NORMAL & ABNORMAL
LABOUR
LABOUR
PROCESS BY WHICH FETUS OF VIABLE AGE IS EXPELLED FROM THE UTERUS
NORMAL LABOUR: FETUS PRESENTS BY VERTEX, BEGINS SPONTANEOUSLY AT TERM, TERMINATES NATURALLY WITHOUT ARTIFICIAL AID & WITHOUT COMPLICATIONS
ABNORMAL: ANY DEVIATION FROM ABOVE
PRE-LABOUR
PREMONITORY STAGE PRIMI:BEGINS 2-3 WKS BEFORE ONSET OF TRUE LABOUR MULTI:FEW DAYS BEFORE ONSET
FEATURES: LIGHTENING:PRESENTING PART SINKS INTO TRUE
PELVIS,DECREASE IN FUNDAL HEIGHT,RELIEF FROM CARDIO-RESP EMBARRASMENT,WELCOME SIGN-RULE OUT CPD
CERVICAL CHANGES:SOFT&DILATABLE FALSE LABOUR PAINS:DUE TO STRETCHING OF
CERVIX&LUS. DULL,CONTINOUS,CONFINED TO LOWER ABDOMEN,NOT ASSOCIATED WITH HARDENING OF UTERUS OR DILATATION OF OS,RELIEVED BY ENEMA OR SEDATION
SIGNS OF ONSET OF LABOUR
PAINFUL UTERINE CONTRECTIONS:
INTERMITTENT CONTRACTIONS RECOGNISABLE ON PALPATION INITIALLY FOR 30 SEC AT 15-30 MIN GRADUALLY INCREASE IN FREQUENCY,SEVERITY&DURATION SHOW:
DISCHARGE OF CERVICAL MUCUS PLUG &SLIGHT HEMORRHAGE DILATATION &EFFACEMENT OF INT OS: FORMATION OF BAG OF WATERS:
The Stages of Labor
First Stage Interval between the onset of labor and
full cervical dilation Duration is 8-16 hours in primis &4-8
hours in multisSecond stage: Starts with full dilation of cervix &ends
with expulsion of fetus from birth canal. Duration:1-2 hours in primis. 30 mins in multis.
The Stages of Labour
Third Stage: Begins after expulsion of fetus &ends
with expulsion of placenta and membranes.
Duration:15 mins in both primis &multis.
Fourth Stage: Stage of observation. One hour after expulsion of placenta and
membrane.
VID-20130905-WA0007.mp4
MANAGEMENT OF LABOR
FIRST STAGEPRELIMINARIES - H/o duration of amenorrhoea -time of onset of labor
pains/leaking -general examination -vital parameters -obstetric examination p/a p/v -review of antenatal records
MANAGEMENT OF LABOR
ASSESSMENT OF PROGRESS OF LABORPer-abdominal-uterine contractions- frequency,intensity&duration. -descent of head -FHS -110-160/min. -rhythm & intensity -every half hourWith progress of labor &descent of head maximum
impulse of FHS shifts downwards & medially.All high risk women to be put on CTG monitor.
MANAGEMENT OF LABOR
Per vaginal-dilation &effacement of cervix. -descent of head-station of
head in relation to
ischeal spine -rotation of head -if membrane absent-colour of
liquor -if cx 4 cm or more –ARM -any caput or moulding
MANAGEMENT OF LABOR
MATERNAL CONDITION:Every 2 hourly Hydration Pulse B.P. Temperature Urine output
MANAGEMENT OF LABOR
SECOND STAGE:The transition from 1st to 2nd stage is
evidenced by-increasing intensity of uterine
cont. -bearing down effort -urge to defecatePer vaginal –full dilation of cervix
CONDUCT OF DELIVERYDELIVERY OF HEAD Maintain flexion Prevent early extension Regulate slow escape out of vulvaBearing down encouraged during
contraction&deep breathing in between contractions
When the perineum is stretched &threatening to tear,an episiotomy should be performed.
CROWNING OF HEAD
EPISIOTOMY
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