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