Definition Childbirth is the period from the onset

Definition: Childbirth is the period from the onset of regular uterine contractions until expulsion of the.

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 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. 5 cm fronto bregmatic

4)Breech. presentation eith. Frank complet footling. 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 Expulsion

Descent: This movement is the First requisite for the • . birth of New born. usually follow the engagement • •

Descent occe due to pressure of the A. F(1 Direct pressure to the (2. breech by contraction bearing down of (3. maternal abd. muscles. extention of fetal body(4 • •

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. st shoulder

2) onset of labor. The plysiological processes in human • pregnancy that result in initiation of emain poorly defined. ction. • 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 5 cm avaragble duration is 12 hr • •

First stage of labor Regular 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 to 2 hr in nullparus • 20 min 1 hr in multi para.

Third stage of labor From expulsion of the fetus till the • Delivery of placenta it is 30 min