Definition of Normal Labor (Area 2) 2024 PDF

‫عملي‬ Part 1 Area 2 ( ‫)عملي نسا‬ 2024 Dr. Noor  ‫عملي‬ First stage of Labor Definition of normal labor: Spontaneous expulsi...

‫عملي‬ Part 1 Area 2 ( ‫)عملي نسا‬ 2024 Dr. Noor  ‫عملي‬ First stage of Labor Definition of normal labor: Spontaneous expulsion of; ✓ Mature fetus (37completed weeks-42weeks). ✓ Single viable fetus. ✓ Presented by the vertex occiptoanterior position (left or right). ✓ Within a reasonable time (3-24hours). Presepetated labor > 3 h Prolonged labor < 24 h ✓ Without surgical intervention except episiotomy. ✓ Without complication to the mother or the baby. Stages of the normal labor : First stage Second stage ❖ Stage of cervical dilatation and effacement ❖ Stage of delivery of the pelvic Start true labor pain Start full full cervical dilatation End full cervical dilatation End delivery of the fetus ❖ Duration : ❖ Duration : 12-16 hours in primigravida 1–2 hours in primigravida 6-8 hours in multipara 0.5 – 1 hours in multipara Third stage Fourth stage ❖ Stage of the delivery of the placenta ❖ Observe complication after full labor Start delivery of the fetus End delivery of the placenta ❖ Duration : ❖ Duration : 2 hours 5 – 30 min Prodromal phase 1. Luitning , cheitining 2. Frequance of the urine 3. Force labor pain  ‫عملي‬ Procedure 1. Hand washing 2. Prepare equipment 3. Ensure privacy 4. Help her undress and get into bed if there are any complication as bleeding, PROM with high head, PIH, cardiac disease, or any other medical problems. ✓ Determine whether the woman is in labor or not 1. Uterine contractions (true labor pain) True labor pain False labor pain Regular, increase in frequency and Irregular , decrease in frequency and duration as labor progress. duration. Begin in lower abdomen then Begin in lower abdomen. refereed to the back. Not accompanied with cervical dilatation. Accompanied with cervical Not accompanied with bulge the dilatation. forewater. Accompanied with bulge the Relived by analgesic. forewater. Not relived by analgesic. - Observe and record the frequency, duration and intensity of the uterine contractions/30 min along the first stage of labor. Uterine contraction in latent phase Uterine contraction in active phase o Frequency: o Frequency: 1 uterine contraction every10 minute 3 uterine contractions every 10 minute. o Duration: o Duration: uterine contraction remains 20sec. uterine contraction remains 40-60 sec. o Intensity: o Intensity: uterus can be dented. uterus is felt hard. 2-Show: The mucous is the cervical mucus plug.  ‫عملي‬ The blood arises from rupture of small vessels due to separation of the lower part of the bag of membrane from the lower uterine segment. 3- Membranes: ask the woman if she had a gush of fluid or not, if she is not sure, use litmus paper and smell it to exclude urine. If membranes are ruptured record the time of rupture. 4- Cervical changes: shortening and dilating of the cervix. Through per vaginal examination. - In the Latent phase: cervical dilatation is less than 3 cm (slow cervical effacement). - In the Active phase: cervical dilatation is from 3-10 cm (progressive cervical dilatation). - Primigravida: cervix dilates about 1.2cm/hour. - Multigravida: cervix dilates about 1.5 cm/hour -Cervical dilatation caused by uterine contraction and retraction which lead to stretch the lower uterine segment and upward traction on the cervix. -Cervical effacement is induced by prostaglandin release as result of direct pressure of the fore water on the cervix before rupture the membrane and presenting part after rupture of membrane. 5- Formation of the bag of water 6- Nursing Management Steps of the First Stage 1. History taking Personal history Medical history Family history Obstetric history menstrual history contraceptive history 2. General examination A- Abdominal examination  ‫عملي‬ 1- Palpate the abdomen gently to detect the fundal height. 2-loepolds maneuver is done. 3-Auscultate and record the FHS for one min For low-risk pregnancies with normal labor, Checked after utrien contraction every 30 min in first stage , every 15 min in sacend stage For high-risk pregnancies, checked every 15 min in1st stage and every 3 to 5 min in 2nd stage B- vaginal examination: Pelvic examinations are done every 2 to 3 h to evaluate labor progress. Lack of progress in dilation and descent of the presenting part may indicate dystocia (fetopelvic disproportion). 3. Investigations: Urine sample for: Test urine for protein and sugar (take the mid- void sample) after vaginal swapping with antiseptic solution and before enema. Complete blood count (CBC) Human immunodeficiency virus(HIV) test Hepatitis B virus test. Kidney and liver function test Blood group and RH.  ‫عملي‬ Vaginal Examination Definition: A vaginal examination is an internal examination of the vagina and cervix (bottom part of the uterus at the inside end of the vagina) and is sometimes called internal examination. Indications: 1- To assess condition of cervix as :- Dilatation (open) the cervix is – from 0cm to 10cm(fully dilated). Consistency (from hard to soft). Position whether anterior or posterior. Effacement: Shortening and softing of the cervix(short and thin). 2- To assess condition of the fetus as :- Engagement Passage of the widest transverse diameter of the presenting part through the plan of the pelvic inlet. - Biparital diameter: in cephalic presentation (9.5).cm - Bitrochantric diameter: in breech presentation (10).cm Position relation between fetus body part to side of the mother Lie relation between long axis of the fetus and long axis of the mother Presentation First fetus part in maternal pelvic Station The relation of the lowermost bony part of the fetal presenting part to two ischial spine Moulding Overlabing of the cranial bones of the fetal skull for each other. Denominator is a landmark on the presenting part used to determine the position of the fetus during labor. 3- To apply a fetal scalp electrode for internal fetal monitoring. 4- Assess progress or delay in labor. 5- Confirm the onset of labor Contraindications:  ‫عملي‬ ✓ Placenta praevia, vasa praevia ✓ Early rupture of fore waters.