Integrated Maternal and Newborn Care Basic Skills Course ...

Severe PPH: Vaginal bleeding in excess of 1000 mL, occurring less than 24 hours after
childbirth.
Stages of labor
• First stage of labor. The first stage of labor begins with the onset of contractions and
ends when the cervix is fully dilated (10 cm). This stage is divided into two phases,
known as the latent and active phases of labor. During the latent phase, the uterine
cervix gradually effaces (thins out) and dilates (opens). This is followed by active labor,
when the uterine cervix begins to dilate more rapidly and contractions are longer,
stronger, and closer together.
• Second stage of labor. The second stage of labor begins when the uterine cervix is
fully dilated and ends with the birth of the baby. This is sometimes referred to as the
pushing stage.
• Third stage of labor. The third stage of labor begins with the birth of the newborn and
ends with the delivery of the placenta and its attached membranes.
• Fourth stage of labor (also known as the “immediate postpartum” period). The fourth
stage of labor begins with the delivery of the placenta and goes from one to six hours
after delivery of the placenta, or until the uterus remains firm on its own. In this
stabilization phase, the uterus makes its initial readjustment to the nonpregnant state.
The primary goal is to prevent hemorrhage from uterine atony and cervical or vaginal
lacerations.
Stillbirth: A baby who is born with no signs of life noted under “live birth.” Stillbirths are of two
types: macerated stillbirth (when the body may be distorted, soft, often smaller than normal,
and the skin is unhealthy with discoloration and peeling) and fresh stillbirth (when the body
appears normal unless associated with a major congenital malformations and the skin appears
normal in texture and consistency, although it may appear pale). Here the death has occurred
fairly close to the time of birth. It may have been due to problems during labor. On some
occasions a live birth with minimal signs of life, such as just a few cord pulsations or an
occasional faint gasp, may mistakenly be passed off as a “stillbirth.” Improved care during labor
and better recognition and reporting will result in a decrease in the number of fresh stillbirths.
Hence, in maintaining records, it is worthwhile to try and differentiate between macerated and
fresh stillbirths.
Term infant: A baby who is born within 37-42 completed weeks of gestation.
Uterine atony: Loss of tone in the uterine muscle. Normally, contraction of the uterine
muscles compresses the uterine blood vessels and reduces blood flow, increasing the
chance of coagulation and helping to prevent bleeding. The lack of uterine muscle
contraction or tone can cause an acute hemorrhage. Clinically, 75 to 80 percent of PPH
cases are due to uterine atony.
Uterine massage: An action used after the delivery of the placenta in which the provider
places one hand on top of the uterus to rub or knead the uterus until it is firm.
Sometimes blood and clots are expelled during uterine massage.
Uterotonic drugs: Substances that stimulate uterine contractions or increase uterine
tone.
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Integrated maternal and newborn care
Basic skills course