week 9 third stage labour Flashcards
what is the definition of third stage labour?
interval from birth of baby until complete expulsion of placenta and membrane
how long does third stage labour last?
any where from 5 mins to an hour
<30 mins ideal
>30 mins considered prolonged
what is the physiology of third stage labour?
as baby is born
uterus size decreases and placental site reduce causing separation of the placenta- placenta strips membranes of the wall of the uterus
placenta and membranes fall into the vagina ready for expulsion
how does the body prevent bleeding/PPH after birth/thrid stage labour?
contraction of obelquw muscle fibres surrounding blood vessles- sealing of maternal - vessels
further contraction causes opposing uterine wall to thicken - exerts pressure on placental site
activation of coagulation and fibrinolytic system - transitory intensification of clot formation
what are the signs of imminate third stage labour?
once senate is delivered - lengthening of umbilical chord gush or trickle of blood contractions/slight need to push rising fundus ballotable - firm ball type feel on palpation of the uterus
what is phsyiological delivery of the placenta?
hand off
delivered by mums effort
uterus should not be stimulated by fundal fiddling
- may stimulate partial separation of placenta- can be difficult in pre-hospital context to check for bleeding
what is active delivery of the placenta?
not commonly practiced pre-hopsital
thought to reduce frisk of PPH
once commenced active manamgent cannot be changed to physiological managment
use of uterotonic drugs
elevating funds with hand and simultaneously providing traction
controlled traction with mums contractions
what are the side effects of active delivery of the placenta?
maternal nausea, vommiting, raised BP
hypotension
what are some of the consequences of early clamping?
Early- prevents transfer of blood to baby
placenta does not reduce so much in size
delayed seperation
active managment of third stage
what is the manamgnet of third stage labour?
clamp chord after pulsation ceases placenta expelled via mums effort utilise gravity imitation of breast feeding - oxytocin support placenta as it delivers ensure uterus is well contracted monitor for PV bleeding
what do you do after the delivery of the placenta?
massage the funds of the uterus through the womens abdomen
palpate for a contacted uterus every 15/60 minutes - for up to 2 hours
ensure the uterus does not relax after uterine massage
what to do after birth and before transport?
asses uterus when contracted but avoid fundal fiddling
mental inspection of genital tract
apply pressure to any tears
encourage passing urine before transport
encourage breast feeding
transport all blood stained material
- inspect placenta and membranes to ensure intact
what is placenta accreta?
placenta accreta - 75% of abnormal implantation into muscle
placenta attached onto myometrium but does not penetrate to muscle itself
what is placenta increta?
17% of abnormal implantation
extends into the muscle itself
what is placenta percreta?
5%
penetrates the entire muscle wall and other organs
