5.normal labour firyal

8/8/2019 5.Normal Labour FIRYAL

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Done by: Firyal Abdulaziz

OMCF-05-35

2nd of November 2010


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Whats labor

How its initiated

Factors effect it Its mechanism

How to diagnose it

How it is progress Stages of labour

Comparison between primi and multi gravid

labour


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Labour: Process by which the products of conception

after attaining viability are separated and expelled from

the uterus

Normal Labour: the process by which the fetus presenting as

vertex is expelled by the natural efforts of the mother when

the pregnancy has reached term and there are no

complications


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There is no definite explanation for what

initiates labour

Hypothesis suggests:

Lose of the balance between pro-pregnancy and

pro-labour factors is what initiates labour

Pro-Pregnancy Pro-LabourProgesterone Estrogen

Nitric Oxide Oxytocin

Catecholamine Prostaglandins

Relaxin Inflammatory mediators


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During Pregnancy:

Pro-pregnancy factors are dominant

Progesterone: Relaxation

Suppresses oxytocin by decreasing receptors sensitivity

Progesterone antagonist to induce labour Mifepristone

Catecholamines: Relaxation

Alters myometrial cell membranes contractility

Used as anti-contraction to suppress preterm labour


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During Labour

Pro-labour factors are dominant

Estrogen: Contraction

Increases oxtycin receptor expression in the uterus

Prostaglandins: Contraction

Promote cervical ripening

Stimulate uterine contractility directly and indirectly by

increasing receptor expression for the oxytocin


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Involves:

Effacement

Dilatation of the cervix

Expulsion of the fetus

Occurs in 3 stages: No specific time for each stage

First stage:

Onset of labour till full dilatation of the cervix

Second stage: Full dilatation of cervix till delivery of the fetus

Third stage:

Delivery of the placenta


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1. Regular and painful contractions that produce

progressive cervical dilatation. (progressive ) Braxton-Hicks:

Uterine contractions NOT associated with cervical change. Shorter in duration

Less intense

Over lower abdomen and groin

Resolve with ambulation

2. Exhibition ofvaginal show

1. The passage of blood stained mucus

3. Rupture of the fetal membranes


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First stage:

Onset of labour till full dilatation of the cervix

Second stage:

Full dilatation of cervix till delivery of the fetus

Third stage:

Delivery of the fetus till the delivery of the placenta


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Mechanism: manner in which the fetus adjust itself

to pass through the birth canal (uterus, cervix, vagina, andvulva)

7cardinal movements of fetus head: Engagement

Descent

Flexion

Internal rotation

Extension

Restitution

External rotation


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Engagement: when the greatest transverse diameter of

the fetal head passes through the pelvic inlet.

Descent: Downward passage of presenting part through

the pelvis. It is brought about by

Amniotic fluid pressure

Uterine contraction

Bearing down efforts of the mother

Extension and straightening of the fetal head

Flexion: Occurs passively as the head descends due tothe shape of the bony pelvis and resistance of pelvicfloor soft tissues Allows smallest diameter of fetal head to pass through the pelvis


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Internal rotation: Rotation of presenting part from the

original transverse position to anteroposterior

position

Extension: the sharply flexed head once is reachesthe pelvic floor is delivered by extension

Restitution:the head rotates to the oblique position

to lie in line with the shoulder.(untwisting of the neck)

External rotation: As the shoulders reach the pelvicfloor they rotate internaly into the anterioposteriordiameter of the pelvis accompanied by external rotation of the head

Return of fetal head to correct anatomic position in relation to the fetal body


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Engagement

Internal Rotation Extension

Flexion


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External Rotation And Expulsion


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Episiotomy

Perform to avoid unnecessary tearing when head is crowning

(maximum dilating vulva )

Anesthetize with pudendal block Put two fingers into the vagina along the posterior wall

Place one blade of scissors between fingers inside vagina,

other blade outside vagina toward anus

Cut to approximately 1 inch away from anus during acontraction

Controlled delivery avoids need for episiotomy in most cases


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Third stage:

Signs of placental separation:

F

resh bleeding Extravulval elongation of the cord

Cricket ball consistency of the uterus with a suprapubic

bulge


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Delivery of the placenta:

Modified Credes maneuver


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Delivery of the placenta:

Brandt-Andrew Maneuver


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First Stage of Labour:

Observation and intervention for any abnormality

Pain relief and emotional support

Adequate hydration

Monitor progress in labourPartogram:

graphic representation of progress of labour to detect abnormalities

Abdominal examination:

monitor uterine contraction actions and descent of the headVaginal exam:

Should be done every 4 h in the first stage of labour

Rate of cervical dilatation normally is 1cm/hr in primigravida and 1.5in multigravida (rate of dilatation)


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Second Stage of Labour:

Conduct of deliver and Episiotomy may be given

An incision of the perineum

Third Stage of Labour: Recognition of placental separation

Assisted delivery of placenta with cord traction

Routine use of oxytocic agents

Post partum haemorraghe:

Risk factors:

Over distended uterus

In macrosomia, multiple pregnancies, tumor complecating pregnancies

Give prophyctic septomatrin

5.normal labour firyal

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