ppt normal labour aruna.ppt 2003.ppt

7/27/2019 ppt normal labour aruna.ppt 2003.ppt

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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

ppt normal labour aruna.ppt 2003.ppt

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