The Powers in Normal Labour1
Transcript of The Powers in Normal Labour1
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• Presented by :Presented by : Asmaa Beltagy. 194Asmaa Beltagy. 194
•Supervised by:Supervised by:Prof.dr.Hossam Ibrahim Azab.Prof.dr.Hossam Ibrahim Azab.
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Objectives What are forces of normal labour?
Uterine contraction: Anatomical and physiologic
considerations Uterine contractions throughout
pregnancy and labour Methods of assesment of uterine
contractions Effects of uterine contractions
Bearing down efforts Abnormalities of uterine contractions
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I-Uterine contractions• The uterine musculature during pregnancy is arranged in
three strata:
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The uterus in pregnancy is functionally divided into:
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• Physiological retraction ring:• a ridge around the inside of the uterus that forms at
the junction of the thinned lower uterine segment and thickened upper segment.
• Pathological Retraction Ring (Bandl’s ring)• It is a retraction ring during obstructed labour due to
marked retraction and thickening of the upper uterine segment while the lower segment is markedly stretched and thinned.
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Physiological properties of uterine contractions:1. Contraction: It is temporary shortening of muscle fibres.
2. Retraction: It is permanent shortening of muscle fibres contractions and retractions contribute to:• a. Taking up (effacement) of the cervix.• b. Reduction of uterine volume and
Expulsion of the fetus. 3. Progressive: increase in intensity and
frequency with time.4. Effective.
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5. co-ordination• The pace-maker: The uterine pace-maker lies just
anterior to the uterotubal-junction i.e. at the uterine cornu
• Polarity • Triple descending gradient• Fundal-dominance
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Important definitions:1. Rest tone: in between uterine contractions (6-12 mmHg).
2. Amplitude: The amount of rise of the intra-uterine pressure caused by the
contractions:1st stage – 40-60 mm Hg2nd stage – 80 mm Hg
3. Frequency of contractions: The number of contractions/unit of time (10 minutes).
4. Uterine activity:measured by Montevideo units.= Intensity X frequency over 10 minutes period. Inadequate uterine contractions, defined as less than 180
Montevideo unitsOr Alexandria units= montivideo units × mean duration of each
contraction.
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Uterine activity throughout pregnancy and labour
• 1. In early pregnancy:
felt by P/V Palmer's sign.
• 2. Braxton Hicks Contractions: also known as practice contractions, are sporadic Painless uterine contractions that are Felt abdominally from 16 weeks up to 36 weeks:
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• False labour pains • infrequent, • occur after 36 weeks,• irregular • Of short duration.• Highest amplitude 10-15 mmHg.• Respond to analgesics.• No effect on the cervix.• No bulging of the membranes.• increasing in intensity and
frequency and becoming more rhythmic
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• true labour pains :• Painful contractions:
Abdominal-Pain : Backache:
• Regular
• Don`t respond to analgesics
• Increased amplitude up to 60 mmHg.
• Frequency: 2-4/10 minutes.
• Progressive dilatation and effacement of the cervix.
• Membranes are bulging during contractions.
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False labour pains True labour pains Less painful More Painful
infrequent More Frequent.
increases after 36 weeks
irregular Regular
.
Amplitude less than 10-15 mmHg Increased amplitude up to 60 mmHg.
Respond to analgesics Don`t respond to analgesics
No effect on the cervix. Progressive dilatation and effacement of the cervix.
No bulging of the membranes. Membranes are bulging during contractions.
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Methods of assessment of uterine contractions:
1. Manual palpation.
2. External tocodynometry.
3. Internal manometry (intra-uterine catheter).
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Effects of uterine contractions• A) Descent of the fetus:• 1- Before ROM: Generalised intraamniotic
pressure:
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• 2- After ROM :Direct fetal axis pressure:
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• B) Cervical effacement: contractions and retraction of the uterinelongtudinal fibers and dilatation
• The dilatation of the cervix is the result of two factors:
• active: retraction of the longitudinal fibers of the uterus.
• Passive: the downward push of the bag of water
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• C) Expulsion of the placenta
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• D) Control of bleeding from placental site :
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II-Bearing down efforts• When to start ? • At the end of first stage
(onset of second stage) after full cervical-dilatation. Must be simultaneous with uterine contractions.
• When to stop?• With crowning of fetal
head
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• Contraindicated in:
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PRECIPITATE LABOUR
• Definition A labour lasting less than 3 hours.
• Aetiology It is more common in multiparas with:
• strong uterine contractions, • small sized baby, • roomy pelvis, • minimal soft tissue resistance.
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HYPOTONIC UTERINE INERTIA
• Definition
The uterine contractions are infrequent, weak and of short duration.
• Types
• Primary inertia• Secondary inertia
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• Aetiology
• the following factors may be incriminated:• Primigravida particularly elderly.• Anaemia and asthenia.• Nervous and emotional as anxiety and fear.• Overdistension of the uterus.• Myomas of the uterus interfering mechanically
with contractions.• Malpresentations, malpositions and
cephalopelvic disproportion. • Full bladder and rectum.
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HYPERTONIC UTERINE INERTIA (Uncoordinated Uterine Action) The condition is more common in
primigravidae and characterised by: • Prolonged labour.• Uterine contractions are irregular
and more painful. • High resting intrauterine pressure in
between uterine contractions• Slow cervical dilatation. • Foetal and maternal distress.
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CONSTRICTION (CONTRACTION) RING
• It is a persistent localised annular spasm of the circular uterine muscles.
• at any part of the uterus but usually at junction of the upper and lower uterine segments.
• occur at the 1st, 2nd or 3 rd stage of labour.
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Thank you:)