labour process
DESCRIPTION
ppts of labour by mandeep kaurTRANSCRIPT
NORMAL LABOUR
Series of events that takes place in the genital organs,is an effort to expel the viable products of conception out of the womb through the vagina into the outer world.
STAGES OF LABOUR
Ist STAGE:-
From onset of true
labour pains till the
full dilatation of
cervix.Its 12 hrs in primigravida and 6 hrs in multiparae.
Contd…
IInd STAGE:-
From full dilatation of
cervix till fetus is
delivered.Its 2 hrs in primigravidae and 30 min. in multiparae.
Contd…
IIIrd STAGE:- From delivery of
fetus till delivery
of placenta.Its of
average 15 mins.
PARAMETERS FOR CONSIDERATION
LIE:-The relationship
between the long axis of
fetus with long axis of
uterus.
E.g.:Longitudnal
Transverse
Oblique
Contd…
ATTITUDE:-
The relationship of
fetal head & its
trunk.
E.g.:- Flexion.
Contd…
PRESENTATION:- The part of fetus which lies at pelvis or lower pole of uterus.
Vertex:- 98.6%
Breech:- 2.5%
Shoulder:- 0.4%
Face:- 0.2%
Brow:- 1%
Contd…
DENOMINATOR:- It is the leading point
of presentation.
In Vertex:- Occiput
In Breech:- Sacrum
In Face:- Chin
Contd… POSITION:- The relationship of
denominator with pelvic brim. L.O.A:- Left Occipito Anterior R.O.A:- Right Occipito Ant. L.O.P:- Lt. Occipito Posterior. R.O.P:- Rt. Occipito Post. L.S.A:- Lt. Sacro Ant. R.S.A:- Rt. Sacro Ant. L.S.P:- Lt. Sacro Post. R.S.P:- Rt. Sacro Post.
PHYSIOLOGY OF Ist STAGE OF LABOUR
Duration Uterine action Fundal dominance Polarity Contraction and Retraction Formation of Retraction Ring A ridge on the inner
uterine surface at the boundary between the upper and lower uterine segments that occurs in the course of normal labor.
Dilatation of cervix Effacement of cervix Show Rupture of Membranes/Formation of Bag
Of Water
MANAGEMENT OF Ist STAGE
Non interference with watchful expectancy. To monitor carefully:-
a) General management
b) Bowel And Bladder Care
c) Rest
d) Diet
e) Relief of pain
Contd…
Note Progress Of Labour:-
a) Abdominal Findings
b) Pelvic Grip
c) Vaginal Examination
d) Fetal And Maternal Condition
First maneuver: Fundal Grip
While facing the woman, palpate the woman's upper abdomen with both hands. often determine the size, consistency, shape, and mobility of the form. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and the shoulders and limbs have small bony processes;
Second maneuver: Umbilical Grip
Still facing the woman, the health care provider palpates the abdomen with gentle. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands.
Third maneuver: Pawlick's Grip
In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen.[2] The individual performing the maneuver first grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand.
Fourth maneuver: Pelvic Grip
The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis.
PHYSIOLOGY OF IInd STAGE OF LABOUR
Contractions become stronger & longer. Continous contraction & retraction of upper
uterine segment & lower uterine segment thins. Nature of contraction become more expulsive &
pressure is extended on the rectum & perineal floor.
There is soft tissue displacement. Bladder is pushed up. Rectum becomes flattened into sacral curve &
pressure of advancing head expels any residue
SIGNS OF IInd STAGE OF LABOUR
Contractions become longer & stronger.
Full dilatation of cervix. Presenting part is seen at vulva. There is pouting & gapping of anus. Buldging of perineum.
MECHANISM OF MECHANISM OF LABOURLABOUR
The series of movements that occur on the head in the
process of adaptation,during its journey through the
pelvis.
The Principle Movements Are:-
Engagement Descent Flexion Internal Rotation Of Head Extension Of Head Restitution External Rotation Of Head & Internal
Rotation Of Shoulders Expulsion Of Head & Trunk
ENGAGEMENT
Mechanism by which fetal nestles into the pelvis.also termed as LIGHTENING or DROPPING.In primigravida it occurs before the onset of labour while in multigravida occurs in late Ist stage with rupture of membranes.
