Page 66 - 2023 Elctronic Book (3) Normal Labor_Neat

segment.
o Gush of blood from the vagina.

o Lengthening of the umbilical cord outside the vulva.
o Loss of pulsation of the cord when pressure is exerted on the fundus.

Nursing Management of the Third Stage of Labor
Assessment
• Assess uterine contractions.

• Observe maternal vital signs.
Nursing Diagnosis

• Fatigue related to inability to rest and pushing efforts during labor.
• Alteration of comfort, pain related to episiotomy, perineal distension, and muscle
strain during labor.

• Alteration of fluid to less than body requirements.
• Knowledge deficit related to physiological changes of normal labor, newborn care,

and self-care.
• High risk of infection secondary to episiotomy during delivery.
Planning and Implementations

• Apply two forceps on umbilical cord and cut in between.
• Carefully inspect vagina, perineum, and labia for lacerations and tears.

• Inspect vulva for bleeding, edema, and hematoma.
• Make sure that the uterus is well contracted. Flabbiness or enlargement of the
uterus indicates bleeding.

• Palpate the height of the fundus. Feeling the fundus above the umbilicus may be
due to presence of another fetus, blood clots, big placenta, or full bladder.

• Avoid vigorous uterine massage because it may lead to irregular contractions, and
cause retained placental parts or membranes.
• Observe signs of placental separation.

• Evacuate the bladder by a catheter if the placenta is not separated within 20
minutes.

• The placenta is expelled by controlled cord traction and use of oxytocic drugs. It is
then received in the hands, and turned through a circle. This method reduces blood
loss and shortens the third stage.

• Examine the placenta and membranes for general appearance, completeness, cord
vessels, and weight.
• Estimate the average blood loss (200-600 ml).

• Clean and dry the vulva, buttocks and thighs and then apply a sterile pad.

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