REVIEWER NOTES FOR MCN LEC SAS 9 TO 16

SAS 9:

PREGNANCY – It last for 10 lunar months or ( 40 weeks or 280 days)

*Fetus Growth Stops at 38th Weeks or 9.5 lunar months
OVULATION AGE - 2 WEEKS LESS THAN THE LENGTH OF PREGNANCY OR GESTATIONAL AGE

LENGTH OF PREGNANCY – FROM LMP UPTO THE PRESENT TIME OF PREGNANCY

ZYGOTE – PRODUCT OF FERTILIZATION

CONCEPTUS – PRODUCT OF PREGNANCY

ORGANOGENESIS - Organogenesis is the phase of embryonic development that starts at theend

of gastrulation and continues until birth

BABINSKI REFLEX- Babinski reflex is one of the normal reflexes in infants. Reflexes are responses
that occur when the body receives a certain stimulus. The Babinski reflex occurs after the sole
of the foot has been firmly stroked. The big toe then moves upward or toward the top surface
of the foot.

LANUGO- fine, soft hair, especially that which covers the body and limbs of a human fetus or
newborn.

Lightening- a drop in the fundal level of the uterus during the last weeks of pregnancy (32
weeks) as the head of the fetus engages in the pelvis.
------------------------------------------------------------------------------------------------------------------
End of Gestational Weeks Highlights-

*4th Weeks - EYES, EARS, NOSE – DISCERNIBLE BULGE HEART; spinal cord is formed and fused
at midpoint. Length is 0.75 to 1cm and weights around 400 mg.

*8th Weeks – Organogenesis is complete, External genetalia is present but can't be discerned by
simple observation, presence of gestational sac, facial features can be discerned, Length is 1
inch and weights around 20g.

*12th Weeks – Sex is distinguishable -HEARTBEAT AUDIBLE THROUGH DOPPLER -KIDNEY

PRESENT – URINE ABSENT -BONE OSSIFICATION BEGINS; TOOTH BUDS -+NAILS BEDS -
+BABINSKI, Length is around 7 to 8cm and weights around 45g.

*16th Weeks – Sex can be determined via ultrasound, urine is present on the amniotic fluid,
LANUGO is well formed, FHB is audible with a stethoscope ,UNCOORDINATED SWALLOWING
REFLEX, Length is around 10 to 17 cm and it weights 55 to 120g

*20th Weeks - -BIORHYTHMS -QUICKENING - INSULATOR PRESENT (BROWN FAT, VERNIX

CASEOSA, HAIR) - MECONIUM PRESENT ( IS THE FIRST FECES, OR STOOL, OF THE
NEWBORN.)

*24th Weeks- REACTIVE TO SOUND, INCREASED LUNG SURFACTANT, OPEN EYES

*28th Weeks- HYPERBARIC OXYGENATION CAN DAMAGE THE RETINA, ALVEOLI MATURES,
TESTES DESCENDS (CRYPTORCHIDISM- also known as undescended testis, is the failure of one or both testes to
descend into the scrotum )

*32 Weeks- -OLD MAN IS LOST -BREECH OR VERTEX -ACTIVE MORO REFLEX -FINGERNAILS
GROW -FE STORES.

*36th Weeks- -1-2 CRISSCROSS - MINERALS DEPOSITS - DIMINISHING LANUGO

*40th Weeks- -HEMOGLOBIN MATURES -ACTIVE KICKS- VERNIX CASEOSA IS FULLY FORMED .
(Crown RUMP length)

