If We Certain That There Is No Second Baby, Administer The A Uterotonic Drug

OSCE - Active Management of the Third Stage of Labor
C Check Palpate the uterus to make sure a second baby is not present
O Oxytocin If we certain that there is no second baby, administer the a
uterotonic drug. Administer prophylactic oxytocin 10 u IM
intramuscularly after delivery of anterior shoulder/ fetal head.
Inform the patient of the medication you are giving and why.
In situations when oxytocin is not available, you may give
misoprostol 600mg orally or sublingually after the birth of the
baby. Advise the mother of risk of shivering and fever. Other
choices are ergonavine, methyergonavine, carboprost, and
carbetocin.
C Cord Clamping Do delayed cord clamping because it is beneficial. Delay cord
clamping by at least 30-60 seconds (2-3 mins) in vigorous and
term newborns not requiring resuscitation. This delay has been
shown to benefit preterm and term newborns
 Benefits:
 < 37 weeks: Dec IVH, Dec, NEC and need for
transfusion
 >/= to 37 weeks: Increase iron stores up to 6 months,
small increase in jaundice requiring phototherapy
T Traction Check for signs of placental separation: Gush of blood, cord
lengthening, uterine fundus rising up in the abdomen, uterus
becomes firmer
We then apply a gentle controlled cord traction to assist in
delivery of the placenta during a uterine contraction to dislodge
the placenta from the uterine cavity to the vagina.
Simultaneously, use external counter-traction (one hand
supporting the uterus just above the pubic bone); Care must be
taken to avoid excessive traction does not cause tearing of the
umbilical cord or placenta.
P Placenta Stop traction:
- if there is resistance encountered
- if fundus of uterus descends with each traction
Delivery of the Feel if the placenta is already at the vagina
placenta Demonstrate:
- Do gentle digital exam along the cord
- if placenta is already at the introitus, hold it and rotate to
facilitate full detachment of the membranes
U Uterine After placental delivery: do a uterine massage
massage assess fundus and massage the fundus and ensure that it is
well-contracted and that there is no significant bleeding;
Inspect the perineum for lacerations and repair as necessary.
P Placental Check placenta for completeness/absence of cotyledons
inspection Possible accessory lobe
D Documentation Then document the relevant info of the delivery: the time the
baby was born, the duration of third stage of labor, and the
uterotonics administered, and estimated blood loss.
MYOMECTOMY (11, 7, 12, 6)
o Obtain consent and explain reasons why myomectomy has been recommended.
Explain the nature of the procedure
o Induction of spinal/epidural/general anesthesia
o Indwelling foley catheter inserted to empty the bladder
o Pelvic examination done including a bimanual examination: (Give the description
of the cervix, size of the uterus. REMEMBER IF UTERUS IS ENLARGED TO
MORE THAN 3 MONTHS SIZE , ADNEXA CANT ASSESSED ANYMORE)
o Asepsis and antisepsis.
o Preparation and drapes are applied
o Midline incision done over the skin carried down to the fascia.
o Muscles split at the midline
o The peritoneum is incised and and cut open w/ metzenbaum scissors.
o Inspect and explore the pelvic and abdominal organs
o State the intra operative findings:
o Optimize exposure pelvic organs by application of self-retaining retractor and

visceral packs. Bladder retractor is applied
o A Rumel Torniquet is tied at the isthmus and around each infundubulopelvic

ligament to occlude the uterine arteries by creating a space/hole at the broad
ligament(optional).
o Uterine walls is incised just above the mass

o Myometrial edges grasped with allis clamps
o Myoma grasped with towel clip and enucleated from its bed by blunt and sharp
dissection
o Bleeders checked, ligated or cauterized
o Myometrium sutured by figure of 8 ,layer by layer using vicryl 0
o Serosa closed by continuous interlocking/inverted T using vicryl 3-0
o Torniquet is released
o Ensure Excellent hemostasis
o Remove the retractors and visceral packs.
o Ensure a complete Instrument and sponges count
o
o Abdomen closed in layers:
 Peritoneum – continuous running suture, using chromic 2.0
 Muscles –simple interrupted suture using chromic 2-0
 Fascia – continuous interlocking using vicryl 0
 Subcutaneous tissues – continuous running suture using vicryl 3.0
o Skin – closed subcuticularly using vicryl 4.0
o Application of sterile dressing
o Specimen was inspected and measured then sent for histopathologic
examination
o Ensure Patient tolerated the procedure well and sent to recovery room in stable
condition
o Document the procedure, the Gross specimen findings, and the estimated blood
loss.

If We Certain That There Is No Second Baby, Administer The A Uterotonic Drug

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If We Certain That There Is No Second Baby, Administer The A Uterotonic Drug

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OSCE - Active Management of the Third Stage of Labor

o Optimize exposure pelvic organs by application of self-retaining retractor and

o A Rumel Torniquet is tied at the isthmus and around each infundubulopelvic

o Uterine walls is incised just above the mass

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