occult- fundus will be rising)
vitals are stable
mom not dizzy, she is lucid
8 ways to assist with expulsion of the placenta?
- push w/contraction
- squatting, birth stool
- nursing, nipple stim, breast pump
- appropriate botanical or homeopathics
- cord traction (guard the uterus so as to not pull it out)
- pitocin (1 cc IM)
- manual extraction
how much blood circulates through the placenta per minute?
~400 cc
what is considered normal blood loss?
less than 500 cc (1 c= 240 cc)
4 ways to manage/treat bleeding?
- rub uterus
- monitor vitals (pulse will drop first then BP rises)
- nursing, nipple stim, breast pump
- consider pitocin
what to look for when examining placenta?
completeness meconium staining? infarctions? calcifications? cord size smell color wt
what can palor of the placenta be assoc w/?
TORCH infxns
ratio of vessels a cord should have?
2 umbilical arteries + 1 umbilical vein
different cord insertions?
battledore (on the perimeter of the placenta)
velamentous (cord not wrapped all together in warfarin’s jelly)
5 placental abnormalities?
- bipartite placenta vs. placenta duplex (can indicate there was a multiple gestation PG)
- placenta succenturiata (accessory lobes)
- placenta membranaceae (very LG placental, more assoc w/death, not safe for home birth)
- circumvallate placenta (more assoc w/fluid leak, chorio or TORCH infxns)
- placenta accreta (implanted in uterine muscle)