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Normal labor for undergraduate

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UNDERGRADUATE COURSE LECTURES IN OBSTETRICS&GYNECOLOGY PREPARED BY DR MANAL BEHERY PROFESSOR OB&GYNE FACULTY OF MEDICINE ZAGAZIG UNIVERSITY

UNDERGRADUATE COURSE LECTURES IN OBSTETRICS&GYNECOLOGY PREPARED BY DR MANAL BEHERY PROFESSOR OB&GYNE FACULTY OF MEDICINE ZAGAZIG UNIVERSITY

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Normal labor for undergraduate

  1. 1. Normal labor DR MANAL BEHERY PROFESSOR OB&GYNE ZAGAZIG UNIVERSITY 2019
  2. 2. Definition of normal labor • Normal labour is contractions of the gravid uterus that expel the fetus and the other products of conception • between 37 and 42 weeks from the last menstrual period (Term Delivery)
  3. 3. Preterm labour:Preterm labor is that occurring before 37 weeks of gestational age. Postdate pregnancy:Postdate pregnancy occurs after 42 weeks .
  4. 4. Criteria for normal labour 1. Spontaneous expulsion, 2. Of a single, 3. Mature fetus (37. completed weeks-42. weeks), 4. Presented by vertex, 5. Through the birth canal (vaginal delivery), 6. Within a reasonable time (more than 3, less than 18 hours), 7. Without complications to the mother, 8. Without complications to the fetus.
  5. 5. Influencing factors  The 3 „P”: (progress of labor)  Power: uterus (myometrium)  Passenger: fetus (head mostly)  Passage: (pelvis of the mother)
  6. 6. True Labor is Uterine Contractions that cause- –Progressive dilation and effacement of cervix –Descent of fetus –Expulsion of fetus and placenta
  7. 7. Cervical dilatation by vaginal examination
  8. 8. • Effacemant :is shortening and thining of the cervical canal (from a length of 3 cm to a circular aperture. Effecemant
  9. 9. How is station (descent )measured and recorded? • -3: 3 cm above the ischial spines 0: at the ischial spines, engaged +3: 3 cm below the ischial spines
  10. 10. Engagement and station of the fetus in labour
  11. 11. Character which define the onset of labor:  Ruptured membranes  Bloody „show”  Complete cervical effacement
  12. 12. True labour vs fales labour • Regular contractions • Increase in frequency and intensity • Cervix dilate • No relive with sedation • Abd and back pain • Irregular • Remain the same • Unchanged • relive • Lower abd
  13. 13. Stages of labor   First stage:  Starts with the onset of true labor contractions  Ends when the cervix is fully dilated (10cm)  Longest stage of labor  Second stage:  Begins with the complete dilatation of the cervix  Ends with the birth of the baby Duration is between 30 and 90 minutes
  14. 14. Stages of delivery  Third stage of labor:  Separation and expulsion of placenta and membranes  Duration is between 5 and 30 minutes  Shortest stage of labor  Fourth stage of labor:  After the expulsion of placenta  Duration is 2 hours  Increased risk for bleeding
  15. 15. First stage of delivery  1. Regular contractions  2. increase in intensity  3. Increasing in frequency (↑)  4. increase in duration  1 causes Cervical dilatation and effacement
  16. 16. First stage of delivery  Contraction and retraction of uterine muscle  Mechanical pressure by the membrane  The descend of the presenting part  Cervical dilatation and effacement
  17. 17. Phases of cervical dilatation:  Latent phase:  the first 3 cm of dilatation, it is a slow process {8 hours at nulliparous, 3 hours at multiparous}  Active phase:  faster dilatation, from 3 cm to fully dilatation (apr. 10cm) {Normal rate is 1 cm / hour}
  18. 18. Effacement: thinning of the cervix
  19. 19. Effacment of the cervix
  20. 20. FRIEDMAN’S CURVE
  21. 21. Station
  22. 22. 2nd stage of labor – expulsion of the fetus  Begins when cervical dilatation is complete and ends with fetal delivery.  Median duration 40-60 min for nulliparas and 20-30 min for multiparas.
  23. 23. LOA position
  24. 24. How does the head negotiate the pelvis? (1) change it’s shape and size (moulding) (2) change it’s position (flexion and rotation)
  25. 25. Left occiput position (LOA, LOT, ROT
  26. 26. Cardinal movement of normal labor
  27. 27. External rotation
  28. 28. The cardinal movements of labor
  29. 29. Third stage of labour    Begins after delivery of the baby and ends with the delivery of the placenta and membranes  It contains two phases  A., Separation  B., Expulsion Duration: 5-20minutes (if actively managed) Blood loss: 150-250 ml (average)
  30. 30. NORMAL LABOR VIDEO
  31. 31. Video of childbirth
  32. 32. Fetal lie  The relation of the long axis of the fetus to that of the mother!  Longitudinal lie (~99%)  Transverse lie (<1%)  Oblique lie unstable and always becomes longitudinal or transverse during the course of labor
  33. 33. Fetal lie – longitudinal axis of the fetus in relation to the long axis of the maternal uterus. assessed by abdominal examination prior to delivery. • Logitudinal transverse oblique • (unstable)
  34. 34. Presentation * • the part of the fetus that is presenting or is the closest in proximity to the birthing canal • Vertex Breech
  35. 35. Presentation * • the part of the fetus that is presenting or is the closest in proximity to the birthing canal • Vertex Breech
  36. 36. Incidences of fetal presentation  Cephalic  Breech  Transverse  Compound  Face  Brow 96,8 % 2,7 % 0,3 % 0,1 % 0,5 % 0,01 %
  37. 37. Fetal attitude or posture  The fetus becomes folded upon itself:  the back becomes markedly convex,  the head is sharply flexed,  the thighs are flexed over the abdomen,  the legs are bent at the knees,
  38. 38. Fetal position According to the determinig points:  the fetal occiput (vertex) – left or right occipital,  the fetal face (mental) – left or right mental,  breech (sacrum) – left or right sacral  shoulder (scapula is the arbitrarily chosen for orientation) presentations.
  39. 39. There are six varieties of each of the three presentations
  40. 40. Labor with occiput presentations  Occiput anterior position (ROA)  Occiput transverse position (ROT)  Occiput posterior position (ROP)
  41. 41. LOA position
  42. 42. Us for detection of position

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