LABOUR

Labour can be defined as

involuntary coordinate uterineconstraction. Cause cervical

effacement and dilataion. Follow up by expulsion of

products of conceptio.

DELIVERY

Delivery is the expulsion of products of conception after viability ofthe fetus(which is around 22 weeks of

gestation.(

LIE OF THE FETUS

Is the relation between the longaxis of the fetus to the long axis of the

mother (longitudinal, transverse, oblique)

POSITION

Is the relation between arbitrarychosen portion of the presenting partand the right or left side of the pelvic,

it also can be anterior, transverse orposterior.

) Occiput, chin and sacrum (in vertix,face and breech respectively.

ONSET OF LABOUR- Estrogen

- STATION OF THE HEAD

it is part of the pelvic assessment toEvaluate the relation between the Presenting part and the pelvis.

It can be determined by the amountof the head felt above the pelvic brim expressed as fifth or more accurate by

the vaginal examination of thepresenting part in relation to the ischialspines and expressed as centimetersabove(-) or below + the ischial spines.

PRESENTATION

Is the portion of the fetus that is Foremost within the birth canal orclosest toil.

It is head or breech in longitudinallie, shoulder in transverselie. Cephalicpresentation is classified according tothe degree of head flexion occiput,Sinciput, below, face presentation.

usually sinciput and brow or transientposition changes with the progress oflabour.

Breech presentation is classifiedaccording to the thigh and leg extension,frank, complete footling.

-

CLINICAL EVALUATION OF LIEPRESENTATION AND POSITION

OF THE FETUS

The examiner should first determinedThe fundal height of the uterus.

First the Uterus Maneuvergentle palpitaion of the fundus of theuterus with the tip of the fingers of bothheads, to determine the fetal part that

occupy the fundus].

Second Maneuverthe palm of the examiner’s hands areplaced on either side of the uterus andpress to exert deep pressure (hard

resistant structure is felt, the back(,numerous nodulation is felt in theside (the extremities).

Third Maneuver

By applying the thumb and fingers onthe presenting part of the lower portionof the maternal abdomen, above thesymphysis pubis.

This maneuver is to determine thepresenting part, careful palpitationmay help to evaluate the degree of head flexion and engagement of thepresenting part.

Fourth Maneuver

The examiner faces the mother’s feet

and with the lip of three fingers of both

hands palpate the presenting part of

vertex presentation. One hand will first

feel the prominent part while the other

will descent more vertex presentation,

or in the side of the back in face

presentation.

When the head is clearly enlarged the

shoulder is felt by this maneuver.

■

IN THE FIRST STAGE

OF LABOUR

Cervical changes is the result of two factors:

■Passive stretching as an effect of the

pressure of the presenting part and

hydrostatic pressure of the amniotic

sac – early rupture of the membranes

does not prolonged labour as far as

the presenting part is will apply to

the cervix.

■Contraction of the longitudinal muscle

fires of the uterus.

THE STAGES OF LABOUR

First is the stage of effacement and dilatation of the cervix.

Second stage is for the expulsion of the fetus.

Third stage is for the expulsion of the placenta and membranes.

Fourth stage is for the early recovery.

IT IS DIVIDED INTO

TWO PHASES

1. Lateral phase – start with the regular uterine contraction till the cervix is 2-2.5 cm dilated and its mean duration is around 7 hours (Friedman’s sters).

2.Active phase – from the end of latent phase until full cervical dilatation.

SECOND STAGE

Cervix is fully dilated and uterine

contraction every 2-3 minutes.

It has 2 component:

Phase I – head begins to descent and

patient feels abdominal lightening

)normal to encourage patient to push

at this phase.(

Phase II – head reaches the pelvic floor

And patient starts to bear down.

IT IS THE THREE COMPONENTS

●Acceleration phase – it usually predict the outcome of labour during which cervix dilate most rapidly.

●Maximum slope – it reflects the efficacy of uterine contraction.

●Deceleration phase – it reflect the fetopelvis relationships the dilatation rate normally is 1.2 cm/hr in nulliparous women and 1.5 cm/hr in multiparous women.(practically 1 cm/hr).

THIRD STAGE

Placenta separation happen

through spongiosa layer. The stage

rarely exceeds 5 minutes.

■Separation is the result of:

● Contraction and refraction of

uterine muscle

● Reduction of uterine volume and

area of placenta site

■Retroplacenta haematoma

If the leading part separate first

)Mathews Duncan mechanism( the raw

surface (maternal) will be exposed.

If the centre separate first Schultse

mechanism.

The fetal surface will be seen first.

Signs of placenta separation:

■ Rising of the uterine fundus

■ Blood show

■ Lengthening of the umbilical cord

THE FOURTH STAGE

OF LABOUR

The immediate recovery phase

following the third stage where patient

needs close observation for any signs

of bleeding.

MECHANICAL OF NORMAL

LABOUR IN OCCIPUT

PRESENTATION

Flexion: Complete flexion of head take

place in vertex presentation and the

occiput used to indicate.

Position : LAO,LOP,LOT,ROA,ROP and

ROT

Engagement of the head – when the largest diameter of the head (Biparietal) passes the pelvic brim.

The sagittal sure is in the transverse

diameter of the pelvis so the occiput

is lateral .

Descent is Limited until the second stage of labour.

Internal rotation – the largest diameterof the pelvic outlet in anteroposterior.So the occiput rotate anteriorly.

Restitution and external rotation – theocciput rotate back to its lateral position.

Extension and delivery of the Head

When the vulva is distended over

the largest diameter of the head the

occiput remain below the public arch

and the sinciput sweeps forwards as

the neck extended (tearing of the perineum should be avoided at the stage).

ONSET OF LABOUR- Estrogen- Progesterone- Prostaglandin appears in the myometrium.- Prostaglandin resistance in the cervix.

Management Delivering Labor - Admission NPO IV line Fetal monitoring Pinard stethoscope every 15-20min Continous CTG High risk Patient Internal scalp electrode Fetal blood scalp sampling

Monitoring of Labour

-Comport of the patient Explain what is likely to happen in labor presence of relative Discuss with her pain killer

Material assessment/ 2 hours abdominally/ 4 hours vaginally Support of the perium at crowing Episiotomy Midline Mediolateral Lateral Delivery of the placenta by CCT

Third stage Oxytocin Ergometrin

Abdominal examination during labour

can be done between contractions.

It provides important information

)retraction ring in obstructed labour(