1 / 49

Third stage of labor: events & management

Third stage of labor: events & management. Prophylaxis of PPH. Labor. Physiological process The products of conception passed form uterus to outside world

iago
Download Presentation

Third stage of labor: events & management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Third stage of labor: events & management Prophylaxis of PPH

  2. Labor • Physiological process • The products of conception passed form uterus to outside world • Normal labour: spontaneous in onset, at term, vertex presentation, natural termination without any complications affecting health of mother &/or newborn • Three stages of labor

  3. Stages of labour • First stage : onset of true labour pains to full dilatation of cervix • Second stage: full dilatation of cervix to expulsion of fetus from birth canal • Third stage: after expulsion of fetus to expulsion of placenta & membranes (afterbirths)

  4. Third stage: events • After expulsion of fetus to expulsion of placenta & membranes (afterbirths) • Duration :15 min.(primigravida multigravida) • AMTSL:5 minutes • Placental separation • Placental expulsion

  5. Placental separation • Sudden diminution in uterine size following delivery of fetus • Limited placental elasticity • Creates disproportion between two • Placenta buckles : placental separation • Spongy layer of decidua basalis • 2 ways : central, marginal separation

  6. Methods of placental separation Central ( Schultze) separation Marginal (Mathews Duncan) separation

  7. Expulsion of placenta • Contraction & retraction of Upper Uterine Segment • Placenta forced to lie in LUS/upper vagina • Voluntary contraction of abdominal muscles • Expulsion of placenta

  8. Mechanisms to control bleeding Effective retraction of uterine muscles : Living ligatures Thrombosis of torn sinuses Myotamponade: apposition of walls of the uterus

  9. Management of third stage • Most crucial stage • Strict vigilance • Follow protocols • Expectant management • Active management

  10. Expectant management • Look for 3 classic signs of placental separation • Lengthening of U. cord • A gush of blood from vagina signifying separation of placenta from uterine wall • Change in shape of uterine fundus from discoid to globular with elevation of fundal height • Spontaneous/Controlled cord traction (CCT) • Expulsion of placenta :20 minutes

  11. CCT • Modified Brandt Andrews method • Left hand: palmar surface of fingers placed above pubic symphysis. Body of uterus pushed upwards & backwards • Right hand: cord traction in downward & backward direction • Uterus feels hard, contracted

  12. Expectant management • Massage the uterus • Intramuscular Oxytocin : 10 IU • Examination of placenta ,membranes, cord • Inspect vulva, vagina & perineum

  13. Examination of placenta ,membranes

  14. Examination of membranes, cord

  15. Active management • AMTSL: Active Management of Third Stage of Labour • Prophylactic uterotonic after delivery of baby ( Oxytocin 10 IU ,IM) • cord clamping, cutting & Controlled cord traction of U cord • Uterine massage • Excites powerful uterine contractions ,aid in early placental separation, minimises blood loss & duration of third stage (5 min.)

  16. Third stage • Most crucial • Life threatening complications • PPH(postpartum haemorrhage) • Retained placenta • Inversion of uterus • Pulmonary embolism

  17. Prophylaxis of PPH

  18. PPH: hard facts • Globally in 10-11% women having live births • Duration between onset of massive bleeding & death: 2 hours • 14 million women worldwide • 1.4 million women die annually • India : 15-25% of maternal deaths due to PPH

  19. PPH • Primary PPH • Haemorrhage <24 hrs of birth • Secondary PPH • Haemorrhage >24 hrs till 6 weeks of birth • Primary PPH: 4T’s • Tone • Trauma • Tissue • Thrombosis

  20. Primary PPH:causes

  21. PPH : risk factors

  22. Prophylaxis of PPH • Improvement of health status of mother(Hb>11gm%) • Identify high risk women • Plan for institutional delivery /SBA • Strict vigilance of all women in 3rd stage labor • Practice AMTSL in all • Examination of afterbirths ,should be a routine • Explore Uterovaginal canal following difficult/ instrumental, destructive delivery

  23. WHO guidelines for Prophylaxis of PPH

  24. WHO guidelines

  25. WHO guidelines

  26. WHO guidelines

  27. WHO guidelines • Give uterotonics routinely during 3rd stage labor, in all births • Oxytocin 10 IU IM is drug of choice • Use other uterotonics only when Oxytocin is not available • Late cord clamping( 1-3 min after birth) is recommended • Early cord clamping (<1min of birth): not recommended until the neonate is asphyxiated & needs immediate resuscitation

  28. MCQ1 • Labor is said to be normal if all are present except: • At term • Breech presentation • Spontaneous in onset • Healthy mother & neonate after delivery

  29. MCQ1 • Labor is said to be normal if all are present except: • At term • Breech presentation • Spontaneous in onset • Healthy mother & neonate after delivery

  30. MCQ2 • Regarding the third stage of labor, following is not true: • Most crucial stage of labor • Duration is 15 minutes • Uterine inversion is most common complication • AMTSL is routine in all

  31. MCQ2 • Regarding the third stage of labor, following is not true: • Most crucial stage of labor • Duration is 15 minutes • Uterine inversion is most common complication • AMTSL is routine in all

  32. MCQ3 • The uterotonic of choice for prophylaxis of PPH in third stage of labor is • Syntometrine • Oxytocin • Misoprostol • carboprost

  33. MCQ3 • The uterotonic of choice for prophylaxis of PPH in third stage of labor is • Syntometrine • Oxytocin • Misoprostol • carboprost

  34. MCQ4 • All are true in relation to AMTSL except: • 10 IU of Oxytocin , IM • Uterine massage • Reduces the duration of third stage • Perform in only high risk cases

  35. MCQ4 • All are true in relation to AMTSL except: • 10 IU of Oxytocin , IM • Uterine massage • Reduces the duration of third stage • Perform in only high risk cases

  36. MCQ5 • Complications during third stage of labor are all except • PPH • Chronic Uterine inversion • Retained placenta • Amniotic fluid embolism

  37. MCQ5 • Complications during third stage of labor are all except • PPH • Chronic Uterine inversion • Retained placenta • Amniotic fluid embolism

  38. MCQ6 • The most frequently observed method of placental separation : • Marginal separation • Central separation • None • both

  39. MCQ6 • The most frequently observed method of placental separation : • Marginal separation • Central separation • None • both

  40. MCQ7 • The most important method to control uterine bleeding following delivery • Myotamponade • Thrombosis • Contraction& retraction of uterine muscle • none

  41. MCQ7 • The most important method to control uterine bleeding following delivery • Myotamponade • Thrombosis • Contraction& retraction of uterine muscle • none

  42. MCQ8 • Following are true regarding misoprostol, except • Low cost • Easy storage • Administered rectally • Drug of choice for AMTSL

  43. MCQ8 • Following are true regarding misoprostol, except • Low cost • Easy storage • Administered rectally • Drug of choice for AMTSL

  44. MCQ9 • Following is true regarding Oxytocin • Given as IV bolus dose • Thermolabile • Contraindicated in cardiac patient • Causes hypertension

  45. MCQ9 • Following is true regarding Oxytocin • Given as IV bolus dose • Thermolabile • Contraindicated in cardiac patient • Causes hypertension

  46. MCQ10 • Prevention of PPH, all are true except • Treatment of anemia in antenatal period • Practice AMTSL in all • Home delivery in high risk cases • In forceps delivery, explore uterovaginal canal

  47. MCQ10 • Prevention of PPH, all are true except • Treatment of anaemia in antenatal period • Practice AMTSL in all • Home delivery in high risk cases • In forceps delivery, explore uterovaginal canal

More Related