Normal Labor and Delivery ????

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Normal Labor and Delivery????

• ???

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• Labor
• the process by which contractions of uterus
  expel the fetus.
• Delivery
• receive the neonate

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1. definition

• Term pregnancy 37-42weeks from LMP
• pre-term delivery (labor) 28- lt37 weeks of
  gestational age
• post-term delivery? 42 weeks
• Abortion lt28 week
• 85 of women spontaneous labor and delivery
  between 37-42 weeks

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2. The four factors for labor

• Force ( uterine contraction)
• birth canal (bony canal)
• fetus (lie,position ,presentation,weight)
• psychical-factors

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Contractions

• onset, frequency, duration, intensity
• increase in frequency and duration
• uterus can be felt to harden during contraction
• lasting about 30-45 seconds
• interval between contractions to be 5 min
• Intensity (slight, middle, heavy)
• the pain of labor is a character

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???? ????
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• Birth canal
• Bony canal
• Soft tissue canal (lower part of uterus, cervix,
  vagina

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Bony pelvis

• The planes of pelvis
• inlet plane (promontory)
• mid plane of pelvis (ischia spines)
• outlet plane(two intersecting triangles)

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• fetus (lie, position ,presentation, weight)
• Long axis of mother
• LOA
• Head down
• Estimation of fetal weight 2500g - lt4000g

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3. Mechanism of labor

• The process of labor and delivery is marked by
  change in fetal position in relation to the
  maternal pelvis
• Engagement
• (BPD decent to a level below the pelvic inlet
• An occiput below the ischial spines is engaged)
• Flexion
• Decent
• Internal rotation
• Extension
• External rotation

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4. Symptoms and signs of the onset of the labor

• Painful uterine contraction
• a show
• effacement and dilation of the cervix
• rupture of membranes

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

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The differentiation of labor

• in labor
• spontaneous uterine contraction
• with progressive dilation of
  the cervix
• interval lt 5
• lasting gt30
• intensity is middle or heavy
• False labor

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5. Three Stages of labor

• The first stage
• onset of labor to full cervical dilation(10cm)
• the latent phase ( onest to lt3cm, lt16h)
• the active phase(gt3cm to 10cm, lt8h)
• The second stage
• 10 cm to the delivery of the infant, lt2h
• The third stage
• delivery of the infant to delivery of the
  placenta, lt30m

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6. Management of normal labor

• The first stage
• education, eating, walking,
• position(sitting, reclining, recumbent)
• monitoring of the fetal heart rate ,
• Palpation of cervix ( effacement ,dilation)
• uterus contractions (palpation or electronic
  monitoring)
• Analgesia and anesthesia

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The second stage

• fetal heart rate
• maternal conditions
• pulse, blood pressure, respiratory rate ,
  
• temperature, urine output, fluid intake
• evaluation of progress of labor
• station, position of the presenting part,
  status of membranes, meconium, blood

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

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

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the third stage

• waiting for up to 30 min
• Separation indication of placentathe fundus
  changes to a globular shape and firm consistency
• A gush of blood appears vaginally
• The umbilical cord appears to lengthen
• delivery of placenta (spontaneously, manually
• inspection of the birth canal
• Repair of lacerations or episiotomy

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Key word and questions

• Labor
• Delivery
• Engagement
• Effacement
• What are the four factors in labor and delivery?
• What is the mechanisms of labor ?
• Explain the separation indications of placenta.