Introduction to Labour by dr wael el banna

8/8/2019 Introduction to Labour by dr wael el banna

1/67


2/67


3/67

A\ Uterine Cont. Of Labour B\ Auxiliary Forces

Forces Of LaboursPowers


4/67

1/ Polarity & Fundal Dominance :

* cont. upper relax lower.* Physiological ring

2/ Painfull due to

2 compression ( m. & n. ) + 2 stretch (cervix &periton.)

A\ Uterine Cont. Of Labour


5/67

3 \ Cont. & Retraction ( not relaxation = do not

return to its normal length )*** Values >>>

4\ Invol. & Rhythmic

5\ Intermittent***Why ???6\ freq , strength & duration

( Give range !! )7\ Coordinated ( m. theory )


6/67

H elpe In :

2nd & 3 rd stages of labour


7/67

H ow To Diagnose A True Labour ???1/ TLP ( differentiate bet. TLP & FLP )

1. Site2. rhythm3 . Freq. strength , duration4. Bulge5. Dilat6. sedation


8/67

2\ The Show :

3 \ Dilatation of cervix

N.B. Multipara (mos)

4\ Bulging Bag ( fore-waters )


9/67

1\ PGs**Why ?? Due to 3 ..2\ Progesterone Withdrawal3 \ Estrogen-Oxytocin4\ Uterine Distension5\ Stretch of lowe part of uterus

6\ Placental Ischemia7\ Fetal Cortison


10/67


11/67

Def.\Prodroma >>A. FLPB. Vaginal DischargeC. Changes after engagement(shelfing lightening )


12/67

3 rd2nd1 st

By

complete expulsion of the fetus

Cervix Dilate

up to( 10 cm)

By

TLPStart

Byexpulsion of the

placenta & memb.

Bycomplete expulsion of

the fetus

Cervix Dilateup to

( 10 cm)End

In both 10 30 min.prima ( 1-2 hrs )Multi ( 1/2 hr)

**Normal \prima ( 10 18 hrs )Multi ( 6 -10 hrs)

**Abnormal \Prolonged

Duration


13/67

** Causes of Cervical Dilatation1 pg,2 contrac, 3 bulge,4 head or presenting part

** Mechanism of Cervical Dilatationin bothPrimigravida & Multipara

** Phases of Cervical Dilatation


14/67

Mechanism of 2 nd Stage of labour

3 rd StageMechanism of 3 rd Stage of labour

2 Ways : Schultze or Duncan


15/67

Tocia >>Eutocia >>

**spontaneous expulsion,, **single,,

** living,, **full term fetus ,,**in vertex cephalic presentation ,, **throw birth canal ,,**after TLP,, **without assistance or complications to both

Distocia >>


16/67

LOA & ROA

LOT & ROT


17/67


18/67

Delivery of The Head

Delivery of The Shoulders & Body


19/67

1- Descent

2- Engagement3 - Flexion ( to achive 9.5 cm )4- Int. Rotation5- Extension ( H inge , 2 forces )6- Restitution7- Ext. Rotaion

See the video...

Delivery of The H ead


20/67

1- Ant. Shoulder hinges below the symphysis.2- post. Shoulder delivered 1st

by lat. Flexion of the spine.3 - Ant. Shoulder then follows , then the rest ofthe body.

Delivery of The Shoulders & Body


21/67

H istory- Onset Show- Liquor amnii- ROM- fetal movements


22/67

Examination- A : General- Vital signs (pulse.,,Blood pr.,,Temp,)- Anxiety- Dehydration- H ight & Weight


23/67

Examination- B : Abdominal- freq , intensity & duration of Uterin cont.- Lie , prsentaion , position, attitude- Engagement- Site,rate,rhythm(when >>> in between

contractions )


24/67

First Leopold maneuverFirst Leopold maneuverPalpation of uterine fundus


25/67


26/67

Th ird LeopoldTh ird Leopoldmaneuvermaneuver

y Fetal presentation andengagement


27/67

Fourt h LeopoldFourt h Leopoldmaneuvermaneuver

y Fetal engagement


28/67


29/67

Examination

- C : Vaginal- Exclude :1\ contracted pelvis

2\ cord prolapse- Asses1\cervix status

2\fetal staions


30/67

30


31/67


32/67


33/67

VARIOU S PO SI TION S OF THE F ETU S


34/67

VARIOU S PO SI TION S OF THE F ETU S


35/67

F req. of theV aginal Exam.


36/67


37/67


38/67


39/67


40/67

Managment fo 1st stage

1 prep.Antspet.(shave, betadine)Bladder and rectum evac.(how)

2 observeMother(p,bp,temp,rr) contractions(by palm

or toco), cx, rom

Fetus (fhs) pinard sonicad, ctg3 nutrionEarly (latent phase sugary fluids. Active

nothing per oral to avoid mendelson .


41/67

If prolonged more than 8h glucose 5%&saline.

4 pain reliefPethidine 50mg im but stopped 2 h before

2nd stEpidural5 instructions

Rom rest in lat pos. If intact walkAvoid straining exhaustion and prolapse


42/67


43/67


44/67


45/67

[1]


46/67

Managment of 2 nd stage

Identification : how???????? /1.10cm 2 .desire to evacuate the rectum3 .Disire to bear down

4. expiratory grunt with bearing down5 rom (2 bags become one bag. Rom could

happen before 2 nd stage .

Conduct1. prep. (in OR room, lithotomy pos., vulva

and perineum are washed , towels are

applied )


47/67

2.Instructions3

.deliv. Of head and prevn. Of tears .Crowning def??????????/before it occipto frontal (11.5) after it

suboccipto frontal (10

cm)a. perineal support done before crowning.b. deliv. Of the head (slow, in between

cont. And with ritgen man.) controldextension of the head.c. Espisiotomy (def. Timing)


48/67

4 after head delliv.

a. Clear air passage by aspiration.b. Colis of umbilical cord ( slipped doubly

clamped and cord cut in between .

c. Delv of shoulders (lift head up then down)d. Handling of fetus ( ankles hold butavoided when ( asphyxia or intracranialhge or preterm fetus)

e. Milking of the cord but avoided when RHnot to bring more antibodies , andpreterm to avoid circulatory overload.


49/67


50/67


51/67


52/67


53/67

R itgen maneuver


54/67


55/67


56/67


57/67


58/67


59/67


60/67


61/67


62/67


63/67

Management of the 3 rd stage

Duration normal (5 to 10) if more than30(prolonged )

A conservative ( exclusion of bleeding andatony) unlar border is put on the fundusrise in the level denotening bleedinginside so never do massage .)

Signs of separationA uterus is smaller harderB suprapubic bulgeC elongation of the cord without receding


64/67

Gush of blood per vagina

(uterine massage)(placental expulsion) ask pt to bear downbut fundal pressure is avoided not tocause inversion.

( uterine stimulants ) to prevent postpartumhge. Ergometrine .25 mg im ot oxytocin 5units

Disadvantages of conservative leads toPostpartum and longer time.


65/67

Active method

1. stimulants2. Brandt andrews (how , advan, disadvan) After placental delv.

Rolling, inspection of placenta , repair of tears if more than 1cm, wash anddressing)

Estimation of blood loss 5 00 cc.


66/67


67/67

Management of 4 th stage:

1h observation , massage every 15 min.Management of newborn1 warmth

2 care of reparation3 care of the stump (hernia)4 care of eye

5 weight6 ident7 congenital anomilies (hypospadius,im.anu

Introduction to Labour by dr wael el banna

Documents

Transcript of Introduction to Labour by dr wael el banna