Ebook Best practice in labour and delivery (2/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Best practice in labour and delivery (2/E): Part 2
Ebook Best practice in labour and delivery (2/E): Part 2
Management of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2elivery of the placenta and membranes. In the majority of cases, the third stage Is uneventful. However, complications of the third stage lead to significant mortality and morbidity, especially so in the developing nations. Worldwide, postpartum haemorrhage leads to approximately 130 000 deaths annu Ebook Best practice in labour and delivery (2/E): Part 2ally, accounting for 10.5% of all births (I]. It is the leading cause of maternal death in Africa and Asia, accounting for up to half of these (2]. ThEbook Best practice in labour and delivery (2/E): Part 2
e death rate in the UK from postpartum haemorrhage (PPH) had not significantly changed in the last Confidential Enquiry into maternal death [31, at 0.Management of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2ternal deaths in the UK during the period of 2009-12 and still accounts for 25% of maternal deaths in the developing world (4).Physiology of the Third Stage of LabourPlacental SeparationDuring birth of the baby, there is a rapid and significant reduction in uterine size. The average of this diminuti Ebook Best practice in labour and delivery (2/E): Part 2on in length from onset of birth to its completion is 6.5 inches in 5 min. This is achieved by myometrial retraction, which is a unique characteristicEbook Best practice in labour and delivery (2/E): Part 2
of the uterine muscle, Involving all three muscle fibre layers, allowing maintenance of the shortened length following each successive contraction. TManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2enta is undermined, detached and propelled into the lower uterine segment. This process is usually completed within 4.5 minof delivery of the baby [51. The second mechanism involved in uterine separation Is haematoma formation, which occurs secondary to venous occlusion and vascular rupture in the p Ebook Best practice in labour and delivery (2/E): Part 2lacental bed caused by uterine contractions.Signs of Placental Separation1The most reliable sign is the lengthening of the umbilical cord as the placeEbook Best practice in labour and delivery (2/E): Part 2
nta separates and is pushed into the lower uterine segment by progressive uterine contractions. Placing a clamp on the cord near the perineum allows fManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2ve the symphysis, otherwise cord lengthening as a result of uterine prolapse or inversion could be mistaken for placental separation.2The uterus takes on a more globular shape and becomes firmer. This occurs as the placenta descends into the lower segment and the body of the uterus continues to retr Ebook Best practice in labour and delivery (2/E): Part 2act. This change may be difficult to appreciate clinically, especially in an obese mother.3A gush of blood occurs. The retro-placental clot is able toEbook Best practice in labour and delivery (2/E): Part 2
escape as the placenta descends to the lower uterine segment. The retro-placental clot usually forms centrally and escapes following complete separatManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2ion. This occurrence is sometimes associated with increased bleeding and a prolonged third stage, with the delivery of the leading edge of the placenta and maternal surfaceBest Practice in Labour and Delivery, Second Edition, ed. Sir Sabaratnam Arulkumaran. Published by Cambridge University Press. ■ Ebook Best practice in labour and delivery (2/E): Part 2© Cambridge University Press 2016.OS«nt7Ạd from http5:/.‘iwEbook Best practice in labour and delivery (2/E): Part 2
cambrldge.arg/core/terms. httpsy/do: org<-10.1017/9781316144961.016available atChapter 14: Management olfirst (the Matthews Duncan method), rather thaManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2 of 500-700 ml/min. The blood vessels penetrating the uterus to supply the placental bed are surrounded by the interlacing muscle fibre of the myometrium. Contraction of these muscle fibres compresses the blood vessels like ‘living ligatures'. Retraction of the muscle fibre keeps the vessels closed. Ebook Best practice in labour and delivery (2/E): Part 2 A vivid demonstration of this physiological control of bleeding is seen at caesarean section (CS) when the emptied uterus becomes thick, firm and palEbook Best practice in labour and delivery (2/E): Part 2
e. In addition to uterine muscle contraction, fibrinous thrombi formation occurs in maternal sinuses, contributing to haemostasis by sealing the smallManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2rineum can be carried out prior to delivery of the placenta, a more thorough, detailed look should be undertaken following placental delivery. The labia and perineum should be evaluated for any lacerations or haematomas. Ihis examination Is especially important following an operative delivery, in wh Ebook Best practice in labour and delivery (2/E): Part 2ich case a rectal examination should also be routinely performed to assess for third- or fourth-degree tears. Instrumental delivery should also promptEbook Best practice in labour and delivery (2/E): Part 2
the routine assessment of vagina and cervix. If there are lacerations around the urethra, consideration should be given to insertion of an indwellingManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2rd Stage ManagementExpectant ManagementThis is often described as physiological. It involves omission of routine use of uterotonic agents, delaying cord clamping/cutting until umbilical pulsations have ceased and delivery of the placenta by maternal effort. Mothers wanting to delay cord clamping for Ebook Best practice in labour and delivery (2/E): Part 2 greaterTable 14.1 Rtsks of physiological vs. active third stage [6]Physiological third stageActive third stageNausea and vomiting4494644936Blood tossEbook Best practice in labour and delivery (2/E): Part 2
>1000 ml29/1 cco13/1000Need for blood transfusion40/100014/1000than five minutes should be supported in this decision as long as there is no fetal orManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2IM ("]) following delivery of the anterior shoulder or immediately after the birth of the baby, before the cord is clamped and cut. This Is followed by delayed cord clamping and controlled cord traction (CCT) once there are signs of placental separation.Women should be advised to have an active thir Ebook Best practice in labour and delivery (2/E): Part 2d stage as it reduces rates of PPH or blood transfusion, although low-risk mothers wanting a physiological third stage should be supported in their deEbook Best practice in labour and delivery (2/E): Part 2
cision as long as they have been counselled regarding the risks (Table 14.1). Unless there are concerns about cord integrity or newborn well-being, thManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2recommendations (7) are for delayed cord clamping of 1-3 min for all births while undertaking simultaneous newborn care. This can reduce rates of neonatal anaemia and is especially relevant in resource-poor settings [6,7]. Some modern resuscitaires can be kept alongside the mothers bedside during va Ebook Best practice in labour and delivery (2/E): Part 2ginal delivery or at time of cs. Ihis allows significantly delayed cord clamping/cutting and a resultant continuation ofcord circulation and transferEbook Best practice in labour and delivery (2/E): Part 2
of maternal oxygen to the newborn until such time that external resuscitation has taken effect. Delaying cord clamping does not lead to increased rateManagement of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the de Ebook Best practice in labour and delivery (2/E): Part 2ly given IV or IM as a bolus. There are no adverse maternal haemodynamic responses to anavailable at 171Osvmloaded from httpiJ/iww.cambrdge.org'core. Stockholm Unr.'ersrty Library, on 02 Sep 2017 at 16:43:37, Ebook Best practice in labour and delivery (2/E): Part 2Management of the Third Stage of LabourHajeb Kamali and Pina AminThe third stage of labour is defined as the time from the birth of the baby to the deGọi ngay
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