Normal Labor and Delivery 正常分娩

1. Normal Labor and Delivery正常分娩 林建华

2. Labor : the process by which contractions of uterus expel the fetus. • Delivery : receive the neonate

3. 1. definition • Term pregnancy: 37-42weeks from LMP • pre-term delivery (labor): 28- <37 weeks of gestational age • post-term delivery: 42 weeks • Abortion : <28 week • 85% of women spontaneous labor and delivery between 37-42 weeks

4. 2. The four factors for labor • Force ( uterine contraction) • birth canal (bony canal) • fetus (lie,position ,presentation,weight) • psychical-factors

5. Contractions onset, frequency, duration, intensity • increase in frequency and duration • uterus can be felt to harden during contraction • lasting about 30-45 seconds • interval between contractions to be 5 min’ • Intensity (slight, middle, heavy) • the pain of labor is a character

7. 正常曲线 异常曲线

8. Birth canal; Bony canal Soft tissue canal (lower part of uterus, cervix, vagina

9. Bony pelvis • The planes of pelvis • inlet plane (promontory) • mid plane of pelvis (ischia spines) • outlet plane(two intersecting triangles)

11. fetus (lie, position ,presentation, weight) • Long axis of mother • LOA • Head down • Estimation of fetal weight :2500g - <4000g

12. 3. Mechanism of labor • The process of labor and delivery is marked by change in fetal position in relation to the maternal pelvis • Engagement (BPD decent to a level below the pelvic inlet An occiput below the ischial spines is engaged) • Flexion • Decent • Internal rotation • Extension • External rotation

13. 4. Symptoms and signs of the onset of the labor • Painful uterine contraction • a show • effacement and dilation of the cervix • rupture of membranes

14. The show • The mucus plug is expelled from the cervix • mixing with a little blood the rupture of the membranes • at any time during labor effacement and dilation of the cervix • to be short,taken up,dilated

15. The differentiation of labor • in labor: spontaneous uterine contraction with progressive dilation of the cervix interval < 5 ’ lasting >30’’ intensity is middle or heavy • False labor:

16. 5. Three Stages of labor The first stage: • onset of labor to full cervical dilation(10cm) • the latent phase ( onest to <3cm, <16h) • the active phase(>3cm to 10cm, <8h) The second stage: • 10 cm to the delivery of the infant, <2h The third stage: • delivery of the infant to delivery of the placenta, <30m’

17. 6. Management of normal labor The first stage: • education, eating, walking, • position(sitting, reclining, recumbent) • monitoring of the fetal heart rate , • Palpation of cervix ( effacement ,dilation) • uterus contractions (palpation or electronic monitoring) • Analgesia and anesthesia

18. The second stage • fetal heart rate • maternal conditions: pulse, blood pressure, respiratory rate , temperature, urine output, fluid intake… • evaluation of progress of labor station, position of the presenting part, status of membranes, meconium, blood

19. Pushing: • with the onset of each contraction, the mother is encouraged to inhale,hold her breath, and push • increase in intra-abdominal pressure • aiding in fetal descent through the birth cacal.

20. Head visible on vulval gapping • Crowning of head • Laceration or Episiotomy • Delivery of fetus • Deal with umbilical cord

23. the third stage: • waiting for up to 30 min • Separation indication of placenta:the fundus changes to a globular shape and firm consistency A gush of blood appears vaginally The umbilical cord appears to lengthen • delivery of placenta (spontaneously, manually • inspection of the birth canal • Repair of lacerations or episiotomy

24. Key word and questions • Labor • Delivery • Engagement • Effacement • What are the four factors in labor and delivery? • What is the mechanisms of labor ? • Explain the separation indications of placenta.