1. NORMAL LABOUR AND DELIVERY Prof Dr MOHD AZHAR MN ROYAL COLLEGE OF MEDICINE PERAK APRIL 2005 DEPARTMENT OF OBST & GYNAE RCMP
2.
3. Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY WHAT IS NORMAL LABOUR ?
4. NORMAL LABOUR APRIL 2005 DEPARTMENT OF OBST & GYNAE RCMP Labour is defined as the onset of regular painful contractions with progressive cervical effacement and dilatation of the cervix accompanied by descent of the presenting part . DEFINITIONS
5.
6.
7. Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY WHAT FACTORS INFLUENCE PROGRESS OF LABOUR ?
8. LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY FACTORS THAT INFLUENCE PROGRESS OF LABOUR Passenger Passage 3 "P" Power
9.
10.
11. THE NORMAL FEMALE PELVIS Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY The important diameters of the female pelvis : Anteroposterior Oblique Transverse BRIM 11 – 11.5 12 12.5 CAVITY 12 12 12 OUTLET 12.5 12 11- 11.5 Diameters (cm)
12.
13.
14. THE FETAL SKULL Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY MOULDING OF THE FETAL SKULL MOULDING ’ is the ability of the fetal head to change its shape and so to adapt itself to the unyielding maternal pelvis during the progress of labour. This property is of the greatest value in the progress of labour.
15. THE FETAL SKULL Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY Diameters of the fetal skull – anterior posterior diameters A B C D E F G AB ~ Suboccipto bregmatic – 9.5 AC ~ Submento bregmatic – 9.5 DE ~ Occipito frontal ~ 11.0 FG ~ Mento vertical – 13.5
16.
17.
18. LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY WHAT INITIATE LABOUR “ ONSET OF LABOUR”
19.
20. LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY DIAGNOSIS OF LABOUR
21.
22. LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY DESCRIBE THE STAGES OF LABOUR
23. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” STAGES OF LABOUR Labour can be divided into three stages , which are unequal in length. The third stage is that of separation and expulsion of placenta and membranes and also involves the control of bleeding. It begins after the birth of the baby and ends with the expulsion of the placenta and membranes. This is the shortest stage, lasting up to 30 minutes, with an average length of 5 to 10 minutes. There is no difference in duration for nulliparous and parous . The second stage of labour begins with complete dilatation of the cervix and ends with the birth of the baby. The duration is about 1 to 1½ hours in nulliparas and about 30 to 45 minutes in parous women. It begins with the onset of true labour contractions and ends when the cervix is fully dilated (10 cm). Cervical effacement and dilatation occur in the first stage First stage of labour consists of two phases:- latent and active . The first stage of labour is the longest for both nulliparous and parous women. THIRD STAGE SECOND STAGE FIRST STAGE
27. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” WHAT HAPPEN DURING THE FIRST STAGE OF LABOUR
28.
29.
30.
31. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” Do Uterine Contractions Affect Fetal Heart Rate? Uterine contractions can affect fetal heart rate by increasing or decreasing that rate in association with any given contraction. The three primary mechanisms by which uterine contractions can cause a decrease in fetal heart rate are compression of: · Fetal head · Umbilical cord · Uterine myometrial vessels FETAL HEART CHANGES
42. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MANAGEMENT FIRST STAGE OF LABOUR
43.
44.
45.
46.
47.
48.
49.
50. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MONITORING FETAL HEART How Do Uterine Contractions Affect Fetal Heart Rate? Uterine contractions can affect fetal heart rate by increasing or decreasing that rate in association with any given contraction. The three primary mechanisms by which uterine contractions can cause a decrease in fetal heart rate are compression of: · Fetal head · Umbilical cord · Uterine myometrial vessels
51.
52. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MONITORING FETAL HEART To detect fetal hypoxia NORMAL ABNORMAL
54. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” RECORDING THE PROGRESS OF LABOUR PATIENT INFORMATION FETAL INFORMATION ~ fetal well being LABOUR INFORMATION ~ Dilatation ~ Descent ~ Contraction MEDICATIONS MATERNAL INFORMATION ~ Well being PARTOGRAM
55. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” RECORDING THE PROGRESS OF LABOUR - Partogram Patient information : Fill out name, gravida, para, hospital number, date and time of admission and time of ruptured membranes. Fetal heart rate : Record every half hour. Amniotic fluid : Record the colour of amniotic fluid at every vaginal examination: I: membranes intact; C: membranes ruptured, clear fluid; M: meconium-stained fluid; B: blood-stained fluid. Moulding : 1: sutures apposed; 2: sutures overlapped but reducible; 3: sutures overlapped and not reducible.
56. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” RECORDING THE PROGRESS OF LABOUR - Partogram Cervical dilatation : Assessed at every vaginal examination and marked with a cross ( X ). Begin plotting on the partograph at 3 cm. Station : recorded as a circle ( O ) at every vaginal examination. Contractions : Chart every half hour; palpate the number of contractions in 10 minutes and their duration in seconds. Less than 20 seconds: Between 20 and 40 seconds: More than 40 seconds: Assess the progress of labour:
57. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” RECORDING THE PROGRESS OF LABOUR - Partogram Oxytocin : Record the amount of oxytocin every 30 minutes when used. Drugs given : Record any additional drugs given – e.g. Pethidine Pulse : Record every 30 minutes and mark with a dot (●). Blood pressure : Record every 4 hours and mark with arrows ( ) Temperature : Record every 2 hours. Protein, acetone and volume: Record every time urine is passed. Progress of maternal well being:
58. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MANAGEMENT SECOND STAGE OF LABOUR
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69. LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY THE MECHANISMS OF NORMAL LABOUR - Occiput anterior -
70. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” Occiput anterior (OA) Anterior Pubis Sacrum Posterior Right Left Occipital bone
71. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” Occiput anterior positions
72. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MECHANISM OF LABOUR for occiput anterior The “mechanism of labour” refers to the sequencing of events related to posturing and positioning that allows the baby to find the “easiest way out”. For a normal mechanism of labour to occur, both the fetal and maternal factors must be harmonious. DEFINITION:
73. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MECHANISM OF LABOUR for occiput anterior Events of mechanism of labour: F: Flexion and descent I: Internal rotation of the fetal head C: Crowning E: Extension R: Restitution I : Internal rotation of the shoulders E: External rotation of the fetal head L: Lateral flexion of the body
74. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MECHANISM OF LABOUR for occiput anterior (OA) Descend Flexion Internal rotation Crowning Extension Restitution Internal rotation of shoulder External rotation of head Lateral flexion of body LOA LOA OA LOA OA OA LOT Delivery F I C E R I E L
75. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MANAGEMENT THIRD STAGE OF LABOUR
76.
77.
78. LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY WHAT ARE THE SIGNS OF PLACENTA SEPARATION
79.
80.
81. LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOUR
82. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MANAGEMENT OF THE THIRD STAGE OF LABOUR ACTIVE MANAGEMENT OF THE THIRD STAGE Active management of the third stage (active delivery of the placenta) helps prevent postpartum haemorrhage . Active management of the third stage of labour includes: ~ use of oxytocin ~ controlled cord traction, and ~ uterine massage .
83. NORMAL LABOUR AND DELIVERY Prof DR MOHD AZHAR – “NOMAL LABOUR & DELIVERY” MANAGEMENT OF THE THIRD STAGE OF LABOUR ACTIVE MANAGEMENT OF THE THIRD STAGE ~ Use of oxytocin Oxytocic drugs should be given with the birth of the anterior shoulder. Syntocinon is the most used oxytocic known to be effective; the addition of ergometrine may reduce blood loss. SYNTOMETRINE (oxytocin 5 IU + ergometrine 0.5 mg) – widely used
![NORMAL LABOUR AND DELIVERY APRIL 2005 DEPARTMENT OF OBST & GYNAE RCMP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CONTENTS](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)