Normal Labour PDF

Dr.Iman Yousif Malik  How we diagnose labor by defining sign and symptoms of labor and stages of labor. What is Partogram.Factors affect progress of normal labor. Explaining different terminology in labor. To let student under stand mechanism of labor on simulator and...

Dr.Iman Yousif Malik  How we diagnose labor by defining sign and symptoms of labor and stages of labor. What is Partogram.Factors affect progress of normal labor. Explaining different terminology in labor. To let student under stand mechanism of labor on simulator and movies. Role of obstetrician in managing labor.  First stage – ( contractions) Latent and active labor Second stage – (Pushing) Descent with pushing to delivery of baby Third stage – Delivery of placenta -from delivery of (20- 30 min.) the fetus to delivery of the placenta Fourth stage – Watch for signs of post-partum hemorrhage involution of the uterus.  Theories of labor onset There are several hypotheses regarding this: was corpus lateral The progesterone-withdrawal theory LR “hormone of pregnancy” because it has a tendency to relax the uterus and maintain the uterine lining, help to maintain the pregnancy. So if progesterone is withdrawn, and the uterus will begin to contract. Oxytocin theory positive feedback more oxytocin is another hypothesis, because this hormone oxytocin leads the uterus to contract, some scientists have proposed that a rise in oxytocin levels may be responsible for initiating labor. The prostaglandin theory of labor : It has been determined that prostaglandins in the cervix and stimulating the uterus to contract. However, evidence supporting the theory that prostaglandins are the agents that trigger labor to begin is inconclusive.  contr 10 mn 5 First stage of labor is characterized by regular strong uterine contractions lasting for one min. or more every 3-5 min.the contractions force the presenting part to the int. os , leading to its effacement & then dilatation. The first stage of labor is divided to 2 phases:the latent phase & the active phase. The latent phase prolonged , last in nullipara up to 7 hr. from onset of labour to 4 cm dilated cx. The active phase is much more rapid,1-2cm / hour. it last from 4cm – 10 cm dilated cx.  Four essential components of labor: 4P These factors are sometimes referred to as the 3 p or “Four Ps” of labor sometimes: Passageway, (pelvis) Passenger, (fetus) Powers, (uterine contractions) Psyche. (phycological condition) speition A problem in any of these four areas will negatively influence the labor process. 26 years old prmi gravid lady presented to labor room with regular uterine cramps every 4 minuts last for 35 sec. On pelvic examination cervical dilatation was 5 cm , 70 % effacement head at -3 station. Questions: In which stage of labor this lady. What is the negative finding in the examination. Haw we will manage and follow up. Labor: is the act of uterine contractions combined with cervical change & dilatation,Fetus is gradually pushed through the birth canal (consisting of the cervix, vagina & perineum),Placenta is extruded and uterus involutes. o  Occ/P a 11.5  vertex I flexed *Presenting part: is the lower part of the fetus palpable on vaginal examination. In cephalic presentation the normal presentation is vertex , which indicate that the head is flexed. Vertex: is the area of the fetal skull bounded by the 2 parietal eminences & the anterior & posterior fontanelles. Any other presentation is called Mal-presentation like breech, cord, brow, face or compound presentation depending on the attitude of the fetus.  Lie: is relationship between longitudinal axis of the fetus to that of mother to the uterus, as: Longtudinal lie, Oblique lie , & Transverse lie Station : this is the level of decent of the presenting parts as assesed on vaginal examination ,when the lowest part of the we presenting part reached the ischial spine the presenting part at level of 0 station. The station prescribed by centimeters above or below ischial spine. Wide torn Engagment : this when the widest diameter BPD passed the pelvic brim, is assessed on abdominal examination by 5  Amniotomy : this is artificial rupture of the membrane , it may be after spontaneous labor ,or part of process of augmentation of labor. Attitude this referred to the relation of the different part of the fetus to each other, usually the attitude is Flexion. Caput succedneum: is edema over the presenting part of the head ,its quite common in prolonged labor. Caputprov ew *Moulding : is the change in the fetal skull to adapt the maternal pelvis during its passage. *The sutures allow some movement between the individual bones the parietal bone slide over the frontal bone & occipital bones ,severe moulding is sign of cephalo-pelvic disproportion. Position : for each presenting part there is a dominators, for cephalic is occiput, for face is mentum , for breech is sacrum, refers to the position of fetal occiput in relation to the maternal pelvis. OA – occipito-anterior“normal” OP – occipito-posterior often rotate on their own to OA. and often leads to a prolonged 2nd stage. OT – occipito-transverse or lateral. There are also fetal positions described for breech and shoulder presentation using the sacrum and scapula respectively. 