contents€¦ · definition of normal labour 2. factors influencing progress of labour 3. diagnosis...

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CONTENTS 1. Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour

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Page 1: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

CONTENTS

1. Definition of normal Labour

2. Factors influencing progress of Labour

3. Diagnosis of Labour

4. Stages of Labour

5. Management of Labour

Page 2: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

LABOUR DEFINITION

Labour is defined

The onset of regular painful uterine contractions with progressive

effacement and dilation of the cervix accompanied by decent of the

presenting part leading to expulsion of the fetus or fetuses and placenta

from the mother

Normal Labour is defined

to expel the viable(alive) products of conception

Page 3: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

DIAGNOSIS OF LABOUR

Signs that can clue into the onset of Labour

• Show- evidence by mucus mixed with blood or mucus plug

• Rupture of membranes- look for leaking liquor

• painful, regular uterine contractions, at least (1:10)

Page 4: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

VAGINAL EXAMINATION

Confirm degree of dilatation and effacement

Identify the presenting part

Fetal head engagement

Confirm or artificially rupture if necessary (ROM)

Exclude cord prolapse

Page 5: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

FACTORS TO HELP DETERMINE IF LABOUR

IS NORMAL

Mature Fetus 37-42 weeks

Spontaneous expulsion

Vertex is the presenting part

Vaginal Delivery

Time ( not < 3hour but not >18 hours)

Complications??

Page 6: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

INFLUENTIAL FACTORS OF THE PROGRESS

OF LABOUR

5P’s

• THE PASSENGER-Fetal head size, Fetal lie, presentation, attitude, position

• THE PASSAGE WAY/PELVIS

• THE POWERS

• THE PLACENTA

• PSYCHOLOGICAL RESPONSE

Page 7: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

PHYSIOLOGY OF NORMAL LABOUR

POWERS

Physiology of normal labour complete into two steps

UTERINE CONTRACTION RETRACTION

1. Uterine contraction : During contraction, uterus becomes hard and somewhat pushed anteriorly to make the long axis of the uterus in the line with that of pelvic axis

2. Uterine contraction : Probable cause of pain are

a) Myometrial hypoxia during contractions.

b) Stretching of the peritoneum over the fundus.

c) Stretching of the cervix during dilatation.

d) Compression of the nerve ganglion.

e) The pain of uterine contractions is distributed along the cutaneous nerve distribution of T10 to L1

Page 8: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

INTENSITY

The intensity gradually increases with advancement of

labour until it becomes maximum in the second stage during

delivery of the baby.

Intrauterine pressure is raised to 40-50 mm Hg during first

stage and about 100-120 mm Hg in the second stage of

labour during contractions.

Page 9: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

In the first stage, the contractions last for about 30 second initially but

gradually increases in duration with the progress of labour.

Thus in the second stage, the contractions last longer than in the first stage.

FREQUENCY

In the early stage of labour, the contractions come at intervals of ten to fifteen

minutes. The intervals gradually shorten with advancement of labour until in the

second stage, when it comes every two or three minutes.

Page 10: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Retraction

Retraction is a phenomenon of the uterus in labour in which the muscle fibers are permanently shortened.

Unlike any other muscle of the body, the uterine muscles have this property to become shortened once and for all

Contraction

is a temporary reduction in length of the fibers, which attain their full length during relaxation. In contrast, retraction results in permanent shortening and the fibers are shortened once and for all.

Page 11: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

The net effect of retraction on normal labour are:-

Essential property in the formation of lower uterine segment

Dilatation and effacement up of the cervix

To maintain the advancement of the presenting part made by the uterine contractions and to help in ultimate expulsion of the fetus.

To reduce the surface area of the uterus favouring separation of placenta.

Effective haemostasis after the separation of the placenta

Page 12: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

The Passenger

The passage of the fetus through the birth canal is influenced by the

size of the fetal head and shoulder

the dimensions of the pelvic girdle

the fetal presentation and position

The bones of the cranial vault are not firmly united, and slight overlapping of the bones, or

moulding of the shape of the head, occurs during labour.

