THIRD STAGE OF LABOUR MANAGEMENT

2 days ago

AIMS

=To deliver the placenta and its membrane.
=To control bleeding and prevent PPH.
=To prevent infections during in the 3rd stage.

ENVIRONMENT

=I will ensure the room is clean to prevent nosocomial infection.
=I will ensure there is proper lighting for easy observation of the woman.
=I will ensure that the room is warm enough to prevent hypothermia.
=I will ensure that there is a drip stand for intravenous fluids and drugs.
=I will prepare some intravenous fluids for energy and hydration.
=I will provide privacy in a room to protect our clients from unwarranted interference in their lives.
=I will ensure that all emergency equipment must be readily available.

PSYCHOLOGICAL SUPPORT

=I will give verbal encouragement by telling her how well she is doing to promote cooperation.
=I will guide the woman on what to do during third stage of labour to prevent complications.

INFECTION PREVENTION

=I will use of sterile gloves during the procedure to prevent infections.
=I will discourage the woman from touching the valva to prevent infections.
=I will clean the bed cover after delivery of the baby to prevent infections.
=I will wash my hands to prevent infections.

POSITION

=I will put the woman in dorsal position for easy applying of cord traction.
= I will allow her to be in this position for comfortability.

DELIVERY OF PLACENTA

=I will give oxytocin 10 iu IM stat to help the uterus contracts fast to control bleeding.
=I will wash my hands and dry them then put on sterile gloves to prevent infections.
=I will clean the valva with savlon to prevent infections.
=I will wait for 2-4 minutes after the delivery of the baby for the contraction and do the traction.
=I will place right hand on lower abdomen and fingers stretching the upper uterine segment upwards toward the umbilical to prevent uterine inversion.
=I will hold the forcep clumped to the cord near the valva
=I will pull the placenta using controlled cord traction method
= As the uterine contractions stop, traction should also be stopped temporary to prevent breaking the cord.
=If the placenta does not descend after 20-30 seconds of traction, I will stop the traction for 1-2 minutes and wait for the to resume.
=When the placenta is visible on the valva I will stop pulling and start to roll the placenta with my hands to coil the membranes preventing them from remaining inside.
=I will put the placenta on the receiver and do a quick examination of the placenta to check if there is any missing lobe which can cause bleeding.
=I will massage the uterus after the placenta and membranes are evacuated to expel clots
before the examination of the genital tract.

OBSERVATION/EXAMINATION OF BIRTH CANAL

=I will observe for the woman's physical state after placenta delivery
= I will do vital signs as raised pulse and low blood pressure will signify excessive bleeding.
=I will observe skin for coldness as this may show or present shock.
=I will monitor the breathing pattern to rule out dyspnea.
==I will position her in a lithotomy position to ease the abdominal muscles for easy access through to genital tract.
=I will ask the assistant to direct a light on to the perineum.
=I will swab the vulva and perineum gently with an antiseptic solution and dry with a soft dry cloth.
= I will gently separate the labia and inspect the vulva, the vagina and the cervix for the presence of any tear and laceration.
=I will inspect the perineum for lacerations and tears as well.
=I will give the woman a pad and leave her comfortable.
=I will take note of the findings and if there is any tear I will suture to stop the bleeding.

CONTROL OF BLEEDING

= I will observe for any perineal lacerations to manage bleeding.
=I will measure blood loss if any and treat accordingly.
=I will ensure and observe uterus contractions as this also compress blood vessels causing blood loss to be less.

REST

=I will ensure the room is free from noise to promote rest.
= I will do all related procedures in blocks to promote rest.
=I will allow the woman to be in her comfortable position to promote comfort and relieve pain thereby promote rest.

EXAMINATION OF PLACENTA

=I will examine all the two surface of the placenta the maternal and the fetal.
=I will put on clean gloves on both hands to prevent infections.
=I will inspect the cut end of the cord for the presence of two arteries and one vein to rule out congenital cardiac abnormalities.
=I will drain out all the blood and measure it to rule out postpartum hemorrhage.
=Measure the cord.
=I will hold the placenta in the palms of the hands with maternal side facing upwards.
=I will hold the cord with one hand inside the membranes with fingers spread out.
=I will Insert the other hand inside the membranes with fingers spread out.
=I will check whether all of the lobules are present and fit together.
=I will inspect the membranes for completeness by stripping the membranes.
=I will note the position of the insertion of the cord.
=I will decontaminate all the equipment used to prevent any cross infections.
=I will note the findings and if any missing part of the placenta and membranes are discovered evacuation or dilatation and curative may be considered.
=I will dispose of the placenta and membranes by incineration or place it in a leak proof.
=I will immerse both gloved hands in 0.5% chlorine solution then remove by turning them
=I will record all findings on the woman’s records.
=I will wash my hands thoroughly with soap and water and dry with clean dry cloth or air dry.
=I will record all findings on the woman’s records.