The document discusses the physiological changes that occur during the third stage of labor. It defines the third stage as beginning with the birth of the baby and ending with delivery of the placenta and membranes. It describes the two main methods of placental separation - the Schultze method where separation begins centrally, and the Matthew's Duncan method where separation occurs at the margins. The key events of the third stage include placental separation facilitated by uterine contractions, formation of a retroplacental clot, descent and expulsion of the placenta, and control of bleeding through uterine retraction.
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
NURSING MANAGEMENT OF THIRD AND FOURTH STAGE OF LABOUR.docx.pptxAyushi958023
In this ppt you will learn about Nursing management of third stage of labor(expected and active management) and Nursing management fourth stage 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.
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.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
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𝘼𝙣𝙩𝙞𝙦𝙪𝙚 𝙋𝙡𝙖𝙨𝙩𝙞𝙘 𝙏𝙧𝙖𝙙𝙚𝙧𝙨 𝙞𝙨 𝙫𝙚𝙧𝙮 𝙛𝙖𝙢𝙤𝙪𝙨 𝙛𝙤𝙧 𝙢𝙖𝙣𝙪𝙛𝙖𝙘𝙩𝙪𝙧𝙞𝙣𝙜 𝙩𝙝𝙚𝙞𝙧 𝙥𝙧𝙤𝙙𝙪𝙘𝙩𝙨. 𝙒𝙚 𝙝𝙖𝙫𝙚 𝙖𝙡𝙡 𝙩𝙝𝙚 𝙥𝙡𝙖𝙨𝙩𝙞𝙘 𝙜𝙧𝙖𝙣𝙪𝙡𝙚𝙨 𝙪𝙨𝙚𝙙 𝙞𝙣 𝙖𝙪𝙩𝙤𝙢𝙤𝙩𝙞𝙫𝙚 𝙖𝙣𝙙 𝙖𝙪𝙩𝙤 𝙥𝙖𝙧𝙩𝙨 𝙖𝙣𝙙 𝙖𝙡𝙡 𝙩𝙝𝙚 𝙛𝙖𝙢𝙤𝙪𝙨 𝙘𝙤𝙢𝙥𝙖𝙣𝙞𝙚𝙨 𝙗𝙪𝙮 𝙩𝙝𝙚 𝙜𝙧𝙖𝙣𝙪𝙡𝙚𝙨 𝙛𝙧𝙤𝙢 𝙪𝙨.
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2. General Objective
At the end of the session, B.Sc. Nursing 3rd year students will
be able to explain about the physiological changes during the
third stage of labor.
3. Specific Objectives
At the end of the session, B.Sc. Nursing 3rd year students will
be able to:
1. define third stage of labor.
2. state the length of third stage of labor.
3. describe the physiology of third stage of labor.
4. Definition
• The stage of labor which begins with the birth of baby and
ends with delivery of the placenta and membranes is known
as third stage of labor.
• It is also known as placental stage of labor.
6. Physiology of Third Stage of Labor
• The physiology of third stage of labor consists of separation
and expulsion of placenta and membranes.
• The placental separation is facilitated by uterine contrations
which begins again after a brief pause at birth.
• After the placental expulsion, the amount of blood loss
depends upon how quickly the uterus contracts.
7. Physiology Continued......
• If the uterus doesnot contract normally then haemorrhage
may result.
• The estimated blood flow to the uterus is 500-800 ml per
minute.
8. Placental Separation
• Placental separation occurs as a result of the abrupt
decrease in size of the uterine cavity during and following
delivery of the baby.
• It is brought about by contraction and retraction of
myometrium which thickens the uterine wall and reduces
the size of placental area.
• Formation of retroplacental clot occurs which further
facilitates the placental separation.
10. Schultze Method
• Common method of placental separation.
• Separation of placenta begins centrally.
• Formation of central retroplacental clot.
• Fetal surface appears at the vulva with the membranes
trailing behind like an inverted umbrella.
• The majority of bleeding occurring with this mechanism is
not visualized until the placenta and membranes are
delivered.
13. Matthew’s Duncan Method
• Separation takes place at margin or periphery of placenta.
• The placenta descends sideways and comes through the
vulva with the lateral border first like a button through
button hole.
• The maternal surface is seen and blood is visualized
externally.
• No formation of retroplacental clot.
14. Before Separation
Per Abdomen
Uterus becomes discoid in shape, firm in feel and non
ballottable.
Fundal height reaches slightly below the umbilicus.
Per Vaginum
Length of the umbilical cord as visible from outside, remains
static.
15. After Separation
Per Abdomen
The fundus feels hard and globular and rises abdominally to
the level of the umbilicus.It is mobile
The fundal height is slightly raised as the separated placenta
comes down in the lower segment and the contracted
uterus rests on top of it.
There may be slight bulging in the supra pubic region due to
distention of the lower segment by the separated placenta.
16. After Separation Continued…..
Per Vaginum
The cord lengthens at the vulva.
A trickle of blood appears when the placenta separates
(gush of the blood i.e 30-60 ml blood usually comes out
from vagina)
17.
18.
19. Separation of Membranes
• The membranes which are attached loosely in the active part
are thrown into multiple folds.
• Those attached to the lower segment are already separated
during its stretching.
• It’s separation is facilitated by partly uterine contraction and
mostly by weight of placenta.
.
20. Separation of Membranes Continued….
• The membranes so separated carry with them bits and
pieces of deciduas vera giving the outer surface of chorion its
characteristic roughness.
• Hence the placenta and membranes descend down into the
lower uterine segment or upper vaginal vault.
21. Expulsion of Placenta
• Placenta expels after the complete separation of placenta.
• It is expelled out by either voluntary contraction of
abdominal muscles (bearing down effort) or by manipulative
procedures.
22. Controlled Bleeding after Separation
Normal physiologic processes that control bleeding are as
follows:
1. Retraction of the oblique uterine muscle fibers in the upper
uterine segment through which the tortuous blood vessels
intertwine.
2. Presence of vigorous uterine contraction following
separation.
3. The achievement of hemostasis.
26. Sample Questions
Objective Type Questions:
Write true or false for the following statements. (2*1 =2)
1. The third stage of labor begins with full dilatation of cervix
and ends with delivery of baby. ( )
2. Schultz method is the peripheral method of placental
separation. ( )
27. Subjective Type Questions:
Answer the following questions.
1.Define third stage of labor. 2
2.Explain briefly the physiology of third stage of labor. 6
28. Topic for the Next Class
Active management of third stage of labor
29. References
• Subedi, D.& Gautam, S. (2016).Midwifery Nursing Part II. (3rd ed.). Medhavi
Publication.(pp:104-106).
• Cooper, M.A. & Fraser, D.M. Myles Textbook for Midwives. (15th ed.). Churchill
Livingstone Elsevier. (pp: 531-534).
• Jacob, A. A Comprehensive Textbook of Midwifery. (3rd ed.). Jaypee Brothers
Medical Publishers. (pp: 205-207).
• Dutta, D.C.(2015).Textbook of Obstetrics. (8th ed.). Jaypee Brothers Medical
Publishers. (pp:143-145).
• Tuitui, R. (2007). Manual of Midwifery – B.(4th ed.). Vidyarthi Pustak Bhandar
• Daftary, N.S.& Chakravarti, S. Holland and Brews Mannual of Obstetrics (3rd ed.).
Elsevier limited.
• Cunningham G.F et.at.(2010).Williams Obstetrics .(22nd ed.) Medical Publishing
Division, New York