Normal Labor and DeliveryAFE Lin Jianhua M D

Normal Labor and Delivery(AFE) 正常分娩 Lin Jianhua M. D. , Ph. D. , Professor Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine

definition Term delivery(labor): 37 -42 weeks n pre-term delivery: 28 - <37 weeks n post-term delivery: 42 weeks n Abortion: <28 weeks n 85% of women spontaneous labor and delivery between 37 -42 weeks n LMP : last menstrual period n EDC: expected date of confinememt n

The four factors for labor Force (contraction) n birth canal (bony canal) n fetus (lie, position , presentation, weight) n psychical-factors n

The contractions increase in frequency and duration n uterus can be felt to harden during contraction n lasting about 30 -45 seconds n interval between contractions to be 5 min’ n the pain of labor is a character n

NST CST

Bony pelvis The planes of pelvis n inlet plane (promontory) n mid plane of pelvis(ischial spines) n outlet plane(two intersecting triangles) n n

Mechanism of labor Engagement* n Flexion n Decent n Internal rotation n Extension n External rotation n

Symptoms and signs of the onset of the labor Painful uterine contraction n a show n effacement and dilation of the cervix n rupture of membranes n

The show n The mucus plug is expelled from the cervix n mixing with a little blood the rupture of the membranes n at any time during labor effacement and dilation of the cervix n to be short, taken up, dilated

Stages of labor n n n n n The first stage: onset of labor to full cervical dilation(10 cm) the latent phase ( onest to <3 cm, <16 h) the active phase(>3 cm to 10 cm, <8 h) The second stage: 10 cm to the delivery of the infant, <2 h The third stage: delivery of the infant to delivery of the placenta, <30 m’ The fourth stage: 2 hours after delivery of the placenta

Management of normal labor The first stage: n education, eating, voiding, n position(sitting, reclining, recumbent) n monitoring of the fetal heart rate , n dilation of cervix and frequency n severity of uterus contractions(auscultation or electronic monitoring) n

The second stage : --- < 2 hour n fetal heart rate n maternal conditions: n pulse, blood pressure, respiratory rate , n temperature, urine output, fluid intake… n evaluation of progress of labor n cervical dilation, station, position of the n presenting part, status of membranes, n meconium, blood n

Pushing: n with the onset of each contraction, the mother is encouraged to inhale, hold her breath, and push n increase in intra-abdominal pressure n aiding in fetal descent through the birth cacal. n

Head visible on vulval gapping* n Crowning of head* n Laceration or Episiotomy n Delivery of fetus n Deal with umbilical cord n

the third stage: waiting for up to 30 min’ n the uterus decreases in size n delivery of placenta(spontaneously, manually n inspection of the birth canal n evaluated for lacerations n

“The fourth stage” postpartum uterine hemorrhage , 1% n uterus palpation through the abdominal wall is repeats n the amount of blood on pads are monitored n pulse and BP are monitored n use of drug : oxytocin n

THANKS FOR YOUR ATTENTION Lin Jianhua M. D. , Ph. D. , Professor Dep. of Obstet. & Gynecol. Renji Hospital Affiliated to SJTU School of Medicine