OVERVIEW OF FETAL CIRCULATION

BLOOD IS OXYGENATED IN THE PLACENTA. HIGHLY OXYGENATED AND NUTRIENT-ENRICHED BLOOD RETURNS TO
THE FETUS FROM THE PLACENTA VIA THE LEFT UMBILICAL VEIN. SOME BLOOD ENTERS LIVER SINUSOIDS; MOST OF
THE BLOOD BYPASSES THE SINUSOIDS BY PASSING THROUGH THE DUCTUS VENOSUS AND ENTERS THE INFERIOR
VENA CAVA (IVC) FROM THE IVC, BLOOD ENTERS THE RIGHT ATRIUM, WHERE MOST OF THE BLOOD BYPASSES THE
RIGHT VENTRICLE THROUGH THE FORAMEN OVALE TO ENTER THE LEFT ATRIUM.FROM THE LEFT ATRIUM, BLOOD
ENTERS THE LEFT VENTRICLE AND IS DELIVERED TO FETAL TISSUES VIA THE AORTA. POORLY OXYGENATED AND
NUTRIENT-POOR FETAL BLOOD IS SENT BACK TO THE PLACENTA VIA RIGHT AND LEFT UMBILICAL ARTERIES. SOME
BLOOD IN THE RIGHT ATRIUM ENTERS THE RIGHT VENTRICLE; BLOOD IN THE RIGHT VENTRICLE ENTERS THE
PULMONARY TRUNK, BUT MOST OF THE BLOOD BYPASSES THE LUNGS THROUGH THE DUCTUS ARTERIOSUS.

SHUNTS AND BYPASSES:

FORAMEN OVALE- BETWEEN R ATRIUM AND L ATRIUM ( 1 YEAR)

DUCTUS VENOSUS- BYPASSES THE LIVER (15-20 DAYS)
DUCTUS ARTERIOSUS- BYPASSES THE LUNGS (1 TO 3 MONTHS) Within 48 hrs if birth by muscular
contraction
UMBILICAL VEIN- CARRIES OXYGENATED BLOOD AND NUTRIENTS TO FETUS (OBLITERATES AFTER BIRTH)
UMBIBLICAL ARTERIES- CARRIES CARBON DIOXIDE AND OTHER WASTES FROM FETUS TO MATERNAL
CIRCULATION. (2 TO 3 MONTHS CLOSURE)

~PRESSURE IS HIGHER ON THE RIGHT SIDE OF THE HEART BEFORE BIRTH

SAS 10

TERATOGEN – are any factors, chemical or physical, that adversely affect the fertilized ovum,
embryo or fetus.

*Usually taken from, alcohol, excessive caffeine, tobacco, harmful drugs, recreational drugs, some
medicines and health problems

TORCH INFECTIONS -
*Toxoplasmosis (Toxoplasma gondii)
* Other Infections like syphilis, hepatitis B virus and HIV
* Rubella
* Cytomegalovirus
* Herpes Simplex Virus (HSV-2)

Transmission can either be vertically transmitted via Placenta or via blood, blood fluids or breast milk.

TORCH SCREENING – immunologic test on the pregnant women to identify fetal risk factors on the
newborn to detect if antibodies vs teratogens are present.

Result: Negative=normal

*If positive for IgM abs, recent or current infection

*If positive for IgG, Maternal abs crossed placenta

Toxoplasmosis – is the leading cause of death from foodborne illness on the United States.
Toxoplasmosis is most present on cat litter and raw undercooked meat.
Toxoplasmosis on infants – causes CNS damage, Hydrocephalus, microcephaly, intracerebral
calcification, retinal deformities

Medication includes - SULFONAMIDES, PYRIMETHAMINE, FOLIC ACID, SPIRAMYCIN

SYPHYLIS – mostly gotten from engaging unprotected sex from someone infected. The disease starts as a
painless sore, typically found on your genitals, rectum or mouth.

RUBELLA (German Measles) - Spreads when infected person coughs or sneezes, this causes serious birth
defects in developing baby.
*Humans are the only known reservoir of this virus.

Protection: MMRV VACCINE.

PARVOVIRUS – virus can pass via placenta to fetus, it can be gotten through respiratory secretions
(coughing, sneezing) through blood or blood products.

*PAROVIRUS B19 only affects humans

LISTERIOSIS – infection caused by eating foods contaminated with bacterium listeria

monocytogenes usually from (raw sprouts, soft cheese, raw milk, smoked fish, Meat and hot
dog)

CYTOMEGALOVIRUS – can be transmitted to an unborn baby during pregnancy leading to birth

defects and long-term disabilities, it is spread through direct contact of fluids including saliva or
mucus. This is a silent type of virus meaning it has no symptoms or signs.

