OBSTETRICS & GYNAECOLOGICAL NURSING physiology and management of third stage of labour-introduction labour stages of labor physiology management of third stage of labour.

2.  Physiological process
 Normal labour: spontaneous in onset, at term,
vertex presentation, natural termination without
any complications affecting health of mother &/or
newborn
 Three stages of labour

3.  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. PRANATI PATRA

5.  After expulsion of fetus to expulsion of placenta &
membranes (afterbirths)
 Duration :15 min.
 Placental separation
 Placental expulsion

6.  Separation of placenta is brought about by contraction
and retraction.
 Reduces the size of placental area.
 Placenta begins to tear off the uterine wall.
 At the area of separation a clot forms.

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

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

14.  Constant watch.
 A hand is placed over the fundus
 Look for 3 classic signs of placental separation

17. 3. Change in shape of uterine fundus from discoid to
globular with elevation of fundal height

19.  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

27.  Massage the uterus
 Examination of placenta ,membranes, cord
 Inspect vulva, vagina & perineum

40.  Most crucial
 Life threatening complications
 PPH(postpartum haemorrhage)
 Retained placenta
 Inversion of uterus
 Pulmonary embolism

41.  Care for at least an hour after delivery.
 The mother should receive cleansing body
wash,mouth wash and perineal care. She
should be encouraged to empty bladder and
bedpan offered.
 Blood pressure , pulse,uterine contaction
,and bleeding should be checked every
15mts.

42.  The baby’s general wellbeing and security
of the cord clamp needs to be checked. as
the baby will chill after birth thoroughly dry
and wrap the baby.
 Mothers intended to breastfeed may be
encouraged. Early breastfeeding causes a
reflex release of oxytocin from the posterior
pituitary and stimulates the uterus to
contract.

44.  Labor is said to be normal if all are present except:
1. At term
2. Breech presentation
3. Spontaneous in onset
4. Healthy mother & neonate after delivery

45.  Labor is said to be normal if all are present except:
1. At term
2. Breech presentation
3. Spontaneous in onset
4. Healthy mother & neonate after delivery

46.  Regarding the third stage of labor, following is not
true:
1. Most crucial stage of labor
2. Duration is 15 minutes
3. Uterine inversion is most common complication
4. AMTSL is routine in all

47.  Regarding the third stage of labor, following is not
true:
1. Most crucial stage of labor
2. Duration is 15 minutes
3. Uterine inversion is most common complication
4. AMTSL is routine in all

48.  The uterotonic of choice for prophylaxis of PPH in
third stage of labor is
1. Syntometrine
2. Oxytocin
3. Misoprostol
4. carboprost

49.  The uterotonic of choice for prophylaxis of PPH in
third stage of labor is
1. Syntometrine
2. Oxytocin
3. Misoprostol
4. carboprost

50.  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

51.  All are true in relation to AMTSL except:
1. 10 IU of Oxytocin , IM
2. Uterine massage
3. Reduces the duration of third stage
4. Perform in only high risk cases

52.  Complications during third stage of labor are all except
1. PPH
2. Chronic Uterine inversion
3. Retained placenta
4. Amniotic fluid embolism

53.  Complications during third stage of labor are all except
1. PPH
2. Chronic Uterine inversion
3. Retained placenta
4. Amniotic fluid embolism

54.  The most frequently observed method of placental
separation :
1. Marginal separation
2. Central separation
3. None
4. both

55.  The most frequently observed method of placental
separation :
1. Marginal separation
2. Central separation
3. None
4. both

56.  The most important method to control uterine
bleeding following delivery
1. Myotamponade
2. Thrombosis
3. Contraction& retraction of uterine muscle
4. none

57.  The most important method to control uterine
bleeding following delivery
1. Myotamponade
2. Thrombosis
3. Contraction& retraction of uterine muscle
4. none

58.  Following are true regarding misoprostol, except
1. Low cost
2. Easy storage
3. Administered rectally
4. Drug of choice for AMTSL

59.  Following are true regarding misoprostol, except
1. Low cost
2. Easy storage
3. Administered rectally
4. Drug of choice for AMTSL

60.  Following is true regarding Oxytocin
1. Given as IV bolus dose
2. Thermolabile
3. Contraindicated in cardiac patient
4. Causes hypertension

61.  Following is true regarding Oxytocin
1. Given as IV bolus dose
2. Thermolabile
3. Contraindicated in cardiac patient
4. Causes hypertension

62.  Prevention of PPH, all are true except
1. Treatment of anemia in antenatal period
2. Practice AMTSL in all
3. Home delivery in high risk cases
4. In forceps delivery, explore uterovaginal canal

63.  Prevention of PPH, all are true except
1. Treatment of anaemia in antenatal period
2. Practice AMTSL in all
3. Home delivery in high risk cases
4. In forceps delivery, explore uterovaginal canal

65. The third stage of labour commences with the completed
delivery of the fetus and ends with the completed delivery
of the placenta and its attached membranes. The third
stage of labour begins once your baby is born, and ends
when you deliver the placenta and the empty bag of waters
attached to the placenta (membranes). It's normal for
there to be some bleeding during this stage of labour.

66.  Shirish S Sheth,“Essential of Obstetrics”, 1stEditio
n, Chapter13, Antenatal Care,Jaypee Brothers Medi
cal Publishers, New Delhi,2004, page no.: 102 - 107.
 Maya Devi Subedi,“Manual of Midwifery A”, 1stEd
ition, Chapter 11, AntenatalAdvice, Books and Stat
ioners, 2005, page no.: 157 - 165.
 •Kamala Shova Napit,“Manual of Midwifery B”, 1st
Edition, Chapter 4,Management of First Stage of L
abour,published by Makalu Books and Stationers,2
005, page no.: 41 to 64.

67.  Miles C Benamin ‘text book of obstetric and
gynaecology ’ 2nd edition page no ; 249-254
 Dutta Dc ‘text book of obstetric & gynaecology ‘ 3rd
edition page no – 139-143

68. WRITE DOWN HOW TO
MANAGE THE THIRD
STAGE OF LABOUR ?