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A\ Uterine Cont. Of Labour B\ Auxiliary Forces
Forces Of LaboursPowers
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1/ Polarity & Fundal Dominance :
* cont. upper relax lower.* Physiological ring
2/ Painfull due to
2 compression ( m. & n. ) + 2 stretch (cervix &periton.)
A\ Uterine Cont. Of Labour
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3 \ Cont. & Retraction ( not relaxation = do not
return to its normal length )*** Values >>>
4\ Invol. & Rhythmic
5\ Intermittent***Why ???6\ freq , strength & duration
( Give range !! )7\ Coordinated ( m. theory )
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H elpe In :
2nd & 3 rd stages of labour
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H ow To Diagnose A True Labour ???1/ TLP ( differentiate bet. TLP & FLP )
1. Site2. rhythm3 . Freq. strength , duration4. Bulge5. Dilat6. sedation
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2\ The Show :
3 \ Dilatation of cervix
N.B. Multipara (mos)
4\ Bulging Bag ( fore-waters )
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1\ PGs**Why ?? Due to 3 ..2\ Progesterone Withdrawal3 \ Estrogen-Oxytocin4\ Uterine Distension5\ Stretch of lowe part of uterus
6\ Placental Ischemia7\ Fetal Cortison
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Def.\Prodroma >>A. FLPB. Vaginal DischargeC. Changes after engagement(shelfing lightening )
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3 rd2nd1 st
By
complete expulsion of the fetus
Cervix Dilate
up to( 10 cm)
By
TLPStart
Byexpulsion of the
placenta & memb.
Bycomplete expulsion of
the fetus
Cervix Dilateup to
( 10 cm)End
In both 10 30 min.prima ( 1-2 hrs )Multi ( 1/2 hr)
**Normal \prima ( 10 18 hrs )Multi ( 6 -10 hrs)
**Abnormal \Prolonged
Duration
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** Causes of Cervical Dilatation1 pg,2 contrac, 3 bulge,4 head or presenting part
** Mechanism of Cervical Dilatationin bothPrimigravida & Multipara
** Phases of Cervical Dilatation
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Mechanism of 2 nd Stage of labour
3 rd StageMechanism of 3 rd Stage of labour
2 Ways : Schultze or Duncan
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Tocia >>Eutocia >>
**spontaneous expulsion,, **single,,
** living,, **full term fetus ,,**in vertex cephalic presentation ,, **throw birth canal ,,**after TLP,, **without assistance or complications to both
Distocia >>
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LOA & ROA
LOT & ROT
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Delivery of The Head
Delivery of The Shoulders & Body
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1- Descent
2- Engagement3 - Flexion ( to achive 9.5 cm )4- Int. Rotation5- Extension ( H inge , 2 forces )6- Restitution7- Ext. Rotaion
See the video...
Delivery of The H ead
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1- Ant. Shoulder hinges below the symphysis.2- post. Shoulder delivered 1st
by lat. Flexion of the spine.3 - Ant. Shoulder then follows , then the rest ofthe body.
Delivery of The Shoulders & Body
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H istory- Onset Show- Liquor amnii- ROM- fetal movements
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Examination- A : General- Vital signs (pulse.,,Blood pr.,,Temp,)- Anxiety- Dehydration- H ight & Weight
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Examination- B : Abdominal- freq , intensity & duration of Uterin cont.- Lie , prsentaion , position, attitude- Engagement- Site,rate,rhythm(when >>> in between
contractions )
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First Leopold maneuverFirst Leopold maneuverPalpation of uterine fundus
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Th ird LeopoldTh ird Leopoldmaneuvermaneuver
y Fetal presentation andengagement
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Fourt h LeopoldFourt h Leopoldmaneuvermaneuver
y Fetal engagement
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Examination
- C : Vaginal- Exclude :1\ contracted pelvis
2\ cord prolapse- Asses1\cervix status
2\fetal staions
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VARIOU S PO SI TION S OF THE F ETU S
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VARIOU S PO SI TION S OF THE F ETU S
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F req. of theV aginal Exam.
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Managment fo 1st stage
1 prep.Antspet.(shave, betadine)Bladder and rectum evac.(how)
2 observeMother(p,bp,temp,rr) contractions(by palm
or toco), cx, rom
Fetus (fhs) pinard sonicad, ctg3 nutrionEarly (latent phase sugary fluids. Active
nothing per oral to avoid mendelson .
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If prolonged more than 8h glucose 5%&saline.
4 pain reliefPethidine 50mg im but stopped 2 h before
2nd stEpidural5 instructions
Rom rest in lat pos. If intact walkAvoid straining exhaustion and prolapse
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[1]
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Managment of 2 nd stage
Identification : how???????? /1.10cm 2 .desire to evacuate the rectum3 .Disire to bear down
4. expiratory grunt with bearing down5 rom (2 bags become one bag. Rom could
happen before 2 nd stage .
Conduct1. prep. (in OR room, lithotomy pos., vulva
and perineum are washed , towels are
applied )
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2.Instructions3
.deliv. Of head and prevn. Of tears .Crowning def??????????/before it occipto frontal (11.5) after it
suboccipto frontal (10
cm)a. perineal support done before crowning.b. deliv. Of the head (slow, in between
cont. And with ritgen man.) controldextension of the head.c. Espisiotomy (def. Timing)
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4 after head delliv.
a. Clear air passage by aspiration.b. Colis of umbilical cord ( slipped doubly
clamped and cord cut in between .
c. Delv of shoulders (lift head up then down)d. Handling of fetus ( ankles hold butavoided when ( asphyxia or intracranialhge or preterm fetus)
e. Milking of the cord but avoided when RHnot to bring more antibodies , andpreterm to avoid circulatory overload.
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R itgen maneuver
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Management of the 3 rd stage
Duration normal (5 to 10) if more than30(prolonged )
A conservative ( exclusion of bleeding andatony) unlar border is put on the fundusrise in the level denotening bleedinginside so never do massage .)
Signs of separationA uterus is smaller harderB suprapubic bulgeC elongation of the cord without receding
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Gush of blood per vagina
(uterine massage)(placental expulsion) ask pt to bear downbut fundal pressure is avoided not tocause inversion.
( uterine stimulants ) to prevent postpartumhge. Ergometrine .25 mg im ot oxytocin 5units
Disadvantages of conservative leads toPostpartum and longer time.
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Active method
1. stimulants2. Brandt andrews (how , advan, disadvan) After placental delv.
Rolling, inspection of placenta , repair of tears if more than 1cm, wash anddressing)
Estimation of blood loss 5 00 cc.
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Management of 4 th stage:
1h observation , massage every 15 min.Management of newborn1 warmth
2 care of reparation3 care of the stump (hernia)4 care of eye
5 weight6 ident7 congenital anomilies (hypospadius,im.anu