Third Stage Of Labor

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Third Stage of Labor
1. Extends from birth of newborn to delivery of placenta; average duration is 30min for nullip and multip

Back 1

Third Stage of Labor
2. Maternal Assessment
a. BP,P, and RR q5m
b. Uterine fundus maintains tone and contraction pattern to deliver placenta by decreasing surface volume of uterus and shearing placenta from uterine wall
c. Monitor for signs of placental separation: uterus rises up in abdomen; uterine volume shrinks as a result of contractions creating a gush of blood vaginally as uterine contents are expelled; and as placenta is separating and beginning to be expelled, umbilical cord protrudes further from vagina and appears to lenthen

Front 2

Third Stage of Labor
3. Fetal assessment
a. Apgar score: quick method to assess fetal adaptation to extrauterine life;
five criteria are scored at 1 and 5 m after birth with 0,1, or 2 pts given for each criteria;
Apgar scores of 8 or greater indicate need for minimal intervention (nasopharyngeal suction and ocygen near face);
scores of 4 to 7 indicate need for oropharyngeal suctioning, tactile stimulation, and oxygen administration;
scores of 3 or less indicate need for resuscitation
b. Respirations: normally 30-60, may be irregular
c. Apical pulse: 120 to 160, may be irregular
d. Temp: skin temp above 97.8F (36.5C)
e. Umbilical cord: normally two arteries and one vein
f. Gestational age assessment: consistent with expected date of delivery
g. Physical assessment: abbreviated examination is conducted to detect presence of visible congenital anomalies

Back 2

Third Stage of Labor
4. Collaborative management
a. Encourage mother to rest and relaz while awaiting delivery of placenta
b. Immediate care of newborn includes placing in a modified Trendelenburg position, suctioning nose and oropharynx (bulb syrinte or DeLee mucus trap), providing and maintaining warmth (dry immediately with warm blankets, skin-to-skin contact with mother covered with warm blankets, radiant heat source, cap)
c. Assist parents in seeing and holding newborn to begin attachment
d. Document time of placental delivery, appearance and intactness of placents, mechanism of placental expulsion, and est delivery blood loss (avg 250 to 500 mL)
e. Administer oxytocic agent as ordered
f. Consider cultural practices in disposal of placenta

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Third Stage of Labor
5. Outcome is that mother and newborn experience a safe labor and birth

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Apgar Scoring
Color(Appearance): 0-blue, pale; 1-blue extremities, pink body; 2-completely pink
HR(Pulse): 0-Absent; 1-<100, 2->100
Reflex Irritability(Grimace): 0-absent; 1-grimace; 2-vigorous cry
Muscle Tone(Activity): 0-absent; 1-some flexion of extremeities; 2-active motion
Respiratory Effort (Respirations): 0-absent; 1-slow, irregular; 2-good cry