NORMAL LABOURAND DELIVERY Dr shatha sami Assistant professor

NORMAL LABOURAND DELIVERY Dr. shatha sami Assistant professor 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 ?

Power Passenger Passage

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

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

WHAT INITIATE LABOUR “ONSET OF 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

DIAGNOSIS OF LABOUR

SYMPTOMS AND SIGNS OF LABOUR Pain as evidence painful regular uterine contractions 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

THE STAGES OF LABOUR

FIRST STAGE OF LABOUR

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

WHAT HAPPEN DURING THE FIRST STAGE OF LABOUR

Uterine action 1. Fudal dominance Contractions start in the fundus and spreads across and downward

2. polarity Its term describe the neuromuscular harmony between two pols or segments of uterus throughout labour

3. Contraction and retraction Intensity- the degree of uterine systole. . Intrauterine pressure is raised to 40 -50 mm Hg during first stage and about 100 -120 mm Hg in the second stage of labour during contractions. Duration - In the first stage, the contractions last for about 30 second initially but in the second stage, the contractions last longer than in the first stage. Frequency - In the early stage of labour, the contractions come at intervals of 1015 minutes. The intervals gradually shorten with advancement of labour until in the second stage, when it comes every two or three minutes

Retraction is a phenomenon of the uterus in labour in which the muscle fibers are permanently shortened

2. Cervical dilatation and effacement: Effacement refers to the inclusion of the cervical canal into the lower uterine segment

Cevical dilitation Dilatation of cervix is the process of opening of the cervix from a tightly closed aperture to an opening large enough to permit the passage of the fetal head

Show: is a blood stained mucoid discharge. Formation of fore water As the lower uterine segment forms and stretches, loosened part of the sac of fluid to bulge downwards into the internal os. Rupture of membrane Fetal Axis Pressure the force of the fundal contraction is transmitted to the upper pole of the fetus down the long axis of the fetus and applied by the presenting part to the cervix.

SECOND STAGE OF LABOUR

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

THIRD STAGE OF LABOUR

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). .

signs of sepration of placenta preceding any trial to delivery of it: 1. gush of bleedingfrom site of sepration of placental bed. 2. increased the length of cord. 3. uterus become round globular due to decreasing the size of uterus and starting of countraction. 4. placenta in vagina on PV examination

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

Quiz: define : 1 st stage of labour cervical effacement