management of normal labor

7/21/2019 Management of Normal Labor

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Management of NormalManagement of Normal

Labor and DeliveryLabor and Delivery


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%dentification of Labor%dentification of Labor

&terine contraction that cause cervical&terine contraction that cause cervical

changechange

'aginal ()am:'aginal ()am:* note dilation+ effacement+ consistency+ stationnote dilation+ effacement+ consistency+ station

* ,uptured membranes,uptured membranes

+ nitra.ine test+ nitra.ine test

sterile speculumsterile speculum

infre/uent vaginal e)ams if #,0Minfre/uent vaginal e)ams if #,0M


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1tages of labor1tages of labor

irst 1tage-- stage of cervical effacementirst 1tage-- stage of cervical effacement

and dilationand dilation

* egins hen uterine contractions of sufficientegins hen uterine contractions of sufficient

fre/uency+ intensity+ and duration are attainedfre/uency+ intensity+ and duration are attained

to bring about effacement and progressiveto bring about effacement and progressive

dilation of the cervi)dilation of the cervi)

* (nds hen the cervi) s fully dilated 56 cm to(nds hen the cervi) s fully dilated 56 cm toallo passage of the fetal headallo passage of the fetal head


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Divisions of irst 1tage of LaborDivisions of irst 1tage of Labor

Divides 5st stage into latent and activeDivides 5st stage into latent and activephase:phase:* latent phase: onset of labor is definedlatent phase: onset of labor is defined

according to riedman as the point at hichaccording to riedman as the point at hichthe mother perceives regular contractionsthe mother perceives regular contractions

regular ct) ta!e place along ith cervical softeningregular ct) ta!e place along ith cervical softeningand effacementand effacement


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Latent #hase LaborLatent #hase Labor

"4 cm dilated"4 cm dilated

8ontractions may or may not be8ontractions may or may not bepainfulpainful

Dilate very slolyDilate very sloly

8an tal! or laugh through8an tal! or laugh throughcontractionscontractions

May last days or longerMay last days or longer

May be treated ith sedation+May be treated ith sedation+

hydration+ ambulation+ rest+ orhydration+ ambulation+ rest+ orpitocinpitocin

#rolonged latent phase: defined#rolonged latent phase: definedas greater than 26 hours in aas greater than 26 hours in anullipara and greater than 54nullipara and greater than 54hours in a parous omanhours in a parous oman


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9ctive #hase Labor9ctive #hase Labor

9t least 4 cm dilated9t least 4 cm dilated

,egular+ fre/uent+ usually,egular+ fre/uent+ usually

painful contractionspainful contractions

Dilate at least 52-5;Dilate at least 52-5;

cm


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irst 1tage of Laborirst 1tage of LaborContractionsContractions

%nterval%nterval

* 56 to 26 minutes beteen contractions: early labor56 to 26 minutes beteen contractions: early labor

* 3 to ; minutes beteen contractions: late labor3 to ; minutes beteen contractions: late labor

DurationDuration* 26 second long contraction: early labor26 second long contraction: early labor

* 46 to =6 second long contraction: late labor46 to =6 second long contraction: late labor

>uality>uality* &terus can be dented poor /uality: early labor&terus can be dented poor /uality: early labor

* &terus is hard good /uality: late labor&terus is hard good /uality: late labor


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irst 1tage of Laborirst 1tage of Labor

ManagementManagement

etal ?eart ,ate should be beteen 526 -etal ?eart ,ate should be beteen 526 -

5@6 #M5@6 #M

Mother should be coached to rela) andMother should be coached to rela) and

conserve energy beteen contractionsconserve energy beteen contractions


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Maternal Monitoring andMaternal Monitoring and

Management during LaborManagement during Labor

Maternal 'ital 1igns every 4 hoursMaternal 'ital 1igns every 4 hours

* if temperature: chorioamnionitis: need toif temperature: chorioamnionitis: need to

treat ith antibiotics that ill cover gramtreat ith antibiotics that ill cover gramnegative and anaerobes ampicillin andnegative and anaerobes ampicillin and

gentamicingentamicin

9nalgesia9nalgesia


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9ssessing #rogress of Labor9ssessing #rogress of Labor

'aginal ()am'aginal ()am

55 8ervi)8ervi)* 1oft or ?ard1oft or ?ard

* (ffaced or Ahic!(ffaced or Ahic!

