normal labor and delivery by dr.nawal alsinany
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Normal Labor and Delivery by Dr.Nawal ALsinany. Definition:. Childbirth is the period from the onset of regular uterine contractions until expulsion of the placenta. Mechanisms of labor. - PowerPoint PPT PresentationTRANSCRIPT
Definition:
Childbirth is the period from the onset of regular uterine
contractions until expulsion of the placenta . .
–at the onset of labor the position of the fetus with respect to the birth canal is critical to the route of the
delivery .
–It is important to know the fetal position within the uterine cavity at
the onset of labor
Fetal lie : is the relation of the long axis of the fetus to that of the mother it
is either longitudinal 99% or transverse or oblique (due polyhyd ,p.p ,ulnine
anomali)
Fetal presentation is the portion of the fetal body that is either fore most within
the birth canal or closest proximity to it.
1(cephalic presentation.
•It is classified according to relation ship
between the head and the body of the fetus.
2 (face presentation
•Fetal neck sharply extended so that the
occiput and back come in contact
3(brown presentation
•Partially extended head .is the greatest diameter 13.5cm fronto bregmatic
4(Breech. presentation
eith.Frankcompletfootling.
Delivery usually by cls
Fetal postion
•Relation ship of an chosen portion of the fetal presenting pant to the Rt or Lt .side
of birth canal
Labor with.Occiput presentation.
•1)in the most of the cases the vertex inter the pelvis with the sagittal suture lying in
transverse pelvic diameter .
•(L.O.T. )40%
•(R.O.T. )20%
Cardinal movements in the mechanism of labor and
Delivery in left .occiput. anterior position
Descent
Flexion
Internal rotation
External rotation
Expulsion
Descent:
•This movement is the First requisite for the birth of New born .
•usually follow the engagement .
•
Descent occe due to
•1)pressure of the A.F
•2)Direct pressure to the breech by contraction.
•3)bearing down of maternal abd .muscles.
•4)extention of fetal body.
Flexion:
•When descending head meets resistance from cervix –walls of the pelvis or pelvic floor
•This results in the chin brought into more contact with the fetal thorax.
•-and the suboccipitobregmatic diameter . will be presentation
Internal Rotation
•This movement consists of turning of the head in such a manner that the occiput gradually moves toward the symphysis
pubis .anteriorly
Extension
•After internal Rotation the sharply flexed head reaches the vulva and undergoes
extension
External Rotation–The delivered head undergoes restitution .to
oblique position followed by complition of external
•rotation to transverse position .
Expulsion
•Immediately after external Rotation . the anterior shoulder appears under
symphysis and the perineum soon becames. Distended by post shoulder
2 (onset of labor.•The plysiological processes in human
pregnancy that result in initiation of labor remain poorly defined .
•uterotonin production .
•elevation of the uterotonin receptors in myometriam
Progesterone Estrogen
Reloxin Corticotrophin Releasing hormone (CRH)
Prostaglandins
oxytocin receptors .
Fetal ACTH
Characteristics of normal labor
• Latent phase•defined as the point at whitch the pt. has
regular contraction and cervical dilatation less than 5cm
• avaragble duration is 12hr
•
First stage of laborRegular uterine contraction lead
To cervical dilatation
Formation of distinct lower uterine and upper segments
Duration 4.9 hour
Second stage of labor
•This stage begins when cervical dilatation is complete and ende with
Fetal delivery.
•Duration: 50 min up to2hr in nullparus 20 min 1hr in multi para.
Third stage of labor
•From expulsion of the fetus till the Delivery of placenta it is 30 min