<prompt> Active management of third stage of labor includes all except:Ergometrine after anterior shoulder deliveryUterine massageCord tractionOxytocin infusion  <response>: Ans. B. Uterine massageStages of Labor Duration StageStarts EndsPrimiparousMultiparousAbnormalities1stLatentOnset of labor to 3-4 cm dilation6-11 hours4-8 hoursProlongation seen with excessive sedation hypotonic uterine contractions.Management: Rest and sedation Active4 cm to complete cervical dilation 10 cm4-6 hours 1.2 cmh2-3 hours 1.5 cmhProlongation: Cervical dilation of 1.2cmh primipara1.5cmh multiparaArrest: No cervical change in 2 hoursCause: This abnormality is seen in a passenger fetal size or abnormal presentation, pelvis, or power dysfunctional contractionsManagement:IV oxytocin - Hypotonic contractions Emergency cesarean section - Adequate contractions2ndComplete cervical dilation to delivered of the infant0.5-3.0 hours5-30 minutesSecond-stage arrest: Failure to deliver within 1 hour multipara or 2 hours nullipara Add additional 1 hour if epiduralCause: This abnormality is seen in a passenger, pelvis, or powerManagement: Cesarean - Fetal head is not engaged Trial of obstetric forceps or vacuum extraction - Fetal head is engaged3rdDelivery of infant to delivery of placenta0-0.5 hour0-0.5 hourProlonged third stage: Failure to deliver placenta within 30 minutesCause: Consider placenta percreta accretaincretaManagement: IV oxytocin If oxytocin fails, attempt manual removal Hysterectomy may be needed 