This capacity of the bones to slide over one another permits adaptation to the various

diameters of the pelvis.

Moulding can be extensive, but with most neonates the head assumes its normal shape

within about 3 days after birth.

Page 13: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

MOULDING

The physiological gradual overlapping of the bones as the skull is

compressed during its passage in the birth canal.

One parietal bone overlaps the other and both overlap the

occipital and frontal bones so fontanelles are no more detectable.

It is of a good value in reducing the skull diameters but; severe

and / or rapid moulding is dangerous as it may cause intracranial

haemorrhage.

Page 14: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

MOULDING

The bones of the fetal head

can move closer together or

overlap to help the head fit

through the pelvis.

Parietal bones overlap

occipital and frontal

from +0 to +3,

+0+1 being normal and +3

being cause for concern

Page 15: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

The foetal head can move on the neck about 45 degrees in flexion or extension

Shoulders and Pelvic girdle Because of their mobility, the position of the shoulder (the

shoulder girdle) can be altered during labour, so that one shoulder may occupy a lower

level than the other. This permits a small shoulder diameter to negotiate the passage.

The circumference of the hips, or pelvic girdle, is usually small enough not to create

problems.

Page 16: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

THE FETAL SKULL

Page 17: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

diameters of the skull

Vertex Sub-occipito-bregmatic 9.5cm

OP Sub-occipito-frontal 10cm

Occipito-frontal 11.5 cm

Brow Mento-vertical 13.5cm

Face Sub-mento-bregmatic 9.5cm

Page 18: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

DIAMETERS OF THE SKULL

Page 19: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Caput succedaneum is a diffuse swelling of the scalp

caused by the pressure of the scalp against the dilating

cervix during labour.

Caput can make it difficult to define the position of

the fetal head.

It is graded subjectively from 0 (none) to +3 (marked).

Page 20: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 21: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

The bony pelvis

Page 22: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Pelvic

diame

ters

Page 23: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

PELVIC PRIM /INLET

POST SACRAL PROMENTARY

ANTERIOR S.P

LATERALLY UPPER BORDER OF THE PUBIC BONE AND ILEO-PECTINEAL

LINE

TRANSVERSE DIAMETERE 13.5CM

AP DIAMETER 11CM

INLET ANGLE 60 DEGRESS

Page 24: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

PELVIC MIDCAVITY

middle of the S.P

from the sides : pubic bone , inner aspect of the ischial bone

Posteriorly :S2-S3 Junction

almost round

AP Diameter 12 cm

Feel ischial spine vaginally station

Page 25: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Pelvic outlet

Anteriorly Lower margin of S.P

Laterally Pubic bone descending rami ,ischial tuberosity and

Sacro-tuberous ligament

Posteriorly end of sacrum

Ap diameter 13.5

Transverse diameter 11cm

Page 26: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

FEMALE PELVIS

Basic framework for the

birth canal

True Pelvis- Inlet, cavity and

Outlet ( The fetus must pass

through all three in order

for labour to be sucessful)

Types of Pelvis- Gynaecoid,

Anthropoid, Android and

Platypelloid

Page 27: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 28: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 29: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 30: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 31: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

CAUSES OF THE ONSET OF NORMAL LABOUR

It is unknown but the following theories are proposed:

1-Hormonal Factors

• Oestrogen Theory

• Progesterone withdrawal theory

• Prostaglandin Theory

• Oxytocin Theory

• Fetal Cortisol Theory

2- Mechanical Factors

• Uterine Distension Theory

• Stretch of the lower uterine segment

Page 32: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Hormonal factors:

(i) Oestrogen theory: During pregnancy, most of the oestrogens are present in a binding

form. During the last trimester, more free oestrogen appears increasing the excitability of

the myometrium and prostaglandins synthesis.

(ii) Progesterone withdrawal theory: Before labour, there is a drop in progesterone synthesis

leading to predominance of the excitatory action of oestrogens.