DESCENT
It is a continous process.It is slow in Ist stage & becomes pronounced in Iind stage.Descent is completed with expulsion of fetus.Head is expected to reach pelvic floor by the time cervix is fully dilated.
FACTORS FACILITATING DESCENT
Uterine Contractions & Retractions.
Bearing Down Effort.
Straightening Of Fetus Especially After Rupture Of Membranes.
FLEXION
Process of fetal head nodding forward towards the fetal chest.As the head meets the resistance of birth canal during descent,full flexion is achieved either due to resistance offered by unfolding of cervix walls of pelvic or by pelvic floor
INTERNAL ROTATION OF HEAD
In a well flexed vertex presentation, the occiput leads & meets the pelvic floor Ist & rotates ant. Through 1/8th of the circle.this causes slight twist in neck of fetus as head is no longer in alignment to shoulder.The head slips benesth sub-pubic arch &crowning occurs.
CROWNING After internal rotation
of head, further descent occurs,untill the sub- occiput lies underneath the pubic arch.At this stage the max. diameter of head stretches the vulval outlet without any recession of head even after contraction is over-It is called CROWNING.
Biparietal diameter:- 9.5cm.
EXTENSION OF HEAD
Once crowning has occurred the fetal head can extend.The driving force pushes the head in downward direction.The successive parts of fetal head to be born through stretched vulval outlet are VERTEX,BROW &FACE
RESTITUTIONRESTITUTION
Visible passive movement of head due to untwisting of neck sustained during internal rotation.Movements
of restitution occurs rotating the head through 1/8th of circle in direction opposite to internal
rotation & comes in lateral flexion & faces towards thighs.
EXT. ROTATION OF EXT. ROTATION OF HEAD &INT. ROTATION HEAD &INT. ROTATION
OF SHOULDEROF SHOULDER
Movement of rotation of head visible externally due to internal
rotation of shoulders.As the ant.shoulder rotates towards the symphysis pubis,it carries the head in a movement of ext.
rotation through 1/8th of circle in same direction of restitution.
EXPULSION OF EXPULSION OF SHOULDER & TRUNKSHOULDER & TRUNK
After the shoulders are positioned in ant.-post. Diameter of outlet,further
descent takes place until the ant. Shoulder is born.By a movement of
lat.flexion of spine,the post. shoulder sweeps over the perineum.Rest of the
trunk is expelled out by lateral flexion.
PRINCIPLES OF PRINCIPLES OF MANAGEMENT OF IInd STAGE MANAGEMENT OF IInd STAGE
OF LABOUROF LABOUR
To assist in natural expulsion of fetus slowly & steadily.
To prevent perineal injuries.
MANAGEMENT OF IInd STAGE OF LABOUR
General Measures:-
a)Patient should lie down in bed.
b)Constant supervision for F.H.S.
c)To note maternal vital signs every ½ hrly
d)To administer analgesics.
e) To advice & instruct the patient to keep
up morale.
Vaginal examinationVaginal examination
It is done at early or beginning of 2nd stage of labour to rule out any
accidental cord prolapse.Position & station of head should be once
more noted to progressive descent of head.
Nothing should be given to mother except sips of water.
PREPARATION OF DELIVERY
Shifting of patient to delivery table. Positioning of patient. Aseptic techniques. Toileting of genitalia. Emptying of bladder. Supporting perineum while delivery. Providing EPISIOTOMY to prevent tears. Inj. METHERGIN 0.2 mg I/M after
delivery of anterior shoulder of baby.
CONDUCTION OF DELIVERY
Delivery should be spontaneous & is divided into 3 phases:-
a) Delivery of head.
b) Delivery of shoulders.
c) Delivery of trunk.
SIGNS OF IIIrd STAGE OF LABOUR
Lengthening of cord.
Gush of bleeding.
Uterus becomes full OR boggy uterus.
MANAGEMENT OF IIIrd STAGE OF LABOUR
Control Cord Traction
IV th STAGE OF LABOURIV th STAGE OF LABOUR
Stage of observation for at least 1 hr after expulsion of the after births.
Contd…
Check vital signs of mother & baby.
Bleeding per vagina. Breast Feeding. Comfortable position. Observation for urine
output. Comfort of mother
and newborn.
