NORMAL LABOUR AND DELIVERY By Dr shatha sami

NORMAL LABOUR AND DELIVERY By Dr. shatha sami FICOG CABCOG

NORMAL LABOUR DEFINITIONS Labour is defined as the onset of regular painful contractions with progressive cervical effacement and dilatation of the cervix accompanied by descent of the presenting part. End By delivery of fetus, placenta, membranes

NORMAL LABOUR The following criteria should be present to call it normal labour � Spontaneous expulsion, � of a single, � mature fetus (37 completed weeks – 42 weeks), � presented by vertex, � through the birth canal (i. e. vaginal delivery), � within a reasonable time (not less than 3 hours or more than 18 hours), � without complications to the mother, � or the fetus

WHAT FACTORS INFLUENCE PROGRESS OF LABOUR ?

LABOUR AND DELIVERY FACTORS THAT INFLUENCE PROGRESS OF LABOUR Power Passenger Passage

THE NORMAL FEMALE PELVIS The ideal normal female gynaecoid pelvis: 1. The brim is slightly oval transversely. 2. The sacral promontory is not prominent. 3. The transverse diameter is slightly longer than the anteroposterior. 4. The sidewalls are parallel and straight. 5. The ischial spines are not prominent. 6. The sacrosciatic notches are wide. 7. The sacrum has a good curve. 8. The pubic arch angle are wide, i. e. more than 90 9. Inter tuberous diameter is wide

THE FETAL SKULL MOULDING’ is the ability of the fetal head to change its shape and so to adapt itself to the maternal pelvis during the progress of labour

POWER ► Contractions + Maternal Uterine contractions: pushing Additional force “maternal pushing” q Shortening of muscle fibres q Retractions q intra uterine pressure Intra abdominal pressure EXPULSION OF THE FETUS

UTERINE CONTRACTION Uterine contractions NORMAL CONTRACTION 1. 2. 3. Frequency ~ one in every 2 – 3 min with at least 1 minute interval Intensity ~ strong (> 50 mm. Hg) Duration ~ 45 – 60 sec

LABOUR AND DELIVERY WHAT INITIATE LABOUR “ONSET OF LABOUR”

NORMAL LABOUR Causes of Onset of Labour: - It is unknown but the following theories were postulated: � Hormonal factors 1) Estrogen theory 2) Progesterone withdrawal theory 3) Prostaglandins theory 4) Oxytocin theory 5) Fetal cortisol theory � Mechanical factors 1) Uterine distension theory 2) Stretch of the lower uterine segment by the presenting near term

LABOUR AND DELIVERY DIAGNOSIS OF LABOUR

NORMAL LABOUR AND DELIVERY SYMPTOMS AND SIGNS OF LABOUR �Painful regular uterine contractions – as evidence by contraction at least one in ten minutes �Show – as evidence by mucus mixed with blood �Rupture of membranes – as evidence by leaking liquor �Progressive shortening and dilatation of the cervix

LABOUR AND DELIVERY THE STAGES OF LABOUR

FIRST STAGE OF LABOUR

NORMAL LABOUR AND DELIVERY First stage: from onset of labour till fully effacement and dilitation Divided into: Latent phase – begins with onset of contracts and ends when cervix is 3 cm dilated and effaced Active phase – begins after the cervix is 3 cm dilated

NORMAL LABOUR AND DELIVERY WHAT HAPPEN DURING THE FIRST STAGE OF LABOUR

NORMAL LABOUR AND DELIVERY WHAT HAPPEN DURING THE FIRST STAGE 1. Contractions: CONTRACTIONS 1: Regular 2: Increasing in frequency 3: Stronger

WHAT HAPPEN DURING THE FIRST STAGE OF LABOUR 2. Cervical dilatation and effacement: Phases of cervical dilatation Latent phase – the first 3 cm of dilatation; a slow process (8 hours in nulliparous and 3 hours in multiparous Active phase – this is active process of cervical dilatation; the normal rate is 1 cm/hour

NORMAL LABOUR AND DELIVERY WHAT HAPPEN DURING THE FIRST STAGE 3. Engagement of the presenting part:

SECOND STAGE OF LABOUR

NORMAL LABOUR AND DELIVERY SECOND STAGE OF LABOUR 1. Begins with FULL DILATATION and ends with DELIVERY OF THE BABY. 2. It have TWO Phases a) Propulsive phase – from full dilatation until presenting part has descended to the pelvic floor b) Expulsive phase which ends with the delivery of the baby 3. Average length a) Primigravidae – 40 minutes b) Multigravidae – 20 minutes

APRIL 2005 THIRD STAGE OF LABOUR

NORMAL LABOUR AND DELIVERY THIRD STAGE OF LABOUR 1. Begins after DELIVERY of the baby and ends with DELIVERY OF THE PLACENTA / MEMBRANES. 2. It have TWO Phases a) Separation phase b) Expulsion phase 3. Duration – usually 15 minutes or less (if actively managed). .

Fourth stage Its 3 -4 hours after delivery of placenta & mebrane , period of stabilization of fetus & mother