ppt normal labour aruna.ppt 2003.ppt
TRANSCRIPT
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MS A.ARUNA
FACTORS FOR NORMAL LABOUR
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Introduction
Uterus: pear-shapedmuscle made of 3layers:
Endometriuminnerlining - shed during
menses.Myometrium - muscle
layermiddle
Perimetrium - outer layer -extra support to wholestructure.
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Normal labour: Labour ( eutocia)is a series of event thattake place in the genital organ in an effort to expel theviable products of conception out of worm or uterus
through the vagina in to outer world
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Criteria of normal labour:
Spontaneous in onset & termWith vertex presentation
Without undue prolongation
Natural termination with minimal aids
Without any complication to mother &
baby
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Criteria of Abnormal labour(dystocia)
1. Any deviation from normal
2. Presentation other than vertex
3. Complication even with vertexpresentation
4. Modifying natural termination
5. Adversely affecting the maternal & fetalprognosis
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THEORIES of LABOR:
1. Uterine distension
Myometriu
m-baby
Amniotic
fluid-
distensionof lower
pole
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2. Feto placental contributionFoetal hypothalamus
(triggered by unknown factor)
Releasing factors are produced
Stimulation of anterior pituitary
gland
Production of
adrenocorticotrophic hormone
Stimulation of foetal adrenal
gland
Secretion of cortisolDecrease in
progesterone
level
Increase in oestrogen
level& prostaglandin
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3. Estrogen:
- increase the releaseof oxytocin frommaternal pituitary.
- Promotes thesynthesis ofreceptors foroxytocin in themyometrium and
decidua
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4.Progesterone:first produced by the
corpus Luteum and
then by placenta.
It has a
relaxant effect
on the uterus
It inhibitsuterine
contractility
When the oestrogen level increases , the progesterone levels decrease.
This decreases at the end of pregnancy causing increase production of foetal
dehydroepiandrosterone sulphate (DHEAS)
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Increase fetal production ofdehydroepiandrosterone sulphate (DHEA-
S) & cortisol may inhibit conversion of fetal
pregnenolone to progesterone.
Progesterone level fall before labour,
thereby altering estrogen progesterone
ration which is linked with prostaglandin
ratio.
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5. Prostaglandin: The major sites of synthesis
of prostaglandins are placenta, foetal
membrane, decidual cells and myometrium.It is thought that the decidua at term releases
prostaglandins from the uterus in response
to the release of oestrogen.They act on the uterine muscles and causes it
to contract.
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Synthesis is also triggered by rise in
glucocorticoid, mechanical stretching in
late pregnancy, infection, vaginal
examination separation or rupture ofmembrane.
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2.Oxytocinreleased by the posterior pituitary gland
a stimulating action on the pregnant uterus
Towards the end of pregnancy, there
is an increase in the oxytocin receptors in the decidue vera.
acts directly on the myometrium and causes the uterus to
contract
it acts on
the endometrial tissue and causes the release of prostaglandin.
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PREMONITORING SIGN OF LABOUR:
LighteningCervical changes
Appearance of false pain
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Lightening:
few week prior to onset of
labour ( primigravida) thepp sinks into the true pelvisd/t the pulling up of thelower pole of the uterusaround the pp. This
deminishes the fundalheight, minimise pressureon the diaphragm.
Increase micturition orconstipation d/t pressure by
engaged pp ( welcomesign- as it can rules outCPD)
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Cervical changes:
Few days prior to theonset of labour thecervix become ripe. A
ripe cervix is soft,less than 1.5 cm inlength, admit a fingereasily & is dilatable
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Appearance of false pain: False pain or
spurious labour. It is found more in
primigravida than in parous women. It usually
appears prior to the onset of true labour pain,by 1 or 2 weeks in primigravida & by few
days in multipara
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Feature of false labour pain
Dull in nature usually confined to the lowerabdomen & groin
Continous & unrelated to hardening of
uterus
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Without any effect on dilatation of the cervix
Usually relieved by enema and
administration of a sedative
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True labour pain
The feature of true labour pain are Painful uterine contraction at regular
interval
Contraction with ng intensity and duration Show
Progressive effacement & dilatation of
cervix Formation of bag of water
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True labour pain:
through out pregnancy ,
painless braxton hickscontraction withsimultaneous hardening ofuterus occur. Thesecontraction change their
character, become morepowerful, intermittent andare associated with pain.
The pain are more oftenfelt in front of the
abdomen or radiatingtowards the thighs
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Show:
Expulsion ofcervical mucusplug, mixed withblood is calledshow.
With onset of labour, there is profusecervical secretion.
With slight oozing ofblood from rupture
of capillary vesselsof the cervix.
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Dilatation of cervix:
with the onset of labour
pain, the cervical canalbegins to dilate more inthe upper part than in thelower
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Formation of bagof water:
due to stretching ofthe lower uterinesegment, themembrane aredetaches easily
because of its looseattachment to thepoorly formeddecidua,
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with the dilatation of cervical canal, the lower
pole of the fetal membranes becomes
unsupported & tends to buldge in the cervical
canal as it contain liquor, which has passbelow the pp is called bag of water
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FACTORS OF LABOUR:
There are 5 major factors interact during
normal child birth. This are often called as5Ps of labour
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1. Power:
a. Uterine contraction- During 1st stage of
labour uterine contraction are the primary
force that move the fetus through the
maternal pelvis
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b. Maternal pushing effort- During the second
stage along with uterine contraction the
women feel an urge to push & bear down as
the fetus distance her vagina & put pressureon her rectum
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Passage-
The birth passageis the bony pelvis& soft tissue in
which the fetushave to passthrough duringlabour
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d. Passenger-The passenger is the fetus
membrane & placenta
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e. Position- It is a point on presenting part in
relation to the 4 quadrants of maternal pelvis
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f. Psychological support: Anxiety & fear
decreases the women ability to cope with
pain in labour. Maternal catecholamine
secreted in responds to anxiety & fear caninhibits uterine contractility & placental blood
flow
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Factor influencing labour
Maternal
age
Materna
l weightBirth
weight
&gestatio
nal age
Birth
interval
Fetal
position
Status
of
amniotic
sacs
Site of
placental
implantation
Maternal
position
duringlabour
Psychologic
al factorMedica
tion
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STAGE OF LABOUR
1. First stage: it start with true labour pain &
end full dilatation of cervix. This divided intotwo phases
a) Latent phase- 0-3cm cervical dilatation
b) Active phase- acceleration 2.5-4cm
- Maximum slope of 4-9cm
- Deceleration phase 9-10cm
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Physical characteristic of 1st stage Mild
menstrual like cramp, dull back ache, show,
rupture of membrane & ambulation become
difficult. 12 hour for primi & 6 hour for multi
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2. Second stage of labour: it start from full
dilatation of cervix end with expulsion offetus from birth canal.
Phases:
a. propulsive phase- it start from fulldilatation of cervix up to descent of
presenting part to the pelvic floor
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b. Expulsive phase- it is distinguish by
maternal bearing effort and end with delivery
of baby. Duration for primi- 2hours for multi
30 mint
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physical
characteristic-
strong urge to push,
increase pressure &bulging of perineum,
emergent of
presenting part
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3.THIRD STAGE
IT START AFTER EXPULSION OF FETUS & END WITH
EXPULSION OF PLACENTA.
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Duration for primi & multi - 15 mint
Physical characteristic:- cessation of
uterine contraction
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4. Four stage of labour: stage of observation
for 1 hour, during this period generalcondition of patient & behavior of uterus
are to be carefully watch
Physical characteristics: perineal
tenderness & involuntary shivering