Normal & abnormal

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