4 5 contreta 1 minute he give Induction if 75 10min overstimulator  First Stage: labor onset to complete dilation -latent -active 4cm 10cm fully dilated Second Stage: complete dilation to delivery of infant Third Stage: delivery of fetus to delivery of placenta Fourth Stage: After delivery of the placenta 0 It is defined as series of changes in position attitude that the fetus undergoes during its passage through the birth canal 1. Engagement Y 2. Descent 3. Flexion 4. Internal rotation 5. Restitution and external rotation 6. Extension 7. Delivery of shoulders and fetal body  Every Day Instantly Father Explodes µ c 0 1st stage 6/8 H 2/10 H Cerv dilate 1.2cm/H 1.5cm/H 2nd stage 30min/3H 5to 30min 3rd stage 30 min 30 min *Regular uterine contractions combined with cervical change & dilatation. *Fetus is gradually pushed through the birth canal (consisting of the cervix, vagina & perineum). * Placenta is extruded and uterus involutes.  General examination: Abdominal examination (obstetrical examination): inspection, Leopold’s dilatmaneuvers, & assessment of contractions Vaginal examination 1. Cervical ation 2. Effacement 3. Presenting part 4. Station 5. Conditions of membranes  The first stage of labor is timed from the diagnosis of the on set of labor to full dialitation of the cervix. The principle of the management as follows 1. emotional support to the mother. 2. observation of the progress of labor. 3. monitoring of the fetal wellbeing. 4.adequate pain relieve. Adequate hydration. To  Active management of 3rd stage of labor: It reduces the incidence of PPH from 15-5% 1014 1. IM injection of 10 IU oxytocin given as delivery of the anterior shoulder occurs or immediately after delivery of the baby. 2. Early clamping and cutting of umbilical cord. 3. Controlled cord traction: which is done when the signs of placental separation are seen. The placenta may not be expelled by this method in 2 % that required either: 1. Repeat CCT after 10 minutes CCT Win 2. Or manual evacuation under anesthesia oo 3. Or injection of oxytocin into umbilical vein a  Technique Controlled cord traction CORD When contraction is felt, the left hand should be moved supra-pubic and the fundus elevated with palm facing towards the mother. At the same time the right hand should grasp the cord and exerts steady traction so that the placenta is separated and delivered gently. What is the complication that may occur during improper management of 3rd stage? Why?  Signs of separation of the placenta are: Lengthening of the cord protruded through the vulva Small gush of blood. Rising of the uterine fundus above the umbilicus. Active management in placental delivery by controlled cord traction & oxytocin infusion. (Oxytocis drugs) pitocin, methargin or ergot, cytotec.  The monitoring of the fetus is indirect & thus more difficult determination of baseline rate & assessment of fetal heart variation with contractions can be done by auscultation ,the normal range bet. 110-160/ min.fetal distress is secondary to hypoxia, infection, & anemia. The monitoring is either: external CTG (cardiotocography ) ,probe on the abdomen, or internal electrode on the fetal skull vaginally to measure the PH of fetal blood.  Continuous fetal monitoring is more beneficial than intermittent monitoring There is uterine transducer to asses uterine contractions ,to measure the strength & frequency of uterine cont. & compare to fetal heart to determine the type of decelerations. 58 8 Is a graphic record of labor cervical dilatation Assessment of uterine contraction frequency strength & duration. Descent of the head in fifths palpable , c State of the membranes. o Observation of maternal wellbeing such as BP, PR, Temp. Fetal assessment cervical Fent of herd  Analgesia: is the loss of pain perception may be local or systemic, analgesia is achieved by the : Hypnosis. Systemic medication. Regional agents. Inhalational agents like nitrous oxide. Precaution:These medications may got averse effect on the respiratory centers of the fetus especially the opoid allkalloid like Pethidin so fetal injection by Naloxon may be recommended..