Normal LaborNormal Labor

DefinitionsDefinitions

--LieLie מנחמנח

    This refers to the longitudinal axis of This refers to the longitudinal axis of the fetus in relation to the mother's the fetus in relation to the mother's longitudinal axis.longitudinal axis.

- Longitudinal Longitudinal

- TransverseTransverse

- obliqueoblique

--PresentationPresentation מצגמצג

  This describes the part on the fetus This describes the part on the fetus lying over the inlet of the pelvic or at lying over the inlet of the pelvic or at the cervical os. the cervical os.

- Vertex- Vertex

- Breech- Breech

- Shoulder- Shoulder

- Face- Face

- - PositionPosition מצבמצב

  This describes the relation of the This describes the relation of the point of reference (pubis) to one of point of reference (pubis) to one of the 8 octamers of the pelvic inlet the 8 octamers of the pelvic inlet

And OP ,OA

Point of Reference of Point of Reference of DirectionDirection

  This is an arbitrary point on the This is an arbitrary point on the presenting part used to orient it to presenting part used to orient it to the maternal pubis the maternal pubis

- OcciputOcciput - in vertex presentation - in vertex presentation

- MentumMentum (chin) (chin) –– in face presentation in face presentation

- SacrumSacrum –– in breech presentation in breech presentation

EngagementEngagement    

This occurs when the This occurs when the biparietal biparietal diameterdiameter is at or below the is at or below the inlet of inlet of the true pelvisthe true pelvis

StationStation

This references the presenting part This references the presenting part to the level of the to the level of the ischial spinesischial spines measured in plus or minus measured in plus or minus centimeterscentimeters. . (-5 to +5)(-5 to +5)

The mechanical steps the baby The mechanical steps the baby undergoes can be arbitrarily divided, undergoes can be arbitrarily divided, and clinically they are usually broken and clinically they are usually broken down into six or eight steps for ease down into six or eight steps for ease of discussion. It must be understood, of discussion. It must be understood, however, that these are however, that these are arbitrary arbitrary distinctions in a natural continuumdistinctions in a natural continuum. .

The following The following 6 6 –– 8 divisions 8 divisions of labor of labor are easy to useare easy to use: :

Flexion and EngagementFlexion and Engagement

Occurs at various times before the Occurs at various times before the forces of labor beginforces of labor begin

DescentDescent

Occurs as a result of active forces of Occurs as a result of active forces of laborlabor

Internal RotationInternal Rotation

    This occurs as a result of This occurs as a result of impingement of the presenting part impingement of the presenting part on the bony and soft tissues of the on the bony and soft tissues of the pelvispelvis. .

ExtensionExtension

This is the mechanism by which the This is the mechanism by which the head normally negotiates the pelvic head normally negotiates the pelvic curvecurve

External Rotation External Rotation ((Restitution)Restitution)

    This is the spontaneous realignment This is the spontaneous realignment of the head with the shouldersof the head with the shoulders

ExpulsionExpulsion

This is the delivery of the anterior This is the delivery of the anterior and the posterior shoulders, followed and the posterior shoulders, followed by trunk and lower extremities in by trunk and lower extremities in rapid successionrapid succession

Emanuel FriedmanEmanuel Friedman

" The clinical features of uterine " The clinical features of uterine contractions namely frequency, contractions namely frequency, intensity, and duration cannot be relied intensity, and duration cannot be relied upon as measures of progression in upon as measures of progression in labor nor as indices of normality. labor nor as indices of normality. Except for Except for cervical dilatationcervical dilatation and and fetal decentfetal decent, none of the clinical , none of the clinical features of the parturient patient features of the parturient patient appears to be useful in assessing labor appears to be useful in assessing labor progressionprogression””

Lower segment between Lower segment between contracting muscle and cervixcontracting muscle and cervix

תודה על ההקשבה תודה על ההקשבה

שאלות ?שאלות ?•

CrowningCrowning