FOURTH STAGE OF LABOR

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FOURTH STAGE OF LABOR

the period immediately following expulsion of the placenta.Is the time from 1-4 hours after birth in which physiologic readjustment of the mother’s body begins. Blood loss at birth ranges from 250-500 ml. With this blood loss and the easing of pressure exerted by the pregnant uterus on the surrounding vessels blood is redistributed into venous beds. This results in a moderate drop in both systolic and diastolic blood pressure, increase pulse pressure, and moderate tachycardia.nausea and vomiting experienced during transition usually ceases. The woman may be thirsty and hungry. She may experience a shaking chill, which is thought to be associated with the ending of the physical exertion of labor.

Fetal danger Signs of labor High or low fetal heart rate

as a rule, an FHR of more than 160 bpm(fetal tachycardia) or less than 110 bpm(fetal bradycardia) is a sign of fetal distress. An equally important sign is a late or variable decelaration pattern on the fetal monitor.

Meconium Staining

Meconium staining, a green color in the amniotic fluid, is not always a sign of fetal distress but is highly correlated with its occurrence and it reveals that the fetus has had an episode of loss of sphincter control, allowing meconium to pass into the amniotic fluid. It may indicate that the fetus has or is experiencing hypoxia, which stimulates the vagal reflex and leads to increased bowel motility.

Hyperactivity

Ordinarily, a fetus is quiet and barely moves during labor. Fetal hyperactivity may be a sign that hypoxia is occurring, because frantic motion is a common reaction to the need for oxygen.

Fetal Acidosis

If blood analyses are made on a fetus during labor by use of a scalp capillary technique, the finding of acidosis(blood pH lower than 7.2) is a certain sign that fetal well-being is becoming compromised.

Maternal danger signs Rising or falling Blood pressure

Normally, a woman’s blood pressure rises slightly in the 2nd stage of labor because of her pushing effort. A systolic pressure greater than 140 mmHg, or an increase in the systolic pressure of more than 30 mmHg or in diastolic pressure of more than 15 mmHg(the basic criteria for pregnancy-induced hypertension), should be reported.

Abnormal Pulse

Most pregnant women have a pulse rate of 70-80bmp. This rate normally increases slightly during the second stage of labor because of the exertion involved. A maternal pulse rate greater than 100bmp during the normal course of labor is unusual and should be reported. It may be another indication of hemorrage.

Inadequate/prolonged contractions

Uterine contractions normally become more frequent, intense, and longer as labor progresses. If the become less frequent, less intense, or shorter in duration, this may indicate uterine exhaustion(Inertia). If this problem cannot be corrected, a cesarean birth may be necessary.

Pathologic retraction ring

An indentation across a woman’s abdomen, where the upper and lower segments of the uterus join, may be a sign of extreme uterine stress and possible impending uterine rupture.

Abnormal lower abdominal contour

If a woman has a full bladder during labor, around bulge on her lower anterior abdomen may appear. This is dangerous signal for 2 reasons: first, the bladder may be injured by the pressure of a fetal head; 2nd, the pressure of the full bladder may not allow the fetal head to descend.

Increasing apprehension

Warnings of psychological danger during labor are as important to consider in assessing maternal well-being as are physical signs. Increasing apprehension also needs to be investigated for physical reasons, because it can be a sign of oxygen deprivation or internal hemorrhage.