2026 Obstetrics 2 - F.05 3rd and 4th Stage of Labor PDF

PCC SOM PCC SOM 2026 OBSTETRICS 2 F.05 3 AND 4 STAGE OF LABOR...

PCC SOM PCC SOM 2026 OBSTETRICS 2 F.05 3 AND 4 STAGE OF LABOR rd th 2026 OBSTETRICS 2 F.05 3rd AND 4th STAGE OF LABOR Uterine massage- Pad count, Inspect lumbar/ Lower OBSTETRICS 2 LECTURE PERINEAL SHAVING BEFORE DELIVERY back LECTURER: Dr. Sharon Marie Marcial MD FPOGS Insufficient evidence to recommend routine perineal o MassageC fundus to stimulate uterus DATE: December 02, 2024 shaving for women on admission in labor. contraction. This prevents bleeding. (no need shaving before delivery) o Check buttocks, bleeding might pool in the TOPIC OUTLINE Perineal hair is protective. We only shave if hair impedes lumbar area. Labor labor. Shaving is not routine. Binder Uterine contractions Breastfeeding for nipple stimulation enhancing Opestic Changes in the Cervix Late Side Effects attributable to shaving occur later such as: - oxytocin release from the pituitary gland of the Continuous support during Labor Irritation mother. Perineal Shaving before delivery Redness C Oxytocin makes the uterus contract. The 3rd Stage of Labor Uterine Pain and Bleeding Multiple superficial razor scratches Burning and itching of the vulva mother will complain of pain in the hypogastric area. It is called After Pains and Episiorraphy Wound Pain and Healing 3rd STAGE OF LABOR EPISIORRHAPHY WOUND PAIN AND HEALING 4th Stage of Labor Lecture/Important Notes/ Verbatim After the expulsion of the baby and involves the There should be no active bleeding because the separation and expulsion of the placenta and episiorrhaphy should have ligated bleeders. Objectives: membranes. Investigate excessive complaint of vulvar/rectal pain. To recognize labor ALWAYS check the placenta that it has complete WATCH OUT FOR HEMATOMA. To know the significant monitoring in every stage of cotyledons. **When a ptx complain of pain down there, we do not labor There are no exceptions! We always check the placenta assume that is episiorrhapy wound pain, we still have to To know various interventions and key points of What happens if a cotyledon is left in the uterus? → assess, because the pain specially if it is severe, may not be monitoring in every stage of labor Postpartum Hemorrage can occur because of the repair, it can be because of Hematoma and its intervention is different. WHAT IS LABOR? ❖ Uterine pain and bleeding UTERINE CONTRACTIONS (progressive) **It is normal that Uterus get cramps after delivery 4Th STAGE OF LABOR PROGRESSIVE (or significant) CHANGES IN THE especially during breastfeeding. It is in pain because Occurs 1-2 hours after 3rd stage CERVICAL DILATATION AND EFFACEMENT it is contracting. Contractions help so that PUERPERIUM: from delivery of membranes to 6 wks myometrium impedes blood vessel so the woman postpartum UTERINE CONTRACTIONS will not bleed. We monitor that bleeding is equal to ✓ POSTPARTUM CARE At least 1 in 10 mins or 4 in 20 mins 1 : 10 , 4 : 20 the lochia and not hemorrhagic bleeding ✓ BREASTFEEDING – AFTER PAINS Good contractions are contractions that occur 3 in **Uterine pain and bleeding go together because ✓ FAMILY PLANNING 3: 104 10 mins, with the severity appropriate for the stage of labor the bleeding here is lochia coming from the uterus ✓ VACCINATION STATUS ✓ FOLLOW UP CARE Early stages of labor: contractions should not be severe ❖ Episiorrhapy wound pain and healing Labor at 2nd stage: contractions should be more severe o **Episiorrhapy wound pain is painful, physiologically ---------------------------------------End --------------------------------- than early stage. wounds are painful. The wounds should be healing not bleeding, because when repairing the CHECKPOINT! CHANGES IN THE CERVIX episiotomy, it is presumed that during repair, we T/F Cervical effacement of >70-80% start of labor ligate the bleeders. ~ 1. Labor is progressive Uterine contraction For Cervical dilatation of >3cms ***- > 4 cm: good contractions 2. In uterine contraction, good contractions are before 4cms= start labor, now 6cms= start labor 6 cm: LABOR! UTERINE PAIN AND BLEEDING contractions that occur 4 in 10 mins uniformity: a woman is in labor if she is at 4cms with good f Uterus should remain contracted. ~ 3. 3rd stage of Labor is After the expulsion of the contractions or 6cms which definitely means she is in labor! Uterotonics: (helps uterus to contract) baby and involves the separation and expulsion of ✓ OXYTOCIN the placenta and membranes. CONTINUOUS SUPPORT DURING LABOR o Beware because it is also a peripheral 4. There should be an active bleeding because the ELEMENTS OF SUPPORT: vasodilator. Therefore it dilates the vessel in episiorrhaphy should have ligated bleeders Emotional support (continuous presence, the periphery, which cause hypotension ~ 5. 4th Stage of Labor Occurs 1-2 hours after 3rd stage reassurance, and praise) leading to tachycardia of labor Physical measures of comfort (massages, comforting o Intervention: stop oxytocin drip active ~ 6. Oxytocin is a uterotonics, but it is also a peripheral touches, acupressure) ✓ CARBOPROST X vasodilator, which causes hypertension leading to Helping the woman express her needs and wants to others. o Do not give to px with active or history of bronchial asthma ✓ METHYLERGONOVINE MALEATE he gasthand tachycardia 1.T 2.F(3 in 10mins) 3.T 4.F (no active bleeding) 5.T 6.F (hypotension) o Cautious in giving to hypertensive patients NOTE TAKER: Balao-as|✔️Mabanta|Martinez|📑Sangdaan Page 1 | 2 NOTE TAKER: Balao-as|✔️Mabanta|Martinez|📑Sangdaan Page 2 | 2 MGM.