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Introduction
Stage Timing Description Notes
Stage 1
Latent Starts at regular uterine contractions

1-6 hrs Highly variable duration, cervix effaces and slowly dilates
  • Continous FHR monitoring
    • doppler
    • fetal scalp electrode (FSE)
  • Monitor uterine activity
    • tocodynamometer
    • internal uterine pressure catheter
  • Analgesic
    • epidural
    • meperidine
Ends at cervix dilation to 4 cm
Active Starts cervix dilation to 4 cm

4-6 hrs Regular and intense contractions. Cervix effaces and dilates quickly. Fetal head progressively descends into the pelvis.
Ends at full cervix dilation to 10 cm 
Stage 2 Starts at complete cervical dilation

1-2 hrs

Baby undergoes all stages of cardinal movements: 

1) 
Descent
2) Flexion 
3) Internal
rotation 

4) Extension 
5) External rotation 

  • Maternal effort accelerated delivery
  • Perineum control
  • Episiotomies
  • Once head delivered
    • suction nose and mouth
    • evaluate nuchal cord
  • Deliver shoulders
  • gentle downward pressure on head
    • deliver anterior shoulder
    • easy upward force
    • deliver posterior shoulder
  • Deliver body
  • Clamp and cut cord
  • Give infant to mother in warmer
  • Send umbilical cord blood for
    • ABO & Rh testing
    • blood gases
Ends at delivery of baby
Stage 3
Starts after baby is delivered

0-1/2hrs Placenta separates and uterus contracts to establish hemostasis
  • Wait for signs of placental separation
    • uterus firms/rises in abdomen
    • gush of blood
    • lengthening of cord
  • Apply gentle / constant traction
    • may take 30 minutes
Ends at delivery of placenta
Stage 4
Immediate postpartum 2 hrs Period with significant physiologic changes
  • Systematic evaluation of
    • cervix
    • vagina
    • vulva
    • perineum
    • periurethra
  • Monitor for postpartum complications
2 hrs postpartum

References

 

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