HERPES SIMPLEX VIRUS – gotten through sexual contact, forces women to delay conception
which may decrease their chance on pregnancy, if pregnant the virus might be transmitted to
the fetus leading to neonatal herpes and other complications.

ZIKA VIRUS – zika virus infection is primarily transmitted through infected mosquito bites
(Aedes aegypti), can be also transmitted via unprotected sex by someone infected with the
virus. Infection during pregnancy causes microcephaly, and the first symptoms develop within 3
to 12 days .

SAS 11
PARTURITION – a process which the fetus, membranes and placenta are expelled from the uterus. It is
also called LABOUR.

THEORIES OF LABOR
Uterine Stretch Theory – a hollow organ when stretched to capacity contract and empty.

Oxytoxin Theory – production of oxytocin from posterior pituitary gland- contraction of the uterus

Progesterone Deprivation Theory – from the word deprivation itself (means decrease) progesterone
inhibit uterine mobility. A decrease in progesterone ---- uterine contraction.

Prostagladin Theory – increase prostaglandin synthesis---- uterine contraction.

Theory of Aging Placenta- decrease in blood supply to the placenta----- uterine contraction.

The Similarities between 5 of the theories is that they all contract.

Signs of Labour -
*BABY DROPS
*FREQUENT CONTRACTIONS
*INCREASED BACK PAIN
*DIARRHEA
*WATERS BREAK

TRUE CONTRACTIONS ABOUT LABOR:

*BEGINS IRREGULARLY BUT BECOME REGULAR AND PREDICTABLE
*FELT 1ST IN THE LOWER BACK AND SWEEP AROUND TO THE ABDOMEN IN A WAVE
*CONTINUE NO MATTER WHAT THE WOMANS LEVEL OF ACTIVITY
*INCREASE IN DURATION, FREQUENCY AND INTENSITY
*ACHIEVE CERVICAL DILATATION

FALSE CONTRACTIONS ABOUT LABOR:

*BEGIN & REMAIN IRREGULAR
*FELT 1ST ABDOMINALLY & REMAINED CONFINED TO THE ABDOMEN AND GROIN
*OFTEN DISSAPPEAR WITH AMBULATION AND SLEEP
*DO NOT INCREASE IN DURATION, FREQUENCY AND INTENSITY
*DO NOT ACHIEVE CERVIAL DILATATION

SAS 12
5 P’S of LABOR:

PASSAGE (THE PELVIS)

PASSENGER (THE FETUS)
POWERS OF LABOR (UTERINE FACTORS)
PSYCHE
POSITION

TYPES OF PELVIS

GYNECOID - ROUND IN SHAPE (FEMALE)

ANDROID – HEART IN SHAPE (MALE)

ANTHROPOID – ANTEROPOSTERIOR OVAL (APE LIKE)

PLATYPELOID – TRANSVERSE OVAL (FLATTENED)

TERMINOLOGIES

1. PROJECTIONS – PROJECTS ABOVE THE SURFACE OF THE BONE

*TUBEROSITY – ROUNDED PROMINENCE (USUALLY SERVES AS ATTACHMENTS FOR MUSCLES
OR LIGAMENTS
*TUBERCLE – SMALL ROUNDED POINT OF A BONE
*PROMINENCE – BONES NOTICEABLE FROM THE SKIN SURFACE
*CREST- EDGE OF THE BONE
*TROCHANTER- LARGE PROMINENCE OF THE SIDE OF THE BONE

2. HOLES – OPENING OR GROOVE IN THE BONES

*FORAMEN- BONY HOLLOW ARCHWAY

*FISSURE – OPEN SLIT OR BETWEEN BONES
*FOSSA- DEPRESSION

3. ARTICULATIONS – TWO BONES BECOME TOGETHER

*PROCESS – BONY PROJECTIONS ALLOWS ATTACHMENT OF THE MUSCLE
*NOTCH DEPRESSION – THAT PROVIDES STANDARD STABILIZATION TO THE ADJACENT
ARTICULATING BONE

*LINE – RIDGE ALONG THE BONE THAT ALLOWS MUSCLES TO ATTACH TO THE BONE

SAS 13
Cranium is composed of 8 bones, frontal, 2 parietal , occipital, sphenoid, ethmoid & 2 temporal
bones.

