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JMJ

Zamora, Barbara Ally BSN 2H August 31, 2021

Learning Task#1-Video Analysis

Based on the video that is presented answer the following questions and attached to files:
1. Why Ritgen's maneuver is needed during 2nd stage of labor?

The second stage of labor/ pushing stage/ pelvic stage begins when the cervix is fully
dilated and ready for childbirth. The delivery of the fetal head should be managed by the
Ritgens maneuver. When the head has distended the vulva and perineum sufficiently to
widen the vaginal introitus to a diameter of 5 cm or greater, a towel-draped, gloved hand
may be used to put forward pressure on the fetus's chin via the perineum immediately in
front of the coccyx. Concurrently, the other hand applies superior pressure to the occiput. It
is customarily referred to as the Ritgen maneuver or the modified Ritgen maneuver. This
technique enables for controlled head delivery. It also encourages extension, allowing the
head to be delivered with its smallest diameters going through the introitus and over the
perineum protecting its musculature (kirukki, 2013).

2. What are the nursing responsibilities before giving oxytocin injection to the mother
during the 3rd stage of labor?

After the baby is born and the umbilical cord is cut, there is usually a lull for several
minutes. Then the uterus starts contracting again. The third stage of labor is actually the
shortest stage and managing it can either be physiological or active management. On active
management, Uterotonics appear to be the most important factor to decrease postpartum
blood loss and the choices include oxytocin (because it is more effective than the other drugs
and has fewer side effects). Uterotonics may be given before or after placental expulsion
without increasing rates of postpartum hemorrhage, placental retention, or third-stage labor
length (Soltani, 2010). The responsibility of the nurse before giving oxytocin injection to the
mother is to palpate first the lower abdomen to confirm no additional fetuses (undelivered
second twin). Immediately after the birth of the baby, check for the presence of a second
baby by palpating the uterus through the mother’s abdomen. When the nurse
feels certain that the uterus does not contain a second baby, and she can feel that it has
reduced in size to no larger than at 24 weeks of gestation, proceed to the next step. The
reason for checking so carefully is because the drug that the nurse will administer to the
mother in the next step will make the uterus contract so powerfully that it will damage a
baby that remains inside it. If one finds that there is a twin, give the uterotonic drug after the
birth of the second baby. Synthetic oxytocin is identical to that produced by the posterior
pituitary. Action is noted at approximately 1 minute, and it has a mean half-life of 3 to 5
minutes. It isn't given Intravenously as a large bolus, it is instead given as a dilute solution by
continuous intravenous infusion or as an intramuscular injection. Despite the routine use of
oxytocin, no standard prophylactic dose is established for its use following either vaginal
delivery or CS (Nian Baring, 2011). Mothers are given the medication oxytocin after birth to help
the uterus (womb) contract and therefore reduce blood loss (ClinicalTrials.gov, 2012).

3. What is the reason behind why we are delaying the cord clamping for 1-3mins.?

Late cord clamping (performed approximately 1–3 min after birth) is recommended for all
births while initiating simultaneous essential neonatal care. Delaying umbilical cord
clamping appears to benefit both term and preterm babies. Delaying umbilical cord clamping
raises hemoglobin levels at delivery and improves iron reserves in the first few months of life
in term newborns, which may have a positive influence on developmental outcomes. It has
been associated with substantial neonatal benefits in preterm babies, such as enhanced
transitional circulation, better establishment of red blood cell volume, reduced need for
blood transfusion, and a lower incidence of necrotizing enterocolitis and intraventricular
hemorrhage. According to WHO, delaying cord clamping allows blood flow between the
placenta and neonate to continue, which may improve iron status in the infant for up to six
months after birth. This may be particularly relevant for infants living in low-resource
settings with reduced access to iron-rich foods.

4. Why Controlled Cord Traction and Countertraction are very important prior to the
delivery of the placenta?

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, responsible for

about a quarter of all maternal deaths. PPH is the loss of more than 500 ml of blood
following delivery of the baby. Most bleeding comes from where the placenta was attached
to the uterus and is bright or dark blood and usually thick. To minimize the risks of PPH in
this critical stage of labor, a set of procedures have been developed that all birth attendants
should follow, called active management of the third stage of labor (AMTSL). Active
management of the third stage of labor involves giving a prophylactic uterotonic, early cord
clamping, and controlled cord traction to deliver the placenta. A part of the AMTSL is
Controlled cord traction (CCT) which is traction applied to the umbilical cord after a
woman's uterus has contracted following her baby's birth and her placenta is felt to have
separated from the uterine wall, whilst also counter-pressure is applied to her uterus beneath
her pubic bone until her placenta delivers. This should only be performed when a skilled
attendant is present at the birth. To also avoid inversion of the uterus (turning inside out and
coming out of the vagina), controlled cord traction should never be applied without counter-
pressure to the abdomen. Controlled cord traction can cause complications like uterine
inversion, especially if it is used before the uterus has contracted sufficiently and without
delivering appropriate counterpressure to the uterine fundus. As a result, it is a manual skill
that requires extensive practical training in order to be applied safely. Cord traction may
hasten the process of separation and delivery of the placenta, thus reducing blood loss and
the incidence of retained placenta. It is thought that the administration of a uterotonic drug
may cause uterine contraction and retention of the placenta if not combined with controlled
cord traction ( Hofmeyr et al., 2015).

References:

Controlled cord traction | AIMS. (2015). Aims.org.uk. https://www.aims.org.uk/journal/item/controlled-cord-traction

Delayed Umbilical Cord Clamping After Birth. (2020). Acog.org. https://www.acog.org/clinical/clinical-guidance/committee-

opinion/articles/2020/12/delayed-umbilical-cord-clamping-after-birth

Hofmeyr, G. J., Mshweshwe, N. T., & Gülmezoglu, A. M. (2015). Controlled cord traction for the third stage of labour. Cochrane Database
of Systematic Reviews. https://doi.org/10.1002/14651858.cd008020.pub2

kirukki. (2013). Care during labour and delivery. Slideshare.net. https://www.slideshare.net/kirukki/care-during-labour-and-delivery

Labour and Delivery Care Module: 6. Active Management of the Third Stage of Labour: View as single page . (2021). Open.edu.
https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=274&printable=1

Nian Baring. (2011). Vaginal Delivery - Chapter 27 of Williams Obstetrics 24th Edition. Slideshare.net.
https://www.slideshare.net/nianbaring/vaginal-delivery-chapter-27-of-williams-obstetrics-24th-edition

Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants. (2019). World Health Organization.
https://doi.org//entity/elena/titles/cord_clamping/en/index.html

Oxytocin Administration in the Third Stage of Labour - A Study of Appropriate Route and Dose - Full Text View - ClinicalTrials.gov.
(2012). Clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT00200252