Third Stage

The main event of the third stage is placental separation. It begins immediately after the delivery of the fetus and ends with the delivery of the fetal and placental membranes.

Duration

■ Usually under 10 minutes; considered prolonged if more than 30 minutes

The three signs of placental separation are:

1. Gush of blood from vagina

2. Umbilical cord lengthening

3. Fundus of the uterus rises up and becomes firm

If 30 minutes have passed without placental extrusion, manual removal of the placenta may be required.

TRUE LABOR VERSUS FALSE LABOR

False Labor (Braxton Hicks Contractions)

Occur at irregular intervals Intensity remains the same Discomfort in lower abdomen Cervix is not dilated Relieved by medications

True Labor

Occur at regular intervals that shorten Increase in intensity Discomfort in back and lower abdomen Dilated cervix

NOT relieved by medications

BLOOD FACTS ABOUT THE UTERUS

Blood supply to the uterus—uterine and ovarian arteries

Normal blood flow to nonpregnant uterus—100 cc/min

Normal blood flow to 17-week uterus—500 cc/min (intrauterine growth retardation occurs if flow is less)

Normal blood loss for normal vaginal delivery—300 to 500 mL Normal blood loss for normal C-section—800 to 1,000 mL

CLINICAL SIGNS OF LABOR

What are the three signs of placental separation?

1) gush of blood

2) umbilical cord lengthening

3) fundus of uterus rises and firms

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