Normal labour, third stage by Dr Yin Moe

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Normal labour, third stage by Dr Yin Moe

  1. 1. THIRD STAGEDEFINITION• From expulsion of the foetus to delivery of the placenta, cord and membranesDURATION• Primigravida – 15 minutes• Multigravida – 5 minutes• Generally – not > 30 minutes07/31/12 Dr. Yin Moe Han 1
  2. 2. PLACENTA SEPARATIONTwo Methods1. Schultz method - placenta separate from centre2. Matthew Duncan - placenta separate from the peripheral07/31/12 Dr. Yin Moe Han 2
  3. 3. Schultz methodBeginning of 3drstage Placenta in lower segment End of 3rd stage07/31/12 Dr. Yin Moe Han 3
  4. 4. Matthew Duncan Upper segment Trickling of blood Placenta separate from Upper segment contractedBeginning of 3rd stage the peripheral Placenta separated07/31/12 Dr. Yin Moe Han 4
  5. 5. MECHANISM OF PLACENTA SEPARATION • Once the child is delivered, – the uterine muscle contracts – placenta sheared from the uterine wall – pushing it into the lower uterine segment or upper part of the vagina 07/31/12 Dr. Yin Moe Han 5
  6. 6. SIGNS OF PLACENTA SEPARATION1. Lengthening of the cord2. Trickling (gush) of blood3. Uterus - becomes hard - mobile from side to side - height rises to the level of umbilicus07/31/12 Dr. Yin Moe Han 6
  7. 7. LENGTHENING OF THE CORD07/31/12 Dr. Yin Moe Han 7
  8. 8. TRICKLING OF BLOOD Trickling of blood07/31/12 Dr. Yin Moe Han 8
  9. 9. RISING OF THE FUNDAL HEIGHT umbilicus Beginning of 3rd stage placenta at lower segment end of 3rd stage07/31/12 Dr. Yin Moe Han 9
  10. 10. MANAGEMENT• Delivery of the placenta is done by “CONTROLLED CORD TRACTION” method07/31/12 Dr. Yin Moe Han 10
  11. 11. CONTROLLED CORD TRACTION• Signs of placenta separation must be present before doing CCT (to prevent uterine inversion)• Position – supine position• Left hand – rested on the abdomen on the uterine fundus• Right hand – cord traction is applied 07/31/12 Dr. Yin Moe Han 11
  12. 12. 07/31/12 Dr. Yin Moe Han 12
  13. 13. LENGTHENING OF THE CORD07/31/12 Dr. Yin Moe Han 13
  14. 14. CONTROLLED CORD TRACTION07/31/12 Dr. Yin Moe Han 14
  15. 15. MANAGEMENT• Check placenta to see if any cotyledons are missing• Check membranes to see whether they are complete or incomplete• Check tears of the genital tract07/31/12 Dr. Yin Moe Han 15
  16. 16. CHECKING PLACENTA COTYLEDONS 07/31/12 Dr. Yin Moe Han 16
  17. 17. MISSING PLACENTA COTYLEDONSMissing cotyledons 07/31/12 Dr. Yin Moe Han 17
  18. 18. CHECKING FOETAL SURFACE OF THE PLACENTA07/31/12 Dr. Yin Moe Han 18
  19. 19. CHECKING THE MEMBRANES07/31/12 Dr. Yin Moe Han 19
  20. 20. BATTLEDORE PLACENTA07/31/12 Dr. Yin Moe Han 20
  21. 21. 07/31/12 Dr. Yin Moe Han 21

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