Beruflich Dokumente
Kultur Dokumente
objectives
Define labour.
Understand the components of labour
(passage, passenger, power).
Be able to take a focused history, examination
and anlyse the symptoms and signs to
diagnose labour.
Describe the stage sand phases of labour.
Discuss the mechanism of labour.
Discuss the management of labour.
Labour (parturition)
It Is the process where by with time regular
uterine contractions, brings about progressive
affacment and dilatation of the cervix, resulting
in delivery of the fetus from the uterus and
expulsion of the placenta at or beyond 24 (or
28) completed weeks of pregnancy.
It is a social, psycological and economical event
for the couple, family and community.
PTL
1 LNMP
Term
Labour
prolonged
24 W 28 W 37 W 40W 42W
Normal labour:
Spontaneous expulsion, through the
natural passages (birth canal) of a single,
mature (37-42 completed weeks of
pregnancy) Alive fetus, presenting by
vertex, within a reasonable time, without
fetal or maternal complications.
Components of labour:
passengers
The following will pass during labour
(fetus, cord, placenta and membranes).
The most important to pass is the head
and shoulder
Clinical finding
+
++
+++
Diagnosis
A.
symptoms:
1.
True labour pains colicky pain in the abdomen and back
are characterized by:
character
contractions
regular
Interval between
contractions and
intensity
Changes in the cervix
Progressive (increase in
frequency and
intensity)
Associated with
effacement and
dilation of the cervix
Membranes
Response to analgesia
Not relieved by
sedation
Relieved by sedation
Labour
Followed by labour
2.
3.
B. Signs:
o palpable or recorded uterine contraction
o
o
STAGES OF LABOUR:
I-The First stage: stage of cervical
effacement and dilatation
Definition: the first stage of labour refers to
the period from the onset of true uterine
contractions to the fully dilation of the cervix,
when the diameter of the cervical os
measures 10cm.
Duration:
o primigravida = 8-12 h
o multigravida = 6-8 h
Phases of the first stage:
Latent phase: started when the cervix dilatated
slowly and reached to about 3cm.
A. in primigravida = 8h
B. in multigravida = 4h
- Active phase: rapid dilatation of the cervix to
reach 10cm
A. in primigravda = 4h
B. in multigravida =2h
Causes of non-engagement:
Erroneous dates (primigravida)
Extra-uterine:
A.
B.
C.
D.
E.
A.
B.
C.
D.
-Fetal:
A. polyhydramnios.
B. Short umbilical cord(acutal or relative, due
to entanglement)
C. Large baby.
D. Deflexion attitude, and malposition.
E. Multiple pregnancy.
F. Hydrocephalus.
Engagement can be assessed by
abdominal station in fifths during
antenatal period, and by abdominal and
vaginal stations during labour.
Stage of
labour
Definition
Duration
Stage I latent
phase
(affacment)
<20 hours in PG
<14 hours MG
Stage 1 active
phase
(dilatation)
<2/hours in PG
<1.5/ hrs in MG
Stage 2
(descent)
<2 hours in PG
<1 hours in MG
Add 1 hour in epi
Stage 3
(expulsion)
<30 min.
Management of labour
The management of labour should be
commenced during the antenatal
period, and the women should be
classified as high or low risk pregnancy.
The medical or surgical problems
should be corrected as in case of
(anaemia, hypertension, urinary tract
infection), vaccination should be given
if necessary, and all investigations
should be performed and prepared such
as
(HIV,
HCV,
Hbs
Ag,
blood
grouping.etc).
A.
B-Examination:
1. .General:
a-pallor, oedema, varicosities, height, and
built.
b-Vital signs (BP, P, T)
c-Examination of heart, lungs, breast and
other organs if necessary
2. .Abdominal Examination:
a-To determine fundal height in cm using
tape measure (to determine gestational
age clinically), fetal lie, presentation,
engagement in fifths, size of the fetus,
amount of liquor, fetal heart rate.
b-The frequency and duration of the
contraction.
9-Encourage
spontaneous
voiding,
catheterization may be necessary.
10-Test all urine specimen for proteins,
sugar, and acetone.
11-Give IV fluids during labour to avoid
dehydration
a-0.9% Nacl or hartmanns solution at 80125ml/hr
b-Supplementation with 5% dextrose to
prevent ketosis and hypoglycemia.
12-Give analgesia/anesthesia as required.
a-Pethidine (50-150mg)IM.
b-Diamorphin (5-10mg)IM. Every 3-4 hours.
*avoid giving it too early in labour < 3-4cm
cervical dilation or too late when the
delivery is expected within 1-2hours.
b-Active
methods(prophylaxis
against
postpartum haemorrhage)
1-Give
Methargine
0.5
mg
IM
or
Syntometrine
(5units
oxytocin+0.5mg
Methargine), at the time of the anterior
shoulder is free from symphysis pubis or
as soon as possible thereafter.
2-Deliver the placenta and membranes by
control cord traction by right hand, and
the left hand is placed on the suprapubic
region, pushing the uterus upwards.
N.B. USE SYNTOCINON RATHER THAN
METHARGINE
IN
CARDIAC
AND
HYPERTENSIVE CASES.
IV-Post Delivery:
1-examine
the
placenta
for
their
completeness, anomalies, length, and
number of vessels in the cord and record
the placental weight.
2-Suture the episiotomy or any laceration.
3-Estimate blood loss, count swabs, and take
cord blood for Hb, blood group, Rh,
bilirubin, and coombs test for Rh negative
mother.
4-Check BP, P, T, Lochia and firmness of the
uterus before transferring the patient.
5-Continue an infusion of syntocinon through
the first hour if necessary.
6-Allow no food during the first hour, sips of
water may be taken, encourage nursing.
Engagement
Increased flexion
Internal rotation
DESCENT
Crowning
Extension
Restitution
External rotation