(iii) Prostaglandins theory: Postaglandins E2 and F2a are powerful stimulators of uterine

muscle activity

(iv) Oxytocin theory: Although oxytocin is a powerful stimulator of uterine contraction , its

natural role in onset of labour is doubtful. The secretion of oxytocinase enzyme from the

placenta is decreased near term due to placental ischaemia leading to predominance of

oxytocin’s action.

(v) Foetal cortisol theory: Increased cortisol production from the foetal adrenal gland

before labour may influence its onset by increasing oestrogen production from the placenta

Page 33: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Clinical Picture of Labour

Prodromal (pre - labour) stage:

Shelfing

Lightening

It is the relief of upper abdominal pressure symptoms as dyspnoea, dyspepsia and

palpitation due to Descent in the fundal level after engagement of the head

Pelvic pressure symptoms

With engagement of the presenting part the following symptoms may occur: -

Frequency of micturition. - Rectal tenesmus. - Difficulty in walking.

Increased vaginal discharge

False labour pain.

Page 34: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Onset of Labour:

True labour pain

The show

Dilatation of the cervix

Page 35: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

STAGES OF LABOUR First Stage

Begins with the onset of true labour contractions and ends when the cervix is fully dilated (10cm).

Cervical effacement and dilatation occurs in this : Latent & Active

Latent: From diagnosis of labour to 3cm dilatation

Active: From 3cm to full dilatation (10cm)

It takes about 10-14 hours in primi gravida and about 6-8 hours in multi para.

The second stage of labour

begins with complete dilatation and ends with the birth of the baby. Approximately 2 hours in a nulliparous and 1 hour in a multi-para woman

Third stage

Begins after birth and ends with the expulsion of the placenta and membranes Shortest stage: After birth, up to 30 minutes

Page 36: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 37: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

FIRST STAGE WHAT HAPPENS

1- Contractions

1. Regular

2. Increasing Frequency

3. Stronger

2- Cervical Dilatation and Effacement

3. Engagement of the presenting part

Page 38: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

FIRST STAGE WHAT HAPPENS

Latent phase:

This is the first 3-4 cm of cervical dilatation

slow takes about 8 hours in nullipara and 4 hours in multipara.

The latent phase begins with mild, irregular uterine contractions that soften

and shorten the cervix

Active phase

Begin after 4 cm of cervical dilatation.

The normal rate of cervical dilatation in active phase is 1-1.2 cm/ hour in

primigravidae and 1.5 cm/hour in multiparae.

If the rate is < 1cm / hour it is considered prolonged

Page 39: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Quantitatives Assessment

Palpation

External tocodynamometry

Internal uterine pressure catheters.

95 % of women in labor will have 3-5 contractions per 10 minutes.

Page 40: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

SECOND STAGE

First sign of the second stage is the urge to push

Full Dilatation to Delivery of the fetus

The median duration varies in nulliparous and multiparous women is 60 and 30 minutes, respectively.

Other factors may affect its duration:

Epidural analgesia

duration of the first stage

parity

maternal size

birth weight

station at complete dilation.

Signs to look for:-

Distention of the perineum

Satisfactory progress:- steady descent of the fetus through the birth canal & onset of the expulsive phase

Page 41: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

(ACOG) has suggested that a prolonged second stage of labor should be

considered when the second stage of labour exceeds 3 hours in nulliparous and 2

hours in multiparous

Page 42: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 43: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

MECHANISM OF LABOUR

Page 44: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 45: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Delivery of the head:

(1) Descent: It is continuous throughout labour particularly during the second

stage and caused by:

a. Uterine contractions and retractions.

b. The auxiliary forces brought by contraction of the diaphragm and abdominal

muscles.

c. The unfolding of the foetus

(2) Engagement:

The head normally engages in the oblique or transverse diameter of the inlet.

Page 46: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Flexion

Increased flexion of the head occurs when it meets the pelvic floor according to the

lever theory.

Increased flexion results in :

a. The suboccipito - bregmatic diameter (9.5cm) passes through the birth canal

instead of the suboccipito- frontal diameter (10 cm).

