Laboratory testing often includes the hemoglobin, hematocrit, and platelet count and is sometimes repeated following delivery if significant blood loss occurs. Cervical exams are usually performed every 2 to 3 hours unless concerns arise and warrant more frequent exams.
Frequent cervical exams are associated with a higher risk of infection, especially if a rupture of membranes has occurred. Women should be allowed to ambulated freely and change positions if desired. Oral intake should not be withheld.
If the patient remains without food or drink for a prolonged period of time, intravenous fluids should be considered to help replace losses but do not need to be used continuously on all laboring patients. The first stage of labor begins when labor starts and ends with full cervical dilation to 10 centimeters. Thus, defining the onset of labor often relies on retrospective or subjective data. Friedman et al. Based on the analysis from his labor graphs, he proposed that labor has three divisions.
First, a preparatory stage marked by slow cervical dilation, with large biochemical and structural changes. This is also known as the latent phase of the first stage of labor. Second, a much shorter and rapid dilational phase is also known as the active phase of the first stage of labor.
Third, a pelvic division phase, which takes place during the second stage of labor. The first stage of labor is further subdivides into two phases, defined by the degree of cervical dilation. The latent phase is commonly defined as the 0 to 6 cm, while the active phase commences from 6 cm to full cervical dilation.
The presenting fetal part also begins the process of engagement into the pelvis during the first stage. Throughout the first stage of labor, serial cervical exams are done to determine the position of the fetus, cervical dilation, and cervical effacement.
Cervical effacement refers to the cervical length in the anterior-posterior plane. When the cervix is completely thinned out, and no length is left, this is referred to as percent effacement.
When the bony fetal presenting part is aligned with the maternal ischial spine, the fetus is 0 station. During the latent phase, the cervix dilates slowly to approximately 6 centimeters. The latent phase is generally considerably longer and less predictable with regard to the rate of cervical change than is observed in the active phase. A normal latent phase can last up to 20 hours and 14 hours in nulliparous and multiparous women, respectively, without being considered prolonged. Active labor with more rapid cervical dilation generally starts around 6 centimeters of dilation.
During the active phase, the cervix typically dilates at a rate of 1. Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid cervical dilation. The second stage of labor commences with complete cervical dilation to 10 centimeters and ends with the delivery of the neonate. This was also defined as the pelvic division phase by Friedman. After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts.
The fetus passes through the birth canal via 7 movements known as the cardinal movements. These include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.
In parturients without neuraxial anesthesia, the second stage of labor typically lasts less than three hours in nulliparous women and less than two hours in multiparous women. In women who receive neuraxial anesthesia, the second stage of labor typically lasts less than four hours in nulliparous women and less than three hours in multiparous women.
Several elements may influence the duration of the second stage of labor, including fetal factors such as fetal size and position, or maternal factors such as pelvis shape, the magnitude of expulsive efforts, comorbidities such as hypertension or diabetes, age, and history of previous deliveries.
The third stage of labor commences when the fetus is delivered and concludes with the delivery of the placenta.
Separation of the placenta from the uterine interface is hallmarked by three cardinal signs, including a gush of blood at the vagina, lengthening of the umbilical cord, and a globular shaped uterine fundus on palpation.
The function of the stages of labor is to create a universal definition that medical professionals can use to communicate with each other about labor.
Methods: We performed a secondary analysis of a cohort of 7, women who had a vaginal delivery at or beyond 37 weeks 0 days of gestation at a single tertiary care center from April to August Active management of the third stage of labor was routinely used during the study period.
The mean, median, interquartile range, 90th percentile, 95th percentile, and 99th percentile of the third stage of labor duration were calculated. Management of 4th Stage of Labor. Uploaded by Red Williams. Document Information click to expand document information Description: mncmncvhgfg. Did you find this document useful?
Is this content inappropriate? Report this Document. Description: mncmncvhgfg. Flag for inappropriate content. Download now. Related titles. Carousel Previous Carousel Next. Jump to Page. Search inside document. Blessy Solomon. Jeaneil Versace Albert. Florea Rodica. Confidential Enquiry into Maternal and Child Health. Sav- tise Seventh Report on Confi- a small difference in the amount of blood loss in the dential Enquiries into Maternal Deaths in the United King- woman who delivered their placenta by CCT as com- dom.
Penney G, Brace V. Near miss audit in obstetrics. Curr Opin Ac- Obstet Gynecol ; Cochrane Database Syst Rev ; 4. Csorba R: Management of postpartum hemorrhage. Or- CD Active versus 5. BMJ Pregnancy Childbirth ; No: CD WHO Recommendations for the preven- Active management of third Organization, Aflaifel N, Weeks DA.
Active management of the third hemorrhage. J Obstet Gynaecol Can. BMJ ; e doi: Spencer PM. Controlled cord traction in the management Gulmezoglu AM et al. Active management of the third of third stage of labour. British Medical Journal; Lancet 9.
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