Active management of third stage of labor includes all except:
Correct Answer: Uterine massage
Description: Ans. B. Uterine massageStages of Labor Duration StageStarts/ EndsPrimiparousMultiparousAbnormalities1stLatentOnset of labor to 3-4 cm dilation6-11 hours4-8 hoursProlongation seen with excessive sedation hypotonic uterine contractions.Management: Rest and sedation Active4 cm to complete cervical dilation (10 cm)4-6 hours (1.2 cm/h)2-3 hours (1.5 cm/h)Prolongation: Cervical dilation of <1.2cm/h (primipara)/<1.5cm/h (multipara)Arrest: No cervical change in > 2 hoursCause: This abnormality is seen in a passenger (fetal size or abnormal presentation), pelvis, or power (dysfunctional contractions)Management:IV oxytocin - Hypotonic contractions Emergency cesarean section - Adequate contractions2ndComplete cervical dilation to delivered of the infant0.5-3.0 hours5-30 minutesSecond-stage arrest:* Failure to deliver within 1 hour (multipara) or 2 hours (nullipara)* Add additional 1 hour if epiduralCause: This abnormality is seen in a passenger, pelvis, or powerManagement:* Cesarean - Fetal head is not engaged* Trial of obstetric forceps or vacuum extraction - Fetal head is engaged3rdDelivery of infant to delivery of placenta0-0.5 hour0-0.5 hourProlonged third stage:* Failure to deliver placenta within 30 minutesCause: Consider placenta percreta / accreta/incretaManagement:* IV oxytocin* If oxytocin fails, attempt manual removal* Hysterectomy may be needed
Category:
Gynaecology & Obstetrics
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