OB DAY 2

Third Stage

Fetal expulsion to placental delivery

5–15 minutes

average duration of the third stage of labor

Watchful waiting

method used during the third stage of labor

• L: Lengthening of the cord

• U: Uterus firm (Calkin's sign)

• V: Visible placenta in the vagina

• S: Sudden gush of blood

LUVS stand for in the signs of placental separation

• B: Bear down gently

• F: Fundal pressure gently (only in contracted uterus

How can you help during the third stage of labor?

• T: Tone – Oxytocin after delivery of anterior shoulder

• B: Brandt-Andrew’s maneuver – Controlled cord traction

• E: Early clamping/cutting of the cord

active management of the third stage of labor (AMTSL)

prevent postpartum hemorrhage

purpose of early clamping in the third stage of labor

Uterine inversion

major warning during the third stage of labor lasting more than 30 minutes

Recovery stage

fourth stage of labor called

1–4 hours

How long does the fourth stage of labor last?

300–400 mL

average amount of blood loss postpartum

• 500 mL in 1 day (vaginal birth)

• 1000 mL in 24 hours (C-section)

amount of blood loss is considered abnormal postpartum

Uterine atony (70%)

most common cause of postpartum hemorrhage

Firm and grape fruit-like

How should a normal uterus feel during the fourth stage

Involution

return of uterus to its pregnancy state

sub involution

late return of uterus to its pregnancy state

Contraction, ambulation, Nutrition

Needs for involution

6

average duration of the postpartum stage

Presumptive

subjective (sumbong ni mother): lowest level of confirmatory

Pain
Respiratory Changes
Enlarged Breast
Skin Changes
Urinary Frequency
Movements, Morning Sickness, Menses cessation
Palmar Erythema
Tiredness
Increased salivation
Vaginal discharge, Varicosed Veins
Enlarged uterus

Meaning of mnemonic of PRESUMPTIVE

mild and occasional (migraine/new onset)

Head Normal Pain

Increase Blood Volume 40-50%

Cause of Normal Head Pain

Ice pack, Paracetamol

Management for Normal Head Pain

Severe, continuous, unrelieved

Abnormal Head Pain

Cause: Increase Blood Pressure
Complication: Visual Changes (Blurring, floaters)

Cause and Complication of Abnormal Head Pain

Heartburn/Pyrosis

Normal Chest Pain

Reflux/Regurgitate

Cause of Normal Chest Pain

Sphincter relaxed
Stomach pushed upward

2s of Normal Chest Pain

Small frequent feeding
Slow chewing
Should wait 2-3 hours after meal
Side left (sleep)
Support #2 pillows

5s advice for Normal Chest Pain

Alka-Seltzer
Baking Soda
Tomato
Fatty
Citrus/Caffeine/Cola/GAs Forming/Cabbage

Avoid in Normal Chest Pain (ABTFC)

Lower Back Pain Only

Normal Back Pain

Posture: Lordosis (Pride of Pregnancy)
Progesterone + relaxin: soften pelvic joints/ ligaments

Causes of Back Pain

Hot Pads
Acupuncture
Stand Straight
Support pillow in the back
Squatting
Shoes should be low-moderate heeled
Strengthen Lumbar Spine: Pelvic rock (Hallow x 1 min)

Encourage in person with back pain

Cramps

usual type of leg pain during pregnancy

• ↓ Calcium

• ↑ Phosphorus

• Uterine pressure

• Blood pooling/standing

causes leg cramps during pregnancy

• Calcium 1g/day

• Magnesium citrate BID

• Ambulate

• Elevate legs

How can leg cramps be prevented during pregnancy?

Dorsiflex the foot while the knee is extended

How is leg cramp managed?

• S: Stasis of blood (e.g., uterine pressure)

• H: Head of fetus (causing venous damage)

• E: Estrogen ↑ → Thrombocytic effect

3 main causes of DVT (using the acronym SHE)

• Ambulate

• Elevate legs

• Hydrate

• Use elastic stockings (panty hose, before arising)

How can DVT be prevented during pregnancy?

• Homan’s sign (calf pain when dorsiflexing foot)

• Thrombophlebitis - Check for redness, pain, warmth, swelling, fever, and calf tenderness

How do you assess for DVT?

Risk of embolism

What is the warning with DVT that requires urgent management?

• Avoid HAM:

  • Hot compress (moist heat only)

  • Ambulation

  • Massage

• Bed rest (No CBR)

• Call MD

• Doppler ultrasound: Drug - Anticoagulant therapy

• Embolectomy

management steps for suspected DVT

• Anticoagulants - heparin

• Possible embolectomy

treatment for severe DVT or embolism

Warfarin (fetal damage)

Which medication is not used in pregnancy for DVT treatment?