Cranial Sutures- are fibrous joints connecting the bones of skull, allowing the bones to move &
overlap (molding), diminishing the size of the skull so it can pass through the birth canal.

*SAGITTAL SUTURE – JOINS THE 2 PARIETAL BONES

*CORONAL SUTURE – LINE OF JUNCTURE OF THE FRONTAL BONES & THE 2 PARIETAL BONES
*LAMBDOID SUTURE – JUNCTURE OF THE OCCIPITAL BONE & THE 2 PARIETAL BONES.

FONTANELLES- fontanelle (or fontanel) (colloquially, soft spot) is an anatomical feature of the
infant human skull comprising soft membranous gaps (sutures) between the cranial bones that
make up the calvaria of a fetus or an infant. Fontanelles allow for stretching and deformation of
the neurocranium both during birth and later as the brain expands faster than the surrounding
bone can grow

*ANTERIOR FONTANELLE (BREGMA) - at the junction of the coronal & sagittal sutures, diamond
shaped and closes at 18 months
*POSTERIOR FONTANELLE (LAMBDA) - at the junction of the lamboidal & sagittal sutures,
triangular and smaller than the bregma, closes at 2-3 months.
*VERTEX – The space between the fontanelles

MOLDING- REFERS TO THE CHANGE IN SHAPE OF THE FETAL SKILL PRODUCED BY THE FORCE OF
UTERINE CONTRACTIONS, MOLDING LAST ONLY A DAY OR 2 DAYS.

DIAMETERS OF FETAL SKULL -

*SUBOCCIPITOBREGMATIC DIAMETER – Narrowest of the bunch only 9.5cm, from the interior
aspect of the occiput to the center of the anterior fontanelle
*OCCIPITOFRONTAL DIAMETER – 12 cm, measured from the bridge of the nose to the occipital
prominence.

*OCCIPITOMENTAL DIAMETER – WIDEST, 13.5cm. Measured from chin to the posterior

fontanelle

FULL FLEXION – suboccipitobregmatic diameter will be presented

MODERATE FLEXION – OCCIPITOFRONTAL DIAMETER IS PRESENTED

FETAL ATTITUDE – DESCRIBES THE DEGREE OF FLEXION A FETUS ASSUMES DURING LABOR
*NORMAL OR GOOD ATTITUDE – CHIN TOUCHES THE STERNUM
* MODERATE FLEXION – MILITARY POSITION
*PARTIAL EXTENSION – PRESENTS THE BROW
* COMPLETE EXTENSION – POOR FLEXION, BACK ARCHED, NECK EXTENDED.

FETAL ENGAGEMENT – the settling of the presenting part of the fetus far enough into the pelvis
to be at the level of ISCHIAL SPINES.

*FLOATING – IF THE PRESENTING PART IS NOT YET ENGAGED

*DIPPING – PRESENTING PART IS DESCENDING BUT HAS NOT YET REACHED THE ISCHIAL SPINES

4 TYPES OF CEPHALIC PRESENTATION :

*VERTEX
*BROW
*FACE
*MENTUM

BREECH PRESENTATION – EITHER THE BUTTOCKS OR FEET ARE THE 1ST BODY PARTS THAT WILL
MAKE CONTACT WITH THE CERVIX

3 TYPES OF BREECHES:
*COMPLETE (GOOD FLEXION)
*FRANK (MODERATE FLEXION)
*FOOTLING BREECH (VERY POOR FLEXION)

SAS 14
3 PHASES OF UTERINE CONTRACTIONS
*INCREMENT (CRESCENDO) - phase of increasing and building up. The first and longest phase.
*ACME (APEX) - peak of uterine contraction
*DECREMENT (DECRESCENDO) - phase of decreasing contraction, the last and end phase

MEASURING CONTRACTIONS -

*DURATION – PERIOD FROM THE BEGINNING OF INCREMENT TO THE COMPLETION OF

DECREMENT OF THE SAME CONTRACTION, MAX DURATION IS 90 SECONDS IN THE TRANSITION
PHASE
*FREQUENCY- PERIOD FROM THE BEGINNING OF 1 CONTRACTION TO THE NEXT BEGINNING
CONTRACTION, EXPRESSED IN EVERY MINUTES.
*INTENSITY – REFERS TO THE STRENGHT OF A UTERINE CONTRACTION, USUALLY DETERMINED
BY PALPITATION.
PALPATION – PLACING THE HAND LIGHTLY ON FUNDUS WITH THE FINGER SPREAD; DESCRIBED
AS MILD, MODERATE, STRONG BY JUDGING THE DEGREE OF INDENT ABILITY / DEPRESS ABILITY
OF THE UTERINE WALL DURING ACME.

