Topic: Labour management, complications of 3rd stage
Question: Define normal delivery. Enumerate the abnormalities that can occur in each stage of labour
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Normal Delivery:
- Spontaneous onset of labor between 37-42 weeks gestation
- Progression through the stages of labor without complications
- Vaginal delivery of the fetus in vertex presentation
Stage 1 Labor (Dilation/Effacement):
Abnormalities:
- Prolonged latent phase (>20 hours in nulliparous women, >14 hours in multiparous women)
- Abnormal progression of dilation and effacement
- Protracted active phase (>6 hours of inadequate progress in nulliparous women, >4 hours in multiparous women)
- Arrest of dilation
- Hyperstimulation of uterus
- Tachysystole
- Tetanic contractions
- Infection (chorioamnionitis)
Stage 2 Labor (Pushing/Delivery):
Abnormalities:
- Prolonged second stage (>3 hours in nulliparous women with epidural, >2 hours without epidural; >2 hours in multiparous women)
- Arrest of descent
- Fetal distress
- Abnormal fetal heart rate
- Meconium stained fluid
- Cord prolapse
- Placental abruption
- Uterine rupture
- Shoulder dystocia
- Operative vaginal delivery required (forceps or vacuum)
Stage 3 Labor (Placental Delivery):
Abnormalities:
- Retained placenta (>30 minutes after delivery)
- Excessive bleeding/hemorrhage
- Uterine atony
- Genital tract laceration
- Uterine inversion
- Amniotic fluid embolism
Stage 4 Labor (Recovery):
Abnormalities:
- Postpartum hemorrhage
- Infection
- Uterine subinvolution
- Thromboembolic events
- Postpartum depression/psyosis
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