Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
The increased cardiac output related to pregnancy can lead to heart failure, and the increased heart rate in the third trimester can lead to ischemic events. The potential obstetrical complications include preeclampsia or other hypertensive related disorders, premature birth, and small-for-gestational-age births.
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
The increased cardiac output related to pregnancy can lead to heart failure, and the increased heart rate in the third trimester can lead to ischemic events. The potential obstetrical complications include preeclampsia or other hypertensive related disorders, premature birth, and small-for-gestational-age births.
Asphyxia neonatorum, also called birth or newborn asphyxia, is defined as a failure to start regular respiration within a minute of birth. Asphyxia neonatorum is a neonatal emergency as it may lead to hypoxia (lowering of oxygen supply to the brain and tissues) and possible brain damage or death if not correctly managed. Newborn infants normally start to breathe without assistance and usually cry after delivery. By one minute after birth most infants are breathing well. If an infant fails to establish sustained respiration after birth, the infant is diagnosed with asphyxia neonatorum.
According to the World Health Organization, asphyxia neonatorum is one of the leading causes of newborn deaths in developing countries, in which 4 to 9 million cases of newborn asphyxia occur each year, accounting for about 20 percent of the infant mortality rate.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Asphyxia neonatorum, also called birth or newborn asphyxia, is defined as a failure to start regular respiration within a minute of birth. Asphyxia neonatorum is a neonatal emergency as it may lead to hypoxia (lowering of oxygen supply to the brain and tissues) and possible brain damage or death if not correctly managed. Newborn infants normally start to breathe without assistance and usually cry after delivery. By one minute after birth most infants are breathing well. If an infant fails to establish sustained respiration after birth, the infant is diagnosed with asphyxia neonatorum.
According to the World Health Organization, asphyxia neonatorum is one of the leading causes of newborn deaths in developing countries, in which 4 to 9 million cases of newborn asphyxia occur each year, accounting for about 20 percent of the infant mortality rate.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This presentation contains details on normal anatomy on female pelvis and fetal head, process of normal labour, abnormal labour, induction of labour and malpresentations.
physiology and management of third stage of labourPRANATI PATRA
OBSTETRICS & GYNAECOLOGICAL NURSING
physiology and management of third stage of labour-introduction
labour
stages of labor
physiology
management of third stage of labour.
about the process of third stage of labor and management of post Partum Hemorrhage ,which is one of the major causes of blood loss in a pregnant women that needs active management.
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Uterine contractions continue, although less frequently than in the second stage.
The uterus contracts and becomes smaller and, as a result, the placenta separates.
The placenta is squeezed out of the upper uterine segment into the lower uterine segment and vagina. The placenta is then delivered.
The contraction of the uterine muscle compresses the uterine blood vessels and this prevents bleeding. Thereafter, clotting (coagulation) takes place in the uterine blood vessels due to the normal clotting mechanism.
Stages of normal labor- easy explanation for Nursing Students(B.Sc & GNM)...
Introduction, definition of normal labor, definition of normal labor by WHO, Mechanism of labor, stages of labor, Intrapartum management of Labor, pain control.
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.
8. 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
9. Mechanisms to control bleeding
1. Effective retraction of
uterine muscles :
Living ligatures
2. Thrombosis of torn
sinuses
3. Myotamponade:
apposition of walls of
the uterus
10. Management of third stage
• Most crucial stage
• Strict vigilance
• Follow protocols
• Expectant management
• Active management
11. 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
12. 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
13. Expectant management
• Massage the uterus
• Intramuscular Oxytocin : 10 IU
• Examination of placenta ,membranes, cord
• Inspect vulva, vagina & perineum
16. 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.)
17. Third stage
• Most crucial
• Life threatening complications
• PPH(postpartum haemorrhage)
• Retained placenta
• Inversion of uterus
• Pulmonary embolism
19. 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
24. 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
29. 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
30. MCQ1
• 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
31. MCQ1
• 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
32. MCQ2
• 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
33. MCQ2
• 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
34. MCQ3
• The uterotonic of choice for prophylaxis of
PPH in third stage of labor is
1.Syntometrine
2.Oxytocin
3.Misoprostol
4.carboprost
35. MCQ3
• The uterotonic of choice for prophylaxis of
PPH in third stage of labor is
1.Syntometrine
2.Oxytocin
3.Misoprostol
4.carboprost
36. 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
37. MCQ4
• 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
38. MCQ5
• Complications during third stage of labor are
all except
1.PPH
2.Chronic Uterine inversion
3.Retained placenta
4.Amniotic fluid embolism
39. MCQ5
• Complications during third stage of labor are
all except
1.PPH
2.Chronic Uterine inversion
3.Retained placenta
4.Amniotic fluid embolism
40. MCQ6
• The most frequently observed method of
placental separation :
1.Marginal separation
2.Central separation
3.None
4.both
41. MCQ6
• The most frequently observed method of
placental separation :
1.Marginal separation
2.Central separation
3.None
4.both
42. MCQ7
• The most important method to control
uterine bleeding following delivery
1.Myotamponade
2.Thrombosis
3.Contraction& retraction of uterine muscle
4.none
43. MCQ7
• The most important method to control
uterine bleeding following delivery
1.Myotamponade
2.Thrombosis
3.Contraction& retraction of uterine muscle
4.none
44. MCQ8
• Following are true regarding misoprostol,
except
1.Low cost
2.Easy storage
3.Administered rectally
4.Drug of choice for AMTSL
45. MCQ8
• Following are true regarding misoprostol,
except
1.Low cost
2.Easy storage
3.Administered rectally
4.Drug of choice for AMTSL
46. MCQ9
• Following is true regarding Oxytocin
1.Given as IV bolus dose
2.Thermolabile
3.Contraindicated in cardiac patient
4.Causes hypertension
47. MCQ9
• Following is true regarding Oxytocin
1.Given as IV bolus dose
2.Thermolabile
3.Contraindicated in cardiac patient
4.Causes hypertension
48. MCQ10
• 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
49. MCQ10
• 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
