Normal Labor (1) (3) PDF

Labor  Normal labor, stages of labor, cardinal movement of labor Intrapartum period Breech presentation  Normal birth Spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and delivery. The infant is born spontaneously in the vertex...

Labor  Normal labor, stages of labor, cardinal movement of labor Intrapartum period Breech presentation  Normal birth Spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth, mother and infant are in good condition World Health Organization  Stages of labor First stage -Begins from the uterine contractions until mother’s cervix is fully dilated (10cm) Second stage -Begins when the mother’s cervix is fully dilated until the baby is delivered Third stage -Begins when the baby is delivered until placenta is delivered  First stage Latent Phase –when the cervix is dilated about 4 cm Active Phase- when the cervix is dilated from 4 cm about 10cm Opening of the Cervix  How the fetus is located in the uterus Fetal lie Presentation Attitude Position  Presentation and Position https:// www.youtube.com/watch? v=jITAO8AcLz0  Delivery of the Head With each contraction, the vulvovaginal opening is dilated by the fetal head to gradually form an ovoid and finally, an almost circular opening This encirclement of the largest head diameter by the vulvar ring is termed crowning Perineum thins and especially in nulliparous women, may undergo spontaneous laceration The anus becomes greatly stretched, and the anterior wall of the rectum may be easily seen through it.  Delivery of the Head When the head distends the vulva and perineum enough to open the vaginal introitus to a diameter of 5 cm or more, a gloved hand may be used to support the perineum The other hand is used to guide and control the fetal head to avoid expulsive delivery Slow delivery of the head may decrease lacerations  Delivery of the Head Following its delivery, the fetal head falls posteriorly, bringing the face almost into contact with the maternal anus The occiput promptly turns toward one of the maternal thighs, and the head assumes a transverse position This external rotation indicates that the bisacromial diameter, which is the transverse diameter of the thorax, has rotated into the anteroposterior diameter of the pelvis  Delivery The sides of the head are grasped with two hands, and gentle downward traction is applied until the anterior shoulder appears under the pubic arch Next, by an upward movement, the posterior shoulder is delivered Shoulder dystocia Shoulder dystocia refers to a situation where, after delivery of the head, the anterior shoulder of the fetus becomes impacted on the maternal pubic symphysis, or (less commonly) the posterior shoulder becomes impacted on the sacral promontory It is an obstetric emergency, with an incidence of approximately 0.2-3% in all deliveries  Clinical Features of Shoulder dystocia Difficulty in delivery of the fetal head or chin Failure of restitution – the fetal remains in the occipital-anterior position after delivery by extension and therefore does not ‘turn to look to the side’ ‘Turtle Neck‘ sign – the fetal head retracts slightly back into the pelvis, so that the neck is no longer visible, akin to a turtle retreated into its shell Shoulder dystocia Shoulder dystocia Third Stage of Labour-Delivery of the Placenta Third-stage labor begins immediately after fetal birth and ends with placental delivery Goals include: delivery of an intact placenta avoidance of uterine inversion Avoidance of postpartum hemorrhage  Management of placenta period Active Management Expectant Management  Active management of placenta period 1. Giving a drug (uterotonic) to help contract the uterus 2. Clamping the cord early (usually before, alongside, or immediately after giving the uterotonic) 3. Traction is applied to the cord with counter- pressure on the uterus to deliver the placenta Extraction of the fetus in case of breech presentation  Breech Presentation Complete breech: The buttocks are pointing downward with the legs folded at the knees and feet near the buttocks Frank breech: In this position, the baby’s buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head Footling breech: In this position, one or both of the baby’s feet point downward and will deliver before the rest of the body