* DilatationDilatation

22 #resentation#resentation

* #art cephalic+ breech+ shoulder#art cephalic+ breech+ shoulder* le)ion+ ()tensionle)ion+ ()tension

* 1tation1tation


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PartografPartograf


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1econd stage of labor-- stage of e)pulsion of the1econd stage of labor-- stage of e)pulsion of the

fetusfetus

* begins hen dilatation of the cervi) is complete andbegins hen dilatation of the cervi) is complete and

ends ith delivery of the fetusends ith delivery of the fetusDuration of 1econd 1tageDuration of 1econd 1tage

* #rimigravida: ;6 minutes+ ma) 2 hours#rimigravida: ;6 minutes+ ma) 2 hours

* Multiparous: 26 minutes or less+ ma) 5 hoursMultiparous: 26 minutes or less+ ma) 5 hours

8ontractions8ontractions

* %nterval: 2 to 3 minutes%nterval: 2 to 3 minutes

* Duration: ;6 to 566 secondsDuration: ;6 to 566 seconds


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1econd 1tage of Labor1econd 1tage of Labor

ManagementManagement

* Mother may feel urge to push+ coach to pushMother may feel urge to push+ coach to push

only during a contraction once the cervi) hasonly during a contraction once the cervi) has

been determined to be fully dilatedbeen determined to be fully dilated

(pisiotomy(pisiotomy

* #erform to avoid unnecessary tearing hen#erform to avoid unnecessary tearing hen

head is croninghead is croning* 8ontrolled delivery avoids need for episiotomy8ontrolled delivery avoids need for episiotomy

in most casesin most cases


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Ritgen Maneuver

Erbs palsey


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Delivery of head -Delivery of head -80NA,0L head to80NA,0L head toprevent e)plosive deliveryprevent e)plosive deliveryand subse/uent tearingand subse/uent tearing

8hec! for presence of8hec! for presence ofcord around nec!cord around nec!

9spirate oral and nasal9spirate oral and nasalcavities ith bulb syringecavities ith bulb syringe

Deliver anterior shoulderDeliver anterior shoulderith donard pressureith donard pressure

8omplete delivery and8omplete delivery and?9NB 0N A0 9C?9NB 0N A0 9C


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(pisiotomy(pisiotomy

*9nestheti.e ith pudendal bloc! or infiltration9nestheti.e ith pudendal bloc! or infiltration

* #ut to fingers into the vagina along the#ut to fingers into the vagina along the

posterior allposterior all

* #lace one blade of scissors beteen fingers#lace one blade of scissors beteen fingers

inside vagina+ other blade outside vaginainside vagina+ other blade outside vagina

toard anustoard anus* 8ut to appro)imately 5 inch aay from anus8ut to appro)imately 5 inch aay from anus

during a contractionduring a contraction


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Robekan Perineum- Tatalaksana grade IIRobekan Perineum- Tatalaksana grade II


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Robekan Perineum- Tatalaksana grade IIIRobekan Perineum- Tatalaksana grade III


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Aehni! penyambungan ototAehni! penyambungan otot

sfingter anisfingter ani


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Robekan Perineum- Tatalaksana grade IVRobekan Perineum- Tatalaksana grade IV


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#ain ,elief#ain ,elief

NarcoticsNarcotics

8ontinuous Lumbar (pidural8ontinuous Lumbar (pidural

#aracervical loc!#aracervical loc!;6


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9nesthesia During Delivery9nesthesia During Delivery

LocalLocal

#udendal loc!#udendal loc!

(pidural(pidural8audal8audal

1pinal1pinal

;6


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Ahird stage of labor-- stage of separation ofAhird stage of labor-- stage of separation of

separation and e)pulsion of placentaseparation and e)pulsion of placenta

* begins immediately after delivery of the fetusbegins immediately after delivery of the fetus

and ends ith delivery of the placenta andand ends ith delivery of the placenta andfetal membranesfetal membranes

*9citive management9citive management controlled cordcontrolled cord

traction+ o)ytocin+ uterine massagetraction+ o)ytocin+ uterine massage


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8hec! the #lacenta8hec! the #lacenta

management of normal labor

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