Internal rotation

The rule is that the part of foetus meets the pelvic floor first will rotate anteriorly. As

the head descends, the presenting part, usually in the transverse position, is rotated

about 45° to anteroposterior (AP) position under the symphysis

Extension

The suboccipital region lies under the symphysis then by head extension the vertex,

forehead and face come out successively.

Page 47: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Restitution:

After delivery, the head rotates 1/8 of a circle in the opposite direction of

internal rotation to undo the twist produced by it.

External rotation

The shoulders enter the pelvis in the opposite oblique diameter to that

previously passed by the head. When the anterior shoulder meets the pelvic floor

it rotates anteriorly 1/8 of a circle. This movement is transmitted to the head so

it rotates 1/8 of a circle in the same direction of restitution

Page 48: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 49: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 50: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

PARTOGRAM partogram is a composite graphical

record of key data (maternal & fetal)

during labour entered against time on

a single sheet of paper.

Page 51: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 52: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

COMPONENTS OF A PARTOGRAM

Patient Identification

Time (recorded in 1hr intervals)

Fetal Heart Rate

State of Membranes

Cervical Dilatation

Uterine Contractions

Drugs & Fluids

BP (2hr intervals)

Pulse Rate (30min intervals)

Oxytocin

Urinalysis

Temperature

Page 53: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 54: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour
Page 55: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

THIRD STAGE

Begins with fetus delivery and ends with delivery of placenta/membranes

Two phases: Separation and Expulsion

30 mins or less

Average blood loss 150-250 mld

Birth of the placenta (Two stages)

• Separation of the placenta from the wall of the uterus and into the

lower uterine segment or vagina

• Actual expulsion of the placenta out of the birth canal

Page 56: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

BIRTH OF THE PLACENTA Two methods:

Passive Management (wait for spontaneous expulsion of the

placenta)

Active Management

Active management of 3rd stage ,helps to prevent PPH

Includes:-

Use of oxytocin (given around the time of the anterior shoulder delivery, 10

units)

Controlled cord traction

Uterine massage

Page 57: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

SIGNS OF SEPARATION

Globular and hard uterus

Sudden gush of blood

Cord Lengthening (Most reliable clinical sign)

EXAMINATION OF THE PERINEUM

look for lacerations

vulva outlet

vaginal canal & cervix should be inspected

Repair lacerations or episiotomies immediately or completeness and anomalies

Page 58: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

IMMEDIATE CARE OF THE NEWBORN

Assess baby

Health baby with spontaneous respiration place on mother’s abdomen

APGAR scores

Page 59: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Engagement: The fetus is engaged if the widest leading part (typically the

widest circumference of the head) is entering the inlet

Station: Relationship of the bony presenting part of the fetus to the maternal

ischial spines.If at the level of the spines it is at “0 (zero)” station, if it

passed it by 2cm it is at “+2” station.

Attitude: Relationship of fetal head to spine: flexed, neutral (“military”), or

extended attitudes are possible.

Position: Relationship of presenting part to maternal pelvis, i.e. ROP=right

occiput posterior, or LOA=left occiput anterior.

Presentation: Relationship between the leading fetal part and the pelvic

inlet: cephalic, breech (complete, incomplete, frank or footling), face, brow,

mentum or shoulder presentation.

Lie: Relationship between the longitudinal axis of fetus and long axis of the

uterus: longitudinal, oblique, and transverse.

Page 60: CONTENTS€¦ · Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour . LABOUR DEFINITION Labour

Pelvic types Traditional obstetrics characterizes four types of pelvises:

Gynecoid: Ideal shape, with round to slightly oval (obstetrical inlet slightly

less transverse) inlet: best chances for normal vaginal delivery.

Android: triangular inlet, and prominent ischial spines, more angulated pubic

arch.

Anthropoid: the widest transverse diameter is less than the anteroposterior

(obstetrical) diameter.

Platypelloid: Flat inlet with shortened obstetrical diameter.