The document discusses complications of the third stage of labour and their management. It defines labour as the process of expelling the products of conception from the womb through the vagina. The stages of labour are outlined as first, second, third, and fourth. Complications of the third stage include postpartum hemorrhage, retained placenta, shock, inversion of the uterus, and amniotic fluid embolism. Postpartum hemorrhage is defined and types, causes, and risk factors are explained. The prevention and management of third stage hemorrhage and retained placenta are described. Other complications such as shock, inversion of the uterus, and disseminated intravascular coagulation are also summarized
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
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.
nurses/doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
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.
nurses/doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
PPH Postpartum hemorrhage, affecter the delivery of fetus vaginal bleeding you can see with in 24 hours this primary PPH, secondary PPH will be up 28 of delivery.
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.
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdf
Third stage of labor and its management
1. COMPLICATIONS OF 3RD STAGE
OF LABOUR AND ITS
MANAGEMENT
Submitted to
Mrs Geeta Razdan
Lecturer
College of Nursing,
AIIMS
Submitted By
Mr:Sobin Chandran
Post Bsc 1st year
C.O.N ,AIIMS
Roll no 779
2. OBJECTIVES
At the end of the class, students will able to;
define labour
list down the stages of labour
describe the complications of 3rd stage of labour
explain the management of 3rd stage bleeding
3. LABOUR
Labour is the series of events that takes place in the genital
organ in an effort to expel the viable products of conception
out of the womb through the vagina in to the outer world.
T
h
4. STAGES OF LABOR
• First Stage – Starts from the onset of true labor pain and ends
with full dilatation and effacement of the cervix.
• Second Stage – Starts from the full dilatation and effacement of
the cervix and ends with the expulsion of fetus from the birth
canal
• Third Stage – Extends from delivery of a baby to the delivery of
placenta and membranes and this stage last for 15 to 30 Mins.
• Fourth Stage – Stage of observation for at least one hour after
expulsion of placenta and membranes
5.
6. COMPLICATIONS OF 3RD STAGE OF
LABOUR
1. Postpartum haemorrhage
2. Retained placenta
3. Shock(Haemorrhagic and Non haemorrhagic)
4. Inversion of Uterus
5. Amniotic fluid embolism
6. Coagulation disorders – Disseminated intra
vascular coagulation
7. POSTPARTUM HEMORRHAGE
• Clinical definition :Any amount of bleeding from the genital
tract following the birth of baby up to the end of puerperium
which adversely affect the general condition of the mother
which is evidenced by increase in pulse rate and falling blood
pressure. PPH is very common and preventable.
• Quantitative definition :amount of blood loss more than 500 ml in normal delivery
and more than 1000 ml in caesarean delivery.
8. TYPES OF PPH
Primary PPH
Haemorrhage occurs within 24 hours following the birth of
baby. There are two types of primary PPH
a. Third stage haemorrhage – Bleeding occurs before
expulsion of placenta
b. True postpartum haemorrhage - Bleeding occurs
subsequent to expulsion of placenta
Secondary PPH
Haemorrhage occurs beyond 24 hours and within
puerperium and also called delayed or late puerperal
10. ATONIC UTERUS(80%)
• It is the most common cause of PPH. With the separation of
placenta, the uterine sinuses which are torn cannot be
compressed effectively due to imperfect contraction and
retraction of the uterus and bleeding continues
11. TRAUMATIC(20%)
• Trauma to the genital tract usually following operative
delivery even after spontaneous delivery.
12. PRE-DISPOSING FACTORS OF PPH
Over distension of the uterus
Multiple Pregnancy
Polyhydramnios
Grand multipara
Large Infant
hydrocephalous
Anesthesia
Prolonged labor
13. PREVENTION
All pregnant woman should be considered as potential candidates for
excessive bleeding.
During antepartum period
o Improve health and nutrition
o Blood group and Hb should be detected early
o Anaemia should be corrected
o Avoid unnecessary vaginal examinations
o Avoid sexual intercourse in last two months
o Maintain normal blood pressure
o All high risk mothers who are likely to develop PPH should be
screened and delivered in well equipped hospital
14. During intra partum period
o Follow strict aseptic technique
o Administer blood and fluid if necessary
o Avoid unnecessary vaginal examination and manipulation of
uterus
oExamination of the placenta and membrane should be done
o temptation of fiddling or kneading with the uterus or pulling
the cord should be avoided.
During postpartum period
o Avoid unnecessary vaginal examination
o Proper cleanliness of vulva after delivery
15. MANAGEMENT OF 3RD STAGE
HAEMORRHAGE
• Palpate the fundus and massage
• Start IV Fluids[ preferably dextrose saline drip]
• Inj. Methergine 0.2 mg or ergometrine 0.25 mg
intravenously
• Catheterize the bladder
• Sedation
16.
