8.Normal delivery. Stages of labor. Flashcards
(50 cards)
Labour is called normal if?
spontaneous onset , vertex presentation , no prolongation , natural termination with minimal aids , without having any complications affecting the health of the mother
describe false labour ?
more in primigravidae
prior to the onset of true labor pain by 1 or 2 weeks in primigravidae and by a few days in multiparae
no changes in cervix dull in nature , not in frequent intervals confined to lower abdomen and groin , not associated with hardening of uterus , relived by enema and sedation
what is true labour ?
painless BRAXTON Hicks contractions occur with hardening of uterus with no effect on dilatation of the cervix
then false labour
===becoming true labour ===
painful contraction at regular intervals
frequency, duration and intensity of contraction increase
said to be good - intervals at 3–5 minutes and at the height of contraction the uterine wall cannot be indented by the fingers
associated with SHOW, due to progressive effacement and dilation of cervix ( expulsion of the thick mucus plug blocking the cervical canal with blood)
descent of presenting part
bag of waters - stretching of the lower uterine segment, the membranes are detached
lower pole of the fetal membranes becomes unsupported and tends to bulge into the cervical canal. As it contains liquor, which has passed below the presenting part, it is called “bag of waters”.
not relived by enema or sedatives
where is the pace maker of these contraction
tubal ostia
pain of uterine contractions are mainly due to
compression of nerve ganglion distributed along cutaneous nerve T10 - L1
other cause of pain -
myometrial hypoxia ,
stretching of peritoneum over fundus ,
stretching of cervix during dilation
how many stages of labour are there and describe them
1st stage - onset of true labour - complete dilation of the cervix
further subdivided into the latent and the active phase
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2nd stage of labour - from the complete dilation of the cervix - delivery of fetus
has subdivision
The propulsive phase—starts from full dilatation to the descent of the presenting part to the pelvic floor.
The expulsive phase -mother sires to bearing down with her abdominal muscles to expel the fetus
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3rd stage of labour - end of delivery of fetes to delivery of placenta
describe the latent phase of first stage of labour
1)Effacement is the process by which the muscular fibers of the cervix are pulled upward and merges with the fibers of the lower uterine segment
cervix is dilated / thinning and mucus plug will come off - “show” .
In primigravidae, effacement precedes dilatation of the cervix, whereas in multiparae, both occur simultaneously
2) regular uterine contractions- causes cervix to be further dilated and increase in intrauterine pressure
what happens if the amniotic fluid does not rupture and there has already been show ?
amniotic fluid does not rupture because there is weak uterine contractions
perform amniotomy which is artificial rupture of the amniotic sac
this will induce labour
when is amniotomy contraindicated ?
baby is in breech , placental prevae - where placeta is lying over the cervix
describe the active phase in the first stage of labour
4) once the cervix is over 3 cm dilated we are in the active phase , the cervix is constantly pulling up and it become part of the lower uterine wall .
5) uterine contraction continue with increasing intensity and regularly until cervix is fully dilated
6) With the full dilatation of the cervix, the membranes usually rupture and there is escape of good amount of liquor amnii
check if the amniotic fluid is clear - this is normal
green or smelly - indicates meconium - dangerous because meconium would go into the foetus lungs - aspiration - cause respiratory problems
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wall of upper segment of uterus is thick , while the passive lower segment is thin - the junction between the two is called the PHYSIOLOGICAL RETRACTION RING (not pathological retraction ring - feature obstructed by labour- bandyl)
the first stage of labour can be very long in whom ?
nullipara (no delivery of fetus) women
normally the latent stage of stage 1 in nullipara women should take ?
less than 20 hours - longer indicate failure to progress
dilation should continue at what rate after 3 cm in nullipara
enter active phase
should continue every 1.2 cm/hr atleast – slower than this failure to progress
the latent stage for multipara women is how long
less than 14 hours - more than this failure to progress
dilation should continue at what rate after 3 cm effacement in multipara
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active phase is split into ?
less than 1.5cm /hr after 4cm dilation- failure to progress
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acceleration =3-4 in 2hrs
phase of maximum - 4-9cm in 2hrs
deceleration = 9-10cm in 2hrs
what is the clinical management of first stage
maternal monitoring - check freq /intensity / duration of contractions
In primigravidae, the cervix may be completely effaced, feeling like a paper although not dilated to admit a fingertip. It may be mistaken for one that is fully dilated.
anterior lip of the cervix is the last to be effaced!!
-check blood pressure , temp , fluid intake and output
check fetal heart rate every 15-30 mins
analgesia if needed
amniotomy if needed
second stage of labour begin when ? and what happens to the uterus shape during contractions ?
cervix is 10cm dilated
The uterus becomes elongated during contraction, while the anteroposterior and transverse diameters are reduced.
The elongation is partly due to the contractions of the circular muscle fibers of the uterus to keep the fetal axis straight.
the 7 cardinal movement in the second stage of labour only occur when ?
FETUS PERFOMS 7 CARDINAL MOVEMENTS OF LABOUR ONLY PRESENT IN VERTEX POSITION
what are the 7 cardinal movement in the second stage of labour
1 ) Engagment
2) descend
3) Flexion
4) Internal rotation
5) Extension
6) External rotation / resuscitation
7) expulsion
what is engagement ?
fetus is said to be engaged when the widest part of the fetal head (biparital diameter) has passed through the pelvic inlet commonly the transverse diameter or less commonly the oblique
The engaging transverse diameter is biparietal 9.5 cm
The engaging anteroposterior diameter of the head is either suboccipitobregmatic (fully flexed) 9.5 cm
in slight deflexion—the suboccipitofrontal - 10.5cm
fully deflexed face - ocipitofrontal - 11.5cm
ocipitolateral is the most common
due to the head facing laterally the sagittal suture does not strictly correspond with the available transverse diameter of the inlet. Instead, it is either deflected anteriorly toward the symphysis pubis or posteriorly toward the sacral promontory causing asynclinitism - mild degrees are common but severe not
what is descent ?
in multiparae, descent starts with engagement.
in primipare engagemnet in first stage and descend
Head is expected to reach the pelvic floor by the time the cervix is fully dilated
progression of fetal head is measured in -10 to +10
The negative indicate the presenting part is getting proximal from the maternal’s narrowest area the ischial spines
And positives indicates the presenting part is getting distal from the mothers ischial spines
what is flexion ?
resistance by the soft tissues such as the cervix or the pelvis walls and floor
- the chin meets the chest , now the smallest diameter of the babies head -
has to know go
go to the suboccipitobregmatic plane =9.5cm in AP
what is internal rotation
because the shape of the pelvis is downwards forwards and medially - internal rotation occurs
from the ocipitolateral position 2/8 of a circle anterior rotation
in oblique ocipitoanterioir - 1/8
placing the occiput behind the symphysis pubis- fetal in occipital anterioir position
prerequisites of anterior internal rotation : well-flexed head, efficient uterine contraction, favorable shape at the midpelvic plane, and good tone of the levator ani muscles
rotation of the head seen by by position of the sagittal suture, and the occiput
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rotation of the shoulders in the same direction of one-eighth of a circle placing the shoulders to lie in the oblique diameter with one-eighth of torsion in the neck
what is extension ?
subocciput lies underneath the pubic arch. At this stage, the maximum diameter of the head (biparietal diameter) stretches the vulval outletnd there is no recession even after the contraction passes off
before extension in dutta there is crowning
EXTENSION- as fetal head passes under subpubiic arch - releasing the brow , face and chin as the nape pivots underneath the arch
