normal labor lectures 4 n.petrenko, md, phd. 1 birth passage

Normal Labor

Lectures 4NPetrenko MD PhD

1 Birth Passage

1 Birth Passage

1 Birth Passage

1 Birth Passage

brim Cavity Outlet

Transverse 131 125 118

Oblique 125 131 118

Anteroposterior

113 131 125

1 Birth Passage

Four different types of pelvises but frequently mixed types

gynaecoidanthrapoid android

platypelloid

Pelvic inletsGynecoid

Platypoid

Anthropoid Android

1 Birth Passage

1 Birth Passage

1 Birth Passage

1 Birth Passage

1 Birth PassageAsymmetrical pelvises

Abnormality of lower limbAbnormality of pelvic girdleAbnormality of vertebral column

Robertrsquos pelvisOsteomalacic pelvis

Scoliotic pelvisCoxalgic pelvis

Split pelvis Naegelersquos pelvis

1 Birth Passage

Measurement of AP conjugatesbullDiagonal conjugate ~120 cmbullTrue conjugate ~110 cmbullAP outlet ~125 cm

1 Birth Passage

Assess shape of sacrum

2 FetusSutures

Frontal

Sagittal

Coronal

Lambdoidal

Frontal suture

Sagittal suture

Coronal suture

Lambdoidal suture

Note sutures are actually membranous spaces that meet at fontanels

1 Bones 2 parietals 2 frontals 2 temporals occipital2 Sutures sagital frontal lamboidal coronal temporal3 Fontanelles anterior posterior 2 anterior temporals 2 posterior temporals

Foetal skull

Fetal skull

1 Suboccipitobregamatic ~95 cc Vertex2 Suboccipitofrontal ~100 cm Sinciput3 Occipitofrontal~1124 cm persistent OP4 Mentovertical ~138 cm brow5 Submentobregmatic ~95 cm Face6 Submentovertical ~1125 cm incompletelyextended face7 Biparietal diameter ~95 cm

1

2

3

5

6

7

4

Fetus

Fontanelles intersection of sutures allows for molding helps identify position of head

Anterior (bregma)Diamond shaped

Approx 2-3 cm

Ossifies in ~12-18 months

PosteriorTriangle shaped

Smaller

Closes in 8-12 weeks

Fetus Fetal lie

Longitudinal

Transverse

Fetus Fetal lie

Cephalic

Shoulder

Breech

Fetus

Fetal presentation Cephalic

Vertex presentationMost common

Head completely flexed on chest

Suboccipitobregmatic (Smallest diameter)

Occiput in presenting part

Fetus

Fetal presentation CephalicMilitary presentation

Fetal head neither flexed nor extended

Occipitofrontal diameter presents

Top of the head is presenting part

Fetus

Fetal presentation Cephalic

Brow presentationFetal head partially extended

Occipitomental diameter presents

Sinciput is presenting part

Fetus

Fetal presentation Cephalic

Face presentationHead hyperextended

Submentobregmatic diameter presents

Face is presenting part

Fetal presentations

FetusFetal presentation Breech

Sacrum is the landmark

Complete breechKnees and hips are flexed thighs on abdomen (ldquofetal positionrdquo)

Buttocks and feet are presenting parts

FetusFetal presentation Breech

Sacrum is the landmark

Frank breechHips flexed knees extended

Buttocks is presenting part

FetusFetal presentation Breech

Sacrum is the landmark

Footling breechHips and legs extended

Feet are presenting parts (single vs double)

FetusFetal presentation Shoulder

Acromion process of shoulder is presenting part

Station

Station of the head inrelation to ischial spines

1048713In Gynaecoid amp Android pelvis distance between ischial spine to brim is ~5 cm1048713In Anthropoid pelvis distance is ~7 cm1048713In Platypelloid pelvis distance is ~3 cm

Relationship of maternal pelvis and presenting part

Normal uterine action

Normal uterine action

True vs False LaborTrue False

Contractions

Regular uarrfrequency duration intensity

Irregular short duration mild

Pain Starts in back radiates to front

Begins in abdomen

Cervix change

Dilationeffacement No change

Cont change

Does not decrease with rest or warm bath walking makes stronger

Decreases with rest warm bath walking slows

Partogram

Alert line

Acton line

Normal dilatation

Abnormal dilatation

Stages of

Labor

Stages of Labor

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