*IF UTERINE FUNDUS IS FIRM AND CANNOT BE INDENTED WITH FINGERS THE INTENSITY IS
STRONG.
*IF THE FUNDUS IS DIFFICULT TO INDENT, THE INTENSITY IS MODERATE.
*IF THE FUNDUS IS TENSE BUT CAN BE INDENTED EASILY, THE INTENSITY IS MILD.

INTRAUTERINE CATHETHER – MEASURES THE STRENGHT OF CONTRACTIONS DIRECTLY, AT

ACME INTENSITY RANGES FROM 30mm TO 55mm Hg of pressure.
RESTING TONUS AVERAGE = 10 mm Hg

EFFACEMENT – SHORTENING AND THINNING OF THE CERVICAL CANNAL; NORMALLY IT IS 1 TO

2 CM LONG BUT WITH EFFACEMENT THE CANAL VIRTUALLY DISAPPEARS.

PRIMIPARA – EFFACEMENT OCCURS BEFORE DILATATION

MULTIPARAS- DILATATION MAY PROCEED BEFORE EFFACEMENT IS COMPLETE BUT MUST

OCCUR BEFORE THE FETUS CAN BE SAFELY PUSHED.

COUNTOUR CHANGES -
*UPPER PORTION BECOMES THICK AND ACTIVE TO PREPARE STRENGHT TO EXPEL FETUS
*LOWER SEGMENT BECOMES THIN WALLED, SUPPLE AND PASSIVE TO PUSH OUT FETUS EASILY

PHYSIOLOGIC RETRACTION RING – BOUNDARY BETWEEN THE 2 PORTION BECOMES MARKED

BY A RIDGE ON THE INNER UTERINE SURFACE.

SECONDARY POWERS :

A. MATERNAL BEARING DOWN/PUSHING - READINESS FOR PUSHING

B. INTRA-ABDOMINAL PRESSURE – AS WOMAN PUSHES, INTRA-ABDOMINAL PRESSURE
INCREASES.

PSYCHOLOGICAL RESPONSE OF THE MOTHER

A. CULTURAL INFLUENCES – HOW A SOCIETY VIEWS CHILDBIRTH

B. EXPECTATIONS AND GOALS – FOR THE LABOR PROCESS, WHETHER REALISTIC, ACHIEVEABLE
OR OTHERWISE.
C.FEEDBACK FROM OTHER PEOPLE – PARTICIPATING IN THE LABOR PROCESS.

NOTE: FEAR AND ANXIETY AFFECTS LABOR PROGRESS, A WOMAN WHO IS RELAX USUALLY HAS
A SHORTER AND LESS INTENSE LABOR.

SUPPORT SYSTEM
* THE HUSBANDS PRESENCE – LESS ANXIETY, EMOTIONAL TENSION AND LESS PAIN
PERCEPTION
*THE ATTENDING NURSE – PROVIDES A SUPPORTING AND CARING ENVIRONMENT,
RESPECTING THE CLIENTS' NEEDS AND FAMILY. PROVIDES GOOD ATTITUDE AND THERAPEUTIC
COMMUNICATION.

POSITION OF PARTURIENT

1. LEFT LATERAL RECUMBENT (LLR) OR LEFT SIDE LYING POSITION – most comfortable for fetal
well being, prevents SUPINE HYPOTENSION SYNDROME (vena cava syndrome). AVOID SUPINE
POSITION.
2. OPTIMAL POSITION- MAY VARY AND RANGES TO SQUATTING, SITTING, SEMI RECLINED
POSITION OR TO AMBULATING POSITION.

