Physiologic Labour: Stages, Contractions, and Delivery - PDF

PHYSIOLOGIC LABOUR Dra. Guzmán / Dra. Laisa WE MAKE DOCTORS  Review and identify the different stages of labour objectives Perform special maneuvers according to each stage of la...

PHYSIOLOGIC LABOUR Dra. Guzmán / Dra. Laisa WE MAKE DOCTORS  Review and identify the different stages of labour objectives Perform special maneuvers according to each stage of labour Deliver a baby in a simulated physiologic labour scenario Types of pelvis Among them, the gynecoid type of pelvis is the most commonly found and has the diameters that are structurally ideal for vaginal delivery and child birth. Volker, J. H. (n.d.). Gynecoid Pelvis – Earth’s Lab. Earth’s Lab. https://www.earthslab.com/anatomy/gynecoid-pelvis/  INTRODUCTION Progesterone inhibits uterine contractions throughout the first several months of pregnancy. As the pregnancy enter its seventh month, progesterone levels plateau and then drop. The increasing ratio of estrogen to progesterone makes the myometrium more sensitive to stimuli that promote contractions. Physiology of labor – anatomy & physiology. (n.d.). https://pressbooks.ccconline.org/bio106/chapter/physiology-of-labor/ In the eighth month of pregnancy, fetal cortisol rises, which boosts estrogen secretion by the placenta and further overpowers the uterine-calming effects of the progesterone. Some women may feel the result of the decreasing levels of progesterone in late pregnancy as weak and irregular peristaltic Braxton Hicks contractions, also called false labor. Physiology of labor – anatomy & physiology. (n.d.). https://pressbooks.ccconline.org/bio106/chapter/physiology-of-labor/ During pregnancy, a plug of mucus accumulates in the cervical canal, blocking the entrance to the uterus. Approximately 1-2 days prior to the onset of true labor, this plug loosens and is expelled, along with a small amount of blood. Physiology of labor – anatomy & physiology. (n.d.). https://pressbooks.ccconline.org/bio106/chapter/physiology-of-labor/ The posterior pituitary has been boosting its secretion of oxytocin, a hormone that stimulates the contractions of labor. At the same time, the myometrium increases its sensitivity to oxytocin by expressing more receptors for this hormone. Physiology of labor – anatomy & physiology. (n.d.). https://pressbooks.ccconline.org/bio106/chapter/physiology-of-labor/ In a positive feedback loop stimulate the secretion of prostaglandins from fetal membranes. The fetal pituitary also secretes oxytocin, which increases prostaglandins even further. Physiology of labor – anatomy & physiology. (n.d.). https://pressbooks.ccconline.org/bio106/chapter/physiology-of-labor/  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy First stage Cervix complete dilation  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  1 CM 2 CM 3 CM 4 CM CHEERIO GRAPE BANANA SLICE CRACKER CERVICAL DILATION VISUAL AID 5 CM LIME SLICE 6 CM COOKIE 7 CM ORANGE SLICE 8 CM HALVED APPLE 9 CM 10 CM DONUT CANTALOUPE  0-3 cm 3-8 cm 8-10 cm Early or latent Active transition LENGTH OF CONTRACTIONS 30-45 seconds 45-60 seconds 60-90 seconds TIME BETWEEN CONTRACTIONS 5-10 minutes 3-5 minutes 2-3 minutes (ACCELERATION PHASE) (DECELERATION PHASE) Mayo Foundation for Medical Education and Research. (2024, July 23). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/stages-of-labor/art-20046545 LEOPOLD MANEUVERS Situation, fetal presentation The superior surface of the fundus is palpated to determine consistency, shape, mobility. Fetal position Both sides of the uterus are palpated to determine the direction the fetal back is facing. Degree of fetal fitting Determines the part of the fetus at the inlet and its mobility. Fetal attitude Determines the fetal attitude and degree of fetal extension into the pelvis.  Variations in presentation VERTEX PRESENTATION *The vertex presentation known as the occiput anterior position is the most common presentation and is associated with the greatest ease of vaginal birth. Moldenhauer, J. S. (2024, January 17). Fetal Presentation, Position, and Lie (Including Breech Presentation). MSD Manual Professional Edition.  Variations in presentation FACE BROW BREECH SHOULDER Moldenhauer, J. S. (2024, January 17). Fetal Presentation, Position, and Lie (Including Breech Presentation). MSD Manual Professional Edition. second stage Expulsion *It begins when the patient is fully dilated and has a complete effacement*  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy Types of positions  OCCIPUT ANTERIOR POSITION OCCIPUT POSTERIOR POSITION (OA) (OP) Moldenhauer, J. S. (2024, January 17). Fetal Presentation, Position, and Lie (Including Breech Presentation). MSD Manual Professional Edition. Modified ritgen maneuver Protection of the perineum, avoiding muscle tears.  Delayed cord clamping (waiting 30 to 60 seconds) is associated with higher hemoglobin levels after delivery and greater iron stores in the first several months of life. Placing the child “skin-to-skin” results in optimum warmth for the newborn, early maternal–neonatal bonding, and facilitation of early breastfeeding. The cord is doubly clamped and cut between the clamps. Third stage Delivery of the placenta  The placenta is the organ that The contractions start 5-10 delivers food and oxygen to the minutes after birth fetus through the umbilical cord during pregnancy It can last 30 minutes It separates from the wall of the uterus Mayo Foundation for Medical Education and Research. (2024, July 23). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/stages-of-labor/art-20046545  Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-breast/pregnancy  Fetal surface “shiny schultz” Umbilical cord maternal surface “Dirty duncan” cotyledon *A missing placental cotyledon or a membrane defect suggestive of a missing succenturiate lobe also suggests retention of a portion of the placenta and should prompt further clinical evaluation Brandt-ANDREWS MANEUVER DUBLIN MANEUVER  REFERENCES Bickley, L. S. (2017). BATES’ guide to physical examination and history taking (12th ed.). Wolters kluwer india Pvt. page 948, chapter 19. Bennett T, & Proudfit C, & Roman A.S. (2019). Normal & abnormal labor & delivery. DeCherney A.H., & Nathan L, & Laufer N, & Roman A.S.(Eds.),CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 12e. McGraw-Hill Education. https://bibliodig.uag.mx:2091/content.aspx?bookid=2559&sectionid=207399535 Moldenhauer, J. S. (2024, January 17). Fetal Presentation, Position, and Lie (Including Breech Presentation). MSD Manual Professional Edition. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/intrapartum-complications/fetal-presentation-posit ion-and-lie-including-breech-presentation?query=fetal%20presentation,%20position,%20and%20lie%20(including%20breech %20presentation) Volker, J. H. (n.d.). Gynecoid Pelvis – Earth’s Lab. Earth’s Lab. https://www.earthslab.com/anatomy/gynecoid-pelvis/ Physiology of labor – anatomy & physiology. (n.d.). https://pressbooks.ccconline.org/bio106/chapter/physiology-of-labor/ Mayo Foundation for Medical Education and Research. (2024, July 23). Mayo Clinic.https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/stages-of-labor/art-20046545 Stages of labor: Video, Causes, & Meaning | Osmosis. (2016). Osmosis. https://www.osmosis.org/learn/Stages_of_labor?from=/oh/foundational-sciences/physiology/reproductive-system-and-br east/pregnancy