3-93
(see fig. 8)
- If spontaneous placental separation does not occur, remove the placenta manually. Pass a gloved hand
into the uterine cavity and gently apply traction to the umbilical cord, using the side of the hand to develop
a cleavage plane between the placenta and the uterine cavity. - Inspect the placenta to ensure it is complete. Inspect the cord for the presence of the expected
two umbilical arteries and one umbilical vein. - After the delivery of the placenta, palpate the uterus to ensure that it has reduced in size and become
firmly contracted. - Inspect the birth canal in a systematic fashion. Evaluate lacerations of the vagina and/or perineum and
extensions of the episiotomy and repair if necessary (refer to Episiotomy section).
During the Fourth Stage of Labor:
- The likelihood of serious postpartum complications is greatest in the first hour or so after delivery. Palpate
the uterus to ensure that it is firm. Repeat uterine palpation through the abdominal wall frequently during
the immediate postpartum period to ascertain uterine tone. - Monitor pulse, blood pressure and the amount of vaginal bleeding every 15 minutes for the first hour, then
every 30 min. for 3 hrs after delivery to identify excessive blood loss. - Manage pain with NSAIDS or low dose narcotics (i.e., Motrin 800 mg 1 tablet tid with food or Tylenol
#3 1-2 tablets q 4-6 hrs). - Apply ice to the perineum for 20-30 minutes every 4-6 hrs to decreasing swelling after the delivery.
What Not to Do:
Do not contaminate the birth canal prior to birth.
Do not allow the episiotomy to tear into the rectum.
Do not forget to reduce umbilical cord.
Do not forget to suction the baby’s nose and mouth.
Do not forget to clamp and cut the umbilical cord.
Do not forget to clean and dry the baby.
Do not forget to deliver the placenta.
Do not forget to repair an episiotomy and any tears.
Do not forget to monitor the mother’s vital signs.
Symptom: OB Problems: Preterm Labor (PTL)
MAJ Marvin Williams, MC, USAIntroduction: Preterm birth as a result of preterm labor is the most common cause of infant morbidity
and mortality. Complications include respiratory distress syndrome (RDS), intraventicular hemorrhage (IVH),
necrotizing enterocolitis, sepsis, and seizures. Long term morbidity associated with PTL and delivery includes
chronic lung problems (bronchopulmonary dysplasia) and developmental abnormalities. Preterm labor is
defined as regular uterine contractions occurring with a frequency of 10 minutes or less between 20 and
36 weeks gestation, with each contraction lasting at least 30 seconds. When contractions are accompanied
by cervical effacement (thinning), dilation (opening), and/or descent of the fetus into the pelvis, it becomes
increasingly difficult to stop labor. The cause of preterm labor is unknown but many factors have been
associated with it and some include: dehydration, rupture of membranes, infections, uterine enlargement
(twins), uterine distortion (fibroids), and placental abnormalities (previa and abruption), smoking and substance
abuse. Approximately 10-15% of women will rupture the amniotic membrane around the fetus >1 hour prior to
the onset of labor. This is called premature rupture of membranes, or PROM. After PROM, labor must begin
promptly or infection will develop as bacteria ascend through the birth canal. Delivery should be completed
within 24 hours of PROM to avoid infection in fetus and mother. One of the most important causes of early
onset neonatal infection is group B streptococcus (GBS).
Subjective: Symptoms
Menstrual-like cramps, low back pain, abdominal or pelvic pressure, painless uterine contractions, and