3.LITHOTOMY POSITION – MOST COMMON FOR 2ND STAGE OF LABOR. FAVORS THE
HEALTHCARE PROVIDER.

SAS 15

ENGAGEMENT- ENGAGEMENT IS ASSESSED BY VAGINAL AND CERVICAL EXAMINATION

FLOATING – IF THE PRESENTING PART IS NOT YET ENGAGED
DIPPING – PRESENTING PART IS DESCENDING BUT HAS NOT YET REACHED THE ISCHIAL SPINES.

MECHANISMS OF LABOUR -

ENGAGEMENT --> DESCENT --> FLEXION --> INTERNAL ROTATION --> EXTENSION --> EXTERNAL
ROTATION (RESTITUTION) --> EXPULSION OF INFANT.

ENGAGEMENT – OCCURS WHEN THE LARGEST DIAMETER OF THE FETAL HEAD FITS INTO THE
LARGEST DIAMETER OF THE MATERNAL PELVIS.
DESCENT- Downward passage of the presenting part through the pelvis. During the 1st stage
and early 2nd stage of labor, descent of the fetus is secondary to uterine contraction and
amniotic fluid pressure. In the active phase of the 2nd stage of labor, descent of the fetus is due
to voluntary use of abdominal muscle and pushing.

FLEXION - As the fetal head comes in contact with the pelvic floor, cervical flexion occurs. This
allows the presenting part of the fetus to be sub-occipito bregmatic. In this position, the fetal
skull has a smaller diameter, which assists passage through the pelvis.

INTERNAL ROTATION - The pelvic floor has a gutter shape, with a forward and downward Slope.
This allows the head to rotate from left or right occipito-transverse position to an occipito-
anterior position.

EXTENSION - The occiput slips beneath the suprapubic arch as the head extends and the nape is
pivoting against the arch.

EXTERNAL ROTATION - When the head is delivered, the external rotation occurs so that the
head rotates to the position which accord with engagement. The shoulder descends in a path
similar to that traced by the head.

EXPULSION - Anterior shoulder rotates forward, then will be delivered outside pelvis, followed
by posterior shoulder, The rest of the body is then delivered Birth of the fetus ends the second
stage of labor.

DESCENT AND DELIVERY OF THE FETAL HEAD DURING LABOUR

ENGAGEMENT – FETAL HEAD ENTERS PELVIC INLET

ADVANCEMENT – TO THE ISCHIAL SPINES, ROTATION AND FLEXION OF THE FETAL HEAD ,
CONCURRENTLY THE FETAL SHOULDERS ENTER THE PELVIS.

DELIVERY- OF FETAL HEAD FOLLOWING EXTENSION

RESTITUTION – NECESSARY FOR THE DELIVERY OF FETAL SHOULDERS AND BODY.

4 METHODS OF DETERMINING FETAL PRESENTATION, POSITION AND LIE.

* ABDOMINAL INSPECTION & PALPITATION (LEOPOLDS MANUEVER)
*VAGINAL EXAMINATION
*AUSCULTATION OF FHT
*SONOGRAPHY
SAS 16
STAGES OF LABOUR

1. FIRST STAGE (STAGE OF CERVICAL DILATION) - Begins with the onset of regular contractions
and ends with complete dilation.
*Latent Phase – 6 To 8 hours, Cervix dilates from 0 to 3cm. Frequency of 5-10 min; Duration
30-45 seconds, intensity is MILD to MODERATE.
*Active Phase- 3 to 6 hours, Cervix dilates from 4 to 7cm, Active phase last 3 hours in a
Nullipara & 2 hours in a multipara, Frequency is 3 to 5min; duration 45-60 seconds; intensity is
MODERATE. Administration of analgesic has no effect on labor progress at this stage.
*Transition Phase- Cervix dilates from 8 to 10 cm max, at the end of this phase both full
dilatation (10cm) & full effacement (full obliteration of cervix) will have occurred. Frequency is
2 to 3 minutes; duration is 60 to 90seconds; intensity has reached the peak.

