Labor (1).pdf

LABOR Dr. Ahmed Reda Lecturer in Obstetrics and Gynecology  Definition Labor is a physiologic process during which a series of events take place in the female genital organs in an effort to expel the products of conception (ie, the fetus, membranes, umbilical c...

LABOR Dr. Ahmed Reda Lecturer in Obstetrics and Gynecology  Definition Labor is a physiologic process during which a series of events take place in the female genital organs in an effort to expel the products of conception (ie, the fetus, membranes, umbilical cord, and placenta) out of the uterus through the vagina into the outer world Stages First stage Second stage Third stage Stages of Labor Latent phase: CCC by gradual cervical change (till First stage: 4 cm dilatation) Time from onset of Active phase: regular contractions to CCC by rapid cervical complete cervical dilation change of at least 1 cm dilation/hour (>4cm) Passive phase: Second stage: from complete cervical Time from complete dilation to onset of active cervical dilation to maternal expulsive efforts expulsion of the fetus Active phase: from beginning of active maternal expulsive efforts Third stage: to expulsion of the fetus Time from expulsion of the fetus to expulsion of the placenta 1st stage of labor ( stage of cervical dilatation) Onset: start of labor pain Offset: full cervical dilatation Phases: – Latent  up to 4 cm – Active  from 4cm to full cervical dilatation Rate of dilatation: – Primipara (PG)  1.2 cm/hour – Multipara (MP)  1.5 cm/hour Duration: – PG  12 hours – MP  6 hours 2nd stage of labor (Delivery) ( stage of fetal delivery) Onset: full cervical dilatation Offset: fetal delivery Duration: – PG  2 hours – MP  1 hour 3rd stage of labor ( stage of placental delivery) Onset: fetal delivery Offset: delivery of the afterbirth (placenta + cord + membranes) Duration:  1/2 hour (30 min) in both PG & MP The Journey To Life… The The Passages Passenger The Forces Planes of the pelvis The obstetrics pelvic axis The Journey To Life… The The Passages Passenger The Forces The Journey To Life… The The Passages Passenger The Forces Power Uterine contractions and retractions: – Contraction: temporary shortening of muscle fibers after which complete relaxation occurs with regaining of initial length – Retraction: shortening of muscle fibers after which incomplete relaxation occurs with resultant permanent shortening of muscle fibers  As a result of uterine contractions:  Dilatation of cervix  Descent of fetus & delivery  Delivery of placenta  Stoppage of postpartum bleeding Additional force: – Maternal pushing  Abdominal & Diaphragmatic muscles Uterine contractions & retraction: Additional force intra uterine pressure Intra abdominal pressure EXPULSION OF THE FETUS As the journey progresses… The fetal head descends along the pelvic axis. It must rotate to accommodate the appropriate diameters of the head to the pelvic diameters. The reference points during this journey: – The ischial spine is the pelvic reference point – The presenting part is the fetal reference point. Fetal Presentation Is the fetal pole that presents at the pelvic inlet – Cephalic: Head First – Breech: Feet or Buttocks – Shoulder: back or abdomen Malpresentation Any fetal presentation other than cephalic – Breech – Shoulder – Face – Brow – Compound Breech Presentation Compound Presentation Fetal Lie Refers to the relationship between the fetal longitudinal axis and that of the mother. Transverse Lie Normal labor The passage of a 1single, 2term, 3viable fetus of 4average weight, 5cephalic presentation, 6through the natural passages, 7within average duration from 8spontaneous onset of uterine contractions, 9with no interventions (except episiotomy), and 10with no complications to the mother or fetus. A DIAGNOSIS IN RETROSPECT. Background To define abnormal labor, a definition of normal labor must be understood and accepted. Normal labor is defined as uterine contractions that result in progressive dilation and effacement of the cervix. The passage of a 1single, 2term, 3viable fetus of 4average weight, 5cephalic presentation, 6through the natural passages, 7within average duration from 8spontaneous onset of uterine contractions, 9with no interventions (except episiotomy), and 10with no complications to the mother or fetus. Time limits and progress milestones have been identified that define normal labor. Abnormal Labor Definition: Failure to meet time limits and progress milestones of normal labor Dystocia of labor is Terms that are often used: defined as difficult labor dystocia or abnormally slow dysfunctional labor progress of labor. failure to progress cephalopelvic disproportion (CPD) Obstructed Labor Definition:  Failure of fetal delivery  in spite of strong uterine contractions  due to mechanical obstruction.  1) Prolonged latent phase: 1. ≥20 hours for the Nuli Para 2. ≥14 hours for the Multi Para Very difficult to diagnose 2) First stage abnormalities (active phase): i) Protraction disorder: ii) Arrest disorder: Slow rate of cervical dilatation during No cervical change for the active phase of the first stage of 1. ≥ 4 hours despite adequate labor contractions 1. < 1.2 cm/hour for Nuli Para 2. ≥ 6 hours with inadequate 2. < 1.5 cm/hour for Multi Para contractions  3) Second stage abnormalities: i) Protraction disorder: ii) Arrest disorder: 1. >2 hrs in Nuli Para (>3 hrs if regional analgesia) No progress (descent, rotation) 2. >1 hrs in MP (>2 hrs if regional 1. ≥3 hrs in Nuli Para (≥4 hrs if analgesia) regional analgesia) However many women will have 2. ≥2 hrs in MP (≥3 hrs if regional successful vaginal deliveries with analgesia) second stages longer than these times 4) Prolonged third stage: Undelivered placenta > 30 minutes Etiology (causes): Kegel’s exercise Pelvic-floor exercise: involves repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes referred to as the "Kegel muscles". The exercise can be performed many times a day, for several minutes at a time but takes one to three months to begin to have an effect. Perineal Massage Perineal massage is a method of preparing the tissues of the perineum – the area between your vagina and anus – and massaging this pelvic floor for vaginal delivery. Water Birth Benefits of immersion in warm water :  Shorten the duration of labor  Pain relief  Decrease the need for epidurals or other spinal pain relief  Relaxation  Less perineal trauma Adverse consequences:  Decreased mobility  Infection  Water inhalation by the baby ACOG (The American College of Obstetricians and Gynecologists) : – recognize certain benefits, – laboring in water is not recommended beyond the 1st stage of labor. – delivering in water is not recommended. Finally meet the baby … Any questions?? Thank you