3rd Stage of Labour Flashcards
What does it mean if a blood vessel is tortuous?
It is tense and congested with blood
What are the 2 sides of the placenta?
- Amnion (closest to baby)
2. Chorion (embeds in uterus)
What is the umbilical cord made up of?
- Outer layer = amnion
- 2 arteries, 1 vein
- Wharton’s jelly
Step 1 of placental separation
Uterus and placental site decrease in size due to contraction and retraction following delivery
Step 2 of placental separation
Placenta is elastic and becomes wrinkled, so separates from the uterine wall
Step 3 of placental separation
Some foetal blood is pumped back to the baby’s circulation
Step 4 of placental separation
Maternal blood in the intervillous spaces is forced back into the spongy layer of the decidua-basalis
Step 5 of placental separation
Retraction of the oblique muscle fibres constricts the blood vessels to the placenta
Step 6 of placental separation
Tortuous veins rupture to form a retroplacental clot, shearing off the villi of the spongy layer
Step 7 of placental separation
Living ligatures (fibres) contract around the torn maternal blood vessels to achieve haemostasis
What is haemostasis?
Stopping the flow of blood
What are the 2 types of management and how long should they last?
- Physiological (60 mins)
2. Active (30 mins)
Give some signs of placental separation
- Contracted uterus
- Small, fresh blood loss
- Cord lengthening
What are the 2 types of placental separation?
- Shultze (amnion on outside)
2. Matthew Duncan (chorion on outside)
What are the differences between the 2 types of placental separation?
Shultze:
Begins centrally, retroplacental clot present, short duration, less blood loss, complete membranes
Duncan:
Begins at border, no clot, longer duration, more bloos loss, ragged membranes
What should be advised during physiological management?
Breastfeeding
What are the 2 interventions used in active management?
- Uterotonic drugs
2. CCT
What are the 3 types of uterotonic drugs and their doses?
- Syntocinon (10iu)
- Ergometrine (500mcg in 1ml)
- Syntometrine (1ml)
What is a contraindication for ergometrine?
High BP/ PET
What is a common side effect of syntometrine?
N+V
What should be checked on the placenta following its delivery?
- 2 membranes
- Complete (no clots missing)
- Any abnormalities
- 3 umbilical vessels
What does the absence of an umbilical artery indicate?
Renal disease in the baby
What is calcification?
Hardened areas caused by accumulation of calcium salts
When is calcification an issue?
In early pregnancy, as it is a sign that the placenta is ageing early