2. SECOND STAGE (STAGE OF EXPULSION) - Begins with complete cervical dilation and ends with
delivery of fetus.
Ferguson Reflex – the urge to bear down as the presenting part presses on the stretch
receptors on the pelvic floor causing release of oxytoxins.
*Combination of Contractions & Cardinal movements helps expel the fetus.
*perineum begins to bulge & appear tense
*anus becomes everted & stool may be expelled
*vaginal introitus opens & fetal scalp appears at the vaginal opening
*at first opening is slit-like, then becomes oval then circular
* The circle enlarges & this is called CROWNING RITGENS MANUEVER.

3.THIRD STAGE (PLACENTAL STAGE) - Begins immediately after fetus is born and ends when the
placenta is delivered. Placenta is palpated as firm and round mass just below the level of the
umbilicus.

PLACENTAL SEPERATION – active bleeding on the maternal surface of the placenta begins with
separation; the bleeding helps push it away from the attachment site.
*As separation is completed, the placenta sinks to the lower uterine segment of the upper
vagina.

SIGNS OF PLACENTAL SEPERATION:

*lengthening of the umbilical cord
*Sudden gush of vaginal blood
*Change in the shape of the uterus; globular. Which is called CALKIN’S SIGN – 1st Sign.
*Firm contraction of the uterus
*appearance of the placenta at the vaginal opening

SCHULTZE PRESENTATION - Placental expulsion with the fetal surface presenting. This indicates
placental separation progressed from the inside to the outer margins

DUNCAN PLACENTA- if the placenta separates with the MATERNAL SIDE (raw,red & irregular
with the cotyledons showing)

PLACENTAL EXPULSION :
*after separation, the placenta is delivered either by the natural bearing-down effort of the
mother or by the gentle pressure on the contracted uterine fundus by the physician or the
nurse (CREDE’S MANUEVER)

Crede Manuever

CONTROLLED CORD TRACTION (CCT)

*Never apply pressure on a postpartum uterus in a non-contracted state because it may cause
the uterus to evert & hemorrhage.
*if it does not deliver spontaneously, it can be removed manually
*After delivery, inspect the placenta to make sure it is intact & normal in weight & appearance
(15-28 COTYLEDONS)
*with the delivery of placenta, it will indicate that the 3rd stage is over.

4. FOURTH STAGE (MATERNAL HOMEOSTATIC STABILIZATION STAGE) - begins after the delivery
of the placenta and continues 1 to 4 hours after the delivery which initiates POSTPARTUM
period, it is pretty much the stage of recovery & bonding.

LEUKOCYTOSIS- sharp increase in circulating WBC’S due to stress and exertion

RELAXIN - from the ovaries soften cartillage and sacrococcygeal joint increasing the size of the
pelvic ring by as much as 2cm.

NURSING CARE AND RESPONSIBILITIES DURING STAGES OF LABOUR

FIRST STAGE:
*Integration of family expectations
-Safety of Mom & baby
-Specific expectations (For example; Birthplans)
*Nursing Support
-Emotional Support
-Comfort Measures
-Information and Advice
-Advocacy
-Support of a partner
*Cultural Beliefs
-Modesty
-Pain expressions
-Specific Beliefs.

SECOND STAGE:
*Provision of Care
-Complete dilatation
-More frequent VS
-Assist with positioning, breathing & pushing
*Promotion of Comfort
-Rest between UC (uterine contractions)
*Assisting During Birth
-Room prepared
-Birthing positions
-Cleansing the perineum.
THIRD STAGE:
*WATCH OUT FOR THE SIGNS OF PLACENTAL SEPERATIONS

*INSPECT COMPLETENESS OF PLACENTA

*WATCH OUT FOR SIGNS OF HEMORRHAGE

* PSYCHOLOGICAL SUPPORT

FOURTH STAGE:

Physical Assessment
-Fundus
-Lochia
-Perineum
-VS

*Allow family bonding.

DANGER SIGS OF LABOR.

 MATERNAL SIGNS

FETAL SIGNS

HYPERACTIVITY – sign of hypoxia

Oxygen Saturation (40% to 70%) - assessed by a catheter inserted next to the cheek (<40% is
low); plus, acidosis (pH <7.2) suggest fetus is being compromised.