Stuffiness of Nose
Shortness of breath
Speedy Breaths

3s in Respiratory changes

Third trimester - engagement

SOB relieved in what trimester?

Lightening

Third trimester - engagement called?

estrogen

cause of stuffiness of nose

enlarged uterus

cause of shortness of breath

enlarged uterus

cause of speedy breaths (tachycardia)

Blue Veins
Readiness for lactation
Enlarged due to estrogen
Areolar darkening
Secretes colostrum due to high IgA
Tubercles

Mnemonic for Enlarged Breast

Estrogen

What hormone causes increased vascularity leading to blue veins on the breasts during pregnancy?

Progesterone and human placental lactogen (HPL)

Which hormones prepare the breasts for lactation?

Estrogen

What causes enlargement and areolar darkening of the breasts during pregnancy?

colostrum

first milk secreted by the breasts that is high in IgA

16 weeks

At what week of gestation does colostrum secretion begin?

2-3 days

How long does colostrum typically last before true milk appear?

Prolactin.

What hormone is responsible for milk production?

Oxytocin.

What hormone is responsible for milk ejection?

Engorgement.

What is bilateral breast tenderness due to milk filling called?

Address the pain before continuing breastfeeding.

What is the first step in managing breast engorgement pain?

Tubercles

What breast structures become more prominent during pregnancy?

Striae gravidarum
Kloasma/Chloasma/Melasma
Increased pigmentation
Nigra (Line)

Mnemonic for Skin Changes

Melasma

Mask of pregnancy; cheeks and nose

Cocoa Butter Lotion

Use to lessen irritation the striae gravidarum

Linea Nigra

Dark thin line mid abdomen

Increased Bladder Pressure
High Hormones
Increased GFR

Urinary frequency

Mild

Blood Pressure in 1st trimester

fades/absent

Blood Pressure in 2nd Trimester

Stronger

Blood Pressure in 3rd Trimester

Aldosterone

What hormones that retains water and sodium?

First Trimester

HCG increased in what trimester?

Quickening

term for the first fetal movement felt by the mother

18–20 weeks

At what gestational age does quickening typically occur in primigravida women?

Around 16 weeks

At what gestational age does quickening typically occur in multigravida women?

28 to 38 weeks or until engagement.

When does fetal movement usually peak?

Kick count

What tool is used to assess fetal well-being through movement?

once a day

How often/frequency should kick count be done?

Left recumbent position to increase fetal circulation.

What is the recommended position for doing a kick count and why?

After a meal, for 1 hour.

When is the best time to do a kick count?

10–12 kicks per hour

What is the normal rate of fetal kicks per hour?

Give a snack or juice.

What should be done if ambulation is contraindicated and fetal movement is low?

Report immediately

What should be done if there is still no fetal movement after ambulation or snack?

Only in the first trimester

When does morning sickness typically occur during pregnancy?

Nausea and vomiting, often all day

What are common symptoms of morning sickness?

P: Progesterone ↑
H: HCG ↑ in the first trimester
E: Estrogen ↑
G: Glucose ↓ (due to organogenesis in the 1st trimester)

What does the acronym "P-H-E-G" stand for in the causes of morning sickness?

Due to increased use for organogenesis in the 1st trimester

Why does glucose decrease during early pregnancy?

Produced by the placenta, taking over from the corpus luteum

What is the role of HCG in the 2nd trimester?

Snack before bed
Small frequent feeding
Sour candy
Sips of carbonated drinks

What does "S" in the acronym SAD stand for?

What does "A" in the acronym SAD stand for?

Acupuncture
Acupressure wrist band
Avoid 4s: Spicy, Seasoned, Sebo (fatty acid), Sudden movements

Dry toast/cracker before rising (provides glucose) Baking soda test abnormal
Delay breakfast
Doctor if: Nausea and vomiting persist above 12–14 weeks Signs of dehydration

What does "D" in the acronym SAD stand for?

high estrogen; high progesterone

cause of menses cessation

after delivery

return of menses

6-10 weeks

return of menses for non-Breastfeeding

3-4 months

return of menses for Breastfeeding

Lactation Amenorrhea

Full Breast feeding
No menstruation
Up to 6 mos. only

Calamine Lotion

Management for redness and itchiness of palm

Decreased glucose, increased metabolic demands due to organogenesis, and nausea/vomiting

What causes tiredness in the 1st trimester of pregnancy?

Blood volume

What peaks in the 2nd trimester and contributes to fatigue?

Plasma.

In the 2nd trimester, which blood component increases first?