LABOR AND DELIVERIED

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LABOR AND DELIVERIED
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Parturition

• phase of parturition
• 0 pregnancy to 36 wks.
• 1 preparation for labor
• 2 processes of labor
• 3 parturient recovery

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• Lightening
• Bloody show
• False labor pain
• True labor pain

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Phenomena Preliminary to the Onset of Labor

• Lightening the baby settles into the lower
  uterine segment.
• Engagement
• The vaginal secretions increase in amount.
• Loss of weight

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Phenomena Preliminary to the Onset of Labor

• The mucous plug
• Bloody show
• The cervix becomes soft and effaced.
• Persistent backache is present.
• Braxtin-Hicks contractions occur.
• Rupture of Membranes

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True labor pain

• Prodromal sign show
• Uterine contraction
• frequent and regular
• 10 min interval, 30 s duration
• Cervical change Ripening Dilatation Effacement

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Stage of labor

• 1 stage
• Latent phase
• Active phase
• 2 stage
• 3 stage

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Stage of labor

• 1st stage
• ?????????? ??????????????????????????????????????
  ???????
• 2nd stage
• ???????????? ???????????????????????
  ??????????????????????
• 3rd stage
• ??????????????????? ????????????????????????????
  ???????????????????

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• ??????????????
• 1. ???????????????????
• 2. interval ????????????????
• 3. Intensity???????????????
• 4. Discomfort??????????????????????????????
• 5. ??????????sedation
• 6. ???????????????????
• 7. No mucous bloody show

• ?????????????
• ????????????
• interval ??????????????
• Intensity ?????? ???????????
• Discomfort?????????????????????????????????
• sedation ???????
• ????????????????
• mucous bloody show

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??????????????????????
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Phase of parturition
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Normal progression
latent active 2nd stage
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Normal progression

• 1st stage of labor
• 1.1 latent phase
• true labor 3 cm of Cx
  dilated
• 8 hr. 20 hr. 14
  hr.
• 1.2 active phase 5 hr.
• 1.2.1 acceleration phase
• 1.2.2 phase of maximum slope
• 1.2.3 deceleration phase

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Normal progression
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Abnormal progression

• G1
• gt20hr
• lt1.2 cm/hr
• lt1 cm/hr

progression 1.prolonged latent
phase 2.protracted dilatation 3.protracted
descent

• G2
• gt14hr
• lt1.5 cm/hr
• lt2 cm/hr

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Abnormal progression

• G1
• gt3 hr
• gt2hr
• gt1hr
• 0

Abn progression 4.prolonged deceleration
phase 5.2nd arrest of dilatation 6.Arrest of
descent 7.Failure of descent

• G2
• gt1 hr
• gt2hr
• gt1hr
• 0

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evaluation of abnormal progression

• Power
• Passage
• Passenger

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POWER

• 1.Uterine contraction
• involuntory , 40-50 mmHg
• 1st and 2nd stage of labor
• 2.???????????????????????????????????
• 1st stage of labor
• 3.????????????
• voluntory , total 250 mmHg
• 2nd stage of labor

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Uterine contraction

• Interval Duration Intensity
• Normal 2-2 ½ 30-90sec. 40-50mmHg
• Hypertonic lt2 asynconus gt 50 mmHg
• Hypotonic gt5 synconus lt 30 mmHg

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Hypertonic uterine contraction

• Latent phase
• no stimulation
• Morphine 10 mg im antiemetic drug

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Hypotonic uterine contraction

• Latent phase
• observe ,until has indication

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Oxytocin

• 1.????????????????????????? (np11)
  ??????????????????????????
• 2.labor pain and hypotonic contraction
• 3.No CPD
• 4.?????????? abnormal presentation
• over distended uterus
• high parity P5
• previous uterine scar
• fetal well being,muconium stain

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Oxytocin

• start time max.
  
• d/m d/m min d/m
• Low dose 1-2 2 30-40 40
• 2-4 4 15
  80
• High dose 12 12,6,2 20-40 84
• Sappasit 10 5 30 40-80

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PASSAGE

• 1.bony part 2.soft part

• 1.1 inlet contraction
• 1.2 midpelvis cont.
• 1.3 outlet cont.
• 1.4 mixed

2.1 Abn of vulvar 2.2 Abn of vagina 2.3 Abn of
cervix 2.4 Abn of uterus 2.5 other esp.
full bladder
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Inlet Contraction

• Abdominal exam.
• Head foat esp. in labor pain
• Mueller Hillis manuever
• Abnormal presentation

Pelvic exam. Diagonal conjugate lt11.5 cm
Transvere diameter lt 12 cm
Undescent of cephalic X-ray
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Inlet Contraction
Pelvic inlet examination Diagonal conjugate
diameter normal 12-13 cm
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Inlet Contraction
Pelvic side wall
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Midpelvis Contraction

• Interspineous diameter
• lt 9 cm ???? 10.5 ?? .

?????? sacrum ?????????
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Pelvic Outlet

• Intertubereous diameter lt 8 cm 10 cm
• Subpubic angle gt 85
• Posterior sagital diameter 7.5 cm

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PASSENGER

• Malposition
• occiput posterior
• occiput transverse

Malpresentation breech face brow
shoulder compound
Abn fetus macrosomia conjoined twins
hydrocephalus abdominal mass
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Management
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?????????

• Partograph

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