5.Normal Labour FIRYAL
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Transcript of 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