17. MANAGEMENT OF TRUE P.P.H
Uterus hard and contracted
(Traumatic)
Exploration
Suturing on the tear sites
Call for extra help
Commence I.V line with a wide bore cannula
Send blood for cross matching and ask for at least 2 units of
blood
Rapidly infuse normal saline 2 litres till blood is available
Immediate measures
Feel the uterus by abdominal palpation
If uterus is atonic
• Massage the uterus to make it hard
• Inj. Methergine 0.2mg I. V.
• Add oxytocin 10 units in 500 ml of NS / RL at the rate of 40
drops/min.
• Examine the expelled placenta
• Catheterise the bladder
If uterus remain atonic
18. Uterus atonic
• Inj. Prostaglandin or Misoprostol
1000 micro gram per rectum
Uterus atonic
• Uterine massage and
bimanual compression
Uterus atonic
• Tight intra uterine
packing under GA
Uterus atonic Hysterectomy
•Blood transfusion
•Continue oxytocin drip
19.
20. CAUSES OF SECONDARY PPH
• Retained bits of cotyledon or membranes
• Infection and separation of slough over a deep cervico-
vaginal laceration
• Endometritis and subinvolution of the placental site
• Secondary haemorrhage from caesarean section
21. MANAGEMENT OF SECONDARY
PPH
Principles are
1. To assess the amount of blood loss and replace the lost
blood
2. To find out the cause and take appropriate steps to rectify
it Supportive Thereapy
3. Blood transfusion
Administer methergin
Administer antibiotics
22. RETAINED PLACENTA
• The placenta is said to be retained when it is not expelled out even after 30 minutes after the
birth of the baby
• Failure of the placental separation may be mechanical or a result of abnormal penetration of the
trophoblast in to the uterine wall. This is placenta Accreta. It indicates superficial penetration
of the muscle. Deeper penetration is called placenta Increta.
• Placenta percreta indicates that the trophoblast has grown to or completely through the serosa.
23.
24. MANAGEMENT OF RETAINED PLACENTA
• To express the placenta by controlled traction
• Manual removal of placenta
• Management of shock
• Antibiotics to prevent infection
25. INVERSION OF UTERUS
Life threatening condition in which the uterus is turned outside
partially or completely. The incidence is about 1 in 20000 deliveries
Degree of uterine inversion
• 1st Degree - Fundus is depressed while reaching up to internal OS
• 2nd Degree - The fundus passed through the cervix but lies inside
the vagina.
• 3rd Degree – The endometrium with or without the attached
placenta is visible outside the vulva.
26.
27. MANAGEMENT OF INVERSION OF UTERUS
• To replace that part which is inverted last
• To apply counter support by the other hand placed on the
abdomen
• After replacement, the hand should remain inside the uterus
until the uterus become contracted by Inj. oxytocin
• The placenta remove manually only after uterus become
contracted
• Proper management of shock
28. SHOCK
It is a state of circulatory inadequacy with poor tissue perfusion
resulting in generalized cellular hypoxia
Causes
Trauma Haemorrhage
Fluid loss Hypertension & Pre-
eclampsia
Neurogenic shock Sepsis
Pulmonary embolism Anaesthesia and drugs
29. CLINICAL FEATURES OF SHOCK
1.Cold and clammy skin
2.Tachycardia
3.Hypotension
4.Oligurea followed by anuria
5.Cyanosis
6.Pallor
30. MANAGEMENT OF SHOCK
• Infusion and Transfusion
• Foot end elevation of bed
• Resuscitate patient – oxygen by mask or mechanical ventilation
• Monitor BP, HR, CVP
• Inotropic agents to treat hypotension
• Maintain I/O chart
• Antibiotics
• Stop bleeding as soon as possible
Basic management of hemorrhagic shock is to stop bleeding and
replace the volume which has been lost. Prompt diagnosis and
immediate resuscitation is essential to prevent multiple organs
failure.
31. AMNIOTIC FLUID EMBOLISM
Spontaneous embolism of amniotic fluid debris, fetal squamous
cells, mucus, vernix in small pulmonary artery leading to serious
degree of respiratory distress. It occurs only 2%. This condition
may be fatal to the mother.
Risk Factors
• Vigorous labor contractions
• Through fetal membranes as in marginal separation of placenta
32. DIC
It develops due to coagulation defect
Treatment
• Supportive treatment
• O2 inhalation
• Maintenance of BP
• Management of coagulopathy
33. CONCLUSION
The complications of third stage of labour are more crucial for
the mother as most of the complications are fatal.