NM704 Exam 4| QUESTIONS WITH 100% CORRECT ANSWERS| LATEST UPDATE 100%
VERIFIED
Describe active management of the 3rd stage of labor: The Three Components of AMTSL
according to the ICM/FIGO Joint Statement (2003) are:
· Administration of a uterotonic medication within one minute of the birth of the baby, after
ruling out multiple gestation. Oxytocin is the preferred medication.
· Controlled cord traction to assist with placental expulsion.
· Uterine massage immediately after placental expulsion, and then as needed.
Compare outcomes between expectant v. active management of third stage labor: When
labor and birth are physiological, a physiological third stage results in comparable bleeding
outcomes as when AMTSL is implemented with a general population at mixed risk for excessive
bleeding.
How can shared decision making be utilized in third stage labor? Discuss ways ahead of time
to support normalcy in 3rd stage, discuss interventions known to decrease risk of hemmorhage,
avoid procedures that increase postpartum blood loss (induction, augmentation, episiotomy)
What is the 4th stage of labor? The first hour following the expulsion of the placenta. (Also,
this is the time when women are at highest risk for postpartum hemorrhage)
What should be evaluated during fourth stage in terms of the uterus? Check position and
tone every 5-15 minutes, position in relation to the umbilicus, tone- firm, boggy
What two medications are commonly used to manage the stage of labor? Oxytocin and
Methergine
, Oxytocin: action, indication, side effx, contraindications for 4th stage labor Action: promotes
contractions by increasing the intracellular Ca2+. Oxytocin has specific receptors in the
myometrium and the receptor concentration increases greatly during pregnancy, reaching a
maximum in early labor at term.
Indication: Pitocin is indicated to produce uterine contractions during the third stage of labor
and to control postpartum bleeding or hemorrhage.
Side effects: Anaphylactic reaction, Premature ventricular contractions, Postpartum
hemorrhage, Pelvic hematoma, Cardiac arrhythmia, Subarachnoid hemorrhage, Fatal
afibrinogenemia, Hypertensive episodes, Nausea, Rupture of the uterus, Vomiting
Contraindications: Antepartum contraindications include:
o Where there is significant cephalopelvic disproportion;
o In unfavorable fetal positions or presentations, such as transverse lies, which are
undeliverable without conversion prior to delivery;
o In obstetrical emergencies where the benefit-to-risk ratio for either the fetus or the mother
favors surgical intervention;
o In fetal distress where delivery is not imminent;
o Where adequate uterine activity fails to achieve satisfactory progress;
o Where the uterus is already hyperactive or hypertonic;
o In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma, active
herpes genitalis, total placenta previa, vasa previa, and cord presentation or prolapse of the
cord;
o In patients with hypersensitivity to the drug.
Methergine: action, indication, side effx, contraindications for 4th stage labor Action: acts
directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of
rhythmic contractions. Thus, it induces a rapid and sustained titanic uterotonic effect which
shortens the third stage of labor and reduces blood loss.
VERIFIED
Describe active management of the 3rd stage of labor: The Three Components of AMTSL
according to the ICM/FIGO Joint Statement (2003) are:
· Administration of a uterotonic medication within one minute of the birth of the baby, after
ruling out multiple gestation. Oxytocin is the preferred medication.
· Controlled cord traction to assist with placental expulsion.
· Uterine massage immediately after placental expulsion, and then as needed.
Compare outcomes between expectant v. active management of third stage labor: When
labor and birth are physiological, a physiological third stage results in comparable bleeding
outcomes as when AMTSL is implemented with a general population at mixed risk for excessive
bleeding.
How can shared decision making be utilized in third stage labor? Discuss ways ahead of time
to support normalcy in 3rd stage, discuss interventions known to decrease risk of hemmorhage,
avoid procedures that increase postpartum blood loss (induction, augmentation, episiotomy)
What is the 4th stage of labor? The first hour following the expulsion of the placenta. (Also,
this is the time when women are at highest risk for postpartum hemorrhage)
What should be evaluated during fourth stage in terms of the uterus? Check position and
tone every 5-15 minutes, position in relation to the umbilicus, tone- firm, boggy
What two medications are commonly used to manage the stage of labor? Oxytocin and
Methergine
, Oxytocin: action, indication, side effx, contraindications for 4th stage labor Action: promotes
contractions by increasing the intracellular Ca2+. Oxytocin has specific receptors in the
myometrium and the receptor concentration increases greatly during pregnancy, reaching a
maximum in early labor at term.
Indication: Pitocin is indicated to produce uterine contractions during the third stage of labor
and to control postpartum bleeding or hemorrhage.
Side effects: Anaphylactic reaction, Premature ventricular contractions, Postpartum
hemorrhage, Pelvic hematoma, Cardiac arrhythmia, Subarachnoid hemorrhage, Fatal
afibrinogenemia, Hypertensive episodes, Nausea, Rupture of the uterus, Vomiting
Contraindications: Antepartum contraindications include:
o Where there is significant cephalopelvic disproportion;
o In unfavorable fetal positions or presentations, such as transverse lies, which are
undeliverable without conversion prior to delivery;
o In obstetrical emergencies where the benefit-to-risk ratio for either the fetus or the mother
favors surgical intervention;
o In fetal distress where delivery is not imminent;
o Where adequate uterine activity fails to achieve satisfactory progress;
o Where the uterus is already hyperactive or hypertonic;
o In cases where vaginal delivery is contraindicated, such as invasive cervical carcinoma, active
herpes genitalis, total placenta previa, vasa previa, and cord presentation or prolapse of the
cord;
o In patients with hypersensitivity to the drug.
Methergine: action, indication, side effx, contraindications for 4th stage labor Action: acts
directly on the smooth muscle of the uterus and increases the tone, rate, and amplitude of
rhythmic contractions. Thus, it induces a rapid and sustained titanic uterotonic effect which
shortens the third stage of labor and reduces blood loss.
