nm 704 final *MINE* STUDY!! Questions
and answers
placental separation ✔✔- result of abrupt decrease in size of uterine cavity during
& following birth of baby
- sudden disproportion btwn area of implantation & placental size cxing placenta
to buckle & separate from decidua
schultz ✔✔- occurss majority of time
- placenta separates centrally
- fetal side --> smooth & shiney --> exits vagina 1st
- membranes expelled last with maternal side of placenta inside amniotic sac
- inverts placenta & amniotic sac cxing membranes to peel off remainder of
decidua & trails behind placenta
- conceals majority of bleeding until placenta & membranes are expelled
duncan ✔✔- separates marginally
- does NOT invert
- maternal side --> beefy red color
- expelled @ same time as fetal side
- blood loss visible externally & seen earlier than if schultz
,post birth contractions ✔✔- constricts blood vessels that supply blood to placenta
--> cxing hemostasis (stopping blood flow)
small gush of blood -- sign of placental separation ✔✔- blood escapes from btwn
placenta & decidua
lengthening of cord -- sign of placental separation ✔✔- as placenta descends into
vagina --> cord lengthens @ vaginal introitus
rise of uterus into abd -- sign of placental separation ✔✔- placenta descends into
vagina & uterus is displaced upward
uterus becomes firm & rounded -- sign of placental separation ✔✔- once placenta
expelled --> uterus is able to contract more firmly cxing rounded firmer uterus
avoiding mismanagement of 3rd stage ✔✔- *no* cord traction
- *no* uterine massage before placental expulsion
no cord traction ✔✔- if mom in squatting or upright position
no uterine massage ✔✔- before placental expulsion
- could cx incomplete placental separation resulting in iatrogenic hemorrhage
,expectant management of 3rd stage (aka) physiologic management ✔✔- non
interventionist approach
- delayed cord clamping
- no cord traction or if any then gentle
- maternal bearing down efforts to expel placenta
- no external uterine massage following expulsion
- no routine uterotonic agents administered
AMTSL ✔✔- recommended by WHO, ICM, FIGO
- decrease PPH r/t less overall blood loss, less anemia, less need for therapeutic
uterotonics
- recommended especially in low resource settings where PPH Tx is not readily
available
- uterotonic agent administration may be most effective @ preventing PPH
3 things ivolved in AMTSL ✔✔- controlled cord traction --> facilitates placenta
expulsion
- routine administration of prophylactic uterotonic agent --> oxytocin within 1 min
of birth of baby after ruling out multiple gestations
- ICN/FIGO --> recommends external uterine massage following placental
separation & then as needed
AMTSL vs expectant -- AMTSL side ✔✔- less blood loss
- less anemia
, - less need for therapeutic uterotonic agents
AMTSL vs expectant -- expectant side ✔✔- if 1st & 2nd stages were physiological
& woman is low risk for PPH -> then a physiological 3rd stage does not increase
risk for blood loss or PPH
- non interventionalist counter part of AMTSL
AMTSL is evidence ✔✔- strong it doesn't account for birth settings & other
variables like CNM model of care & birth as physiological process
best approach for routine management of 3rd stage ✔✔- should be infividualized
- based on risk factors & birth location --> availability of resources
- mixed AMTSL with expectant management
4th stage definition ✔✔- 1st postpartum hr following expulsion of placenta
uterus evaulation in 4th stage ✔✔every 5-15 min
4th stage uterus position ✔✔- usually midline
- approximately 2/3 to 3/4 way up btwn symphysis pubis & umbilical
if uterus above umbilicus or wat to one side ✔✔- mom may need to empty
bladder
and answers
placental separation ✔✔- result of abrupt decrease in size of uterine cavity during
& following birth of baby
- sudden disproportion btwn area of implantation & placental size cxing placenta
to buckle & separate from decidua
schultz ✔✔- occurss majority of time
- placenta separates centrally
- fetal side --> smooth & shiney --> exits vagina 1st
- membranes expelled last with maternal side of placenta inside amniotic sac
- inverts placenta & amniotic sac cxing membranes to peel off remainder of
decidua & trails behind placenta
- conceals majority of bleeding until placenta & membranes are expelled
duncan ✔✔- separates marginally
- does NOT invert
- maternal side --> beefy red color
- expelled @ same time as fetal side
- blood loss visible externally & seen earlier than if schultz
,post birth contractions ✔✔- constricts blood vessels that supply blood to placenta
--> cxing hemostasis (stopping blood flow)
small gush of blood -- sign of placental separation ✔✔- blood escapes from btwn
placenta & decidua
lengthening of cord -- sign of placental separation ✔✔- as placenta descends into
vagina --> cord lengthens @ vaginal introitus
rise of uterus into abd -- sign of placental separation ✔✔- placenta descends into
vagina & uterus is displaced upward
uterus becomes firm & rounded -- sign of placental separation ✔✔- once placenta
expelled --> uterus is able to contract more firmly cxing rounded firmer uterus
avoiding mismanagement of 3rd stage ✔✔- *no* cord traction
- *no* uterine massage before placental expulsion
no cord traction ✔✔- if mom in squatting or upright position
no uterine massage ✔✔- before placental expulsion
- could cx incomplete placental separation resulting in iatrogenic hemorrhage
,expectant management of 3rd stage (aka) physiologic management ✔✔- non
interventionist approach
- delayed cord clamping
- no cord traction or if any then gentle
- maternal bearing down efforts to expel placenta
- no external uterine massage following expulsion
- no routine uterotonic agents administered
AMTSL ✔✔- recommended by WHO, ICM, FIGO
- decrease PPH r/t less overall blood loss, less anemia, less need for therapeutic
uterotonics
- recommended especially in low resource settings where PPH Tx is not readily
available
- uterotonic agent administration may be most effective @ preventing PPH
3 things ivolved in AMTSL ✔✔- controlled cord traction --> facilitates placenta
expulsion
- routine administration of prophylactic uterotonic agent --> oxytocin within 1 min
of birth of baby after ruling out multiple gestations
- ICN/FIGO --> recommends external uterine massage following placental
separation & then as needed
AMTSL vs expectant -- AMTSL side ✔✔- less blood loss
- less anemia
, - less need for therapeutic uterotonic agents
AMTSL vs expectant -- expectant side ✔✔- if 1st & 2nd stages were physiological
& woman is low risk for PPH -> then a physiological 3rd stage does not increase
risk for blood loss or PPH
- non interventionalist counter part of AMTSL
AMTSL is evidence ✔✔- strong it doesn't account for birth settings & other
variables like CNM model of care & birth as physiological process
best approach for routine management of 3rd stage ✔✔- should be infividualized
- based on risk factors & birth location --> availability of resources
- mixed AMTSL with expectant management
4th stage definition ✔✔- 1st postpartum hr following expulsion of placenta
uterus evaulation in 4th stage ✔✔every 5-15 min
4th stage uterus position ✔✔- usually midline
- approximately 2/3 to 3/4 way up btwn symphysis pubis & umbilical
if uterus above umbilicus or wat to one side ✔✔- mom may need to empty
bladder
