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Normal labor ( eutocia )

Normal labor ( eutocia ). Definition. Series of events that take place in the genital organs in an effort to expel the viable products of conception out of womb through the vagina into the entire world is called labor

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Normal labor ( eutocia )

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  1. Normal labor (eutocia)

  2. Definition • Series of events that take place in the genital organs in an effort to expel the viable products of conception out of womb through the vagina into the entire world is called labor • It is a thunderous uterine contractions that effect dilatation of the cervix and force the fetus through the birth canal

  3. Labor called normal if fulfills the following criteria – spontaneous onset, and at term, with vertex presentation ,without undue prolongation, natural termination with minimal aids, without having any complications affecting the health of the mother or the baby

  4. DYSTOCIA: Any deviation from the definition of normal labor is called abnormal labor or dystocia.

  5. TERMINOLOGY • Preterm labor – Prior to 37 weeks • Term – 37 to 42 weeks • Post term – After 42 weeks • Post dates – After 40 weeks

  6. Stages of Labor • 1ST STAGE • Interval between onset of labor and full cervical dilatation • 2 phases: • Latent – period between onset of labor and point at which a change in slope of rate of cervical dilatation is noted. • Active – Greater rate of cervical dilatation and usually begins around 2-3cm • Duration • primiparous – 12 hrs • Multiparous – 6 hrs

  7. Latent phase: Starts from the onset of labour and ends when the cervix is (2 to3 cm) dilated . It occurs because the thinning of the lower segment and cervix take a lot of uterine work before rapid dilatation can begin . It takes about (6 to 8 hrs) .

  8. Latent Phase • Ends when cervix is dilated 4 cm. • Contractions NOT frequent. • The duration becomes longer. • Intensity - moderate. • Mother is usually alert and talkative, can walk • Contractions last from 30 to 45 seconds • The frequency of contractions is from 5 to 20 minutes. • True labor is considered to be at 4 cm. • Duration varies, sometimes as long as 24 hours.

  9. Active phase :- It is the phase of rapid dilatation of the cervix from 3cm dilatation up to full dilatation it also take (6hrs) with a rate of cervical dilatation of (1.2cm/hour)in PG and (1.5cm/hour)in multigravida . It has three components:- i) Accelerated phase of dilatation from (2.5cmto4cm). ii) Phase of maximum slope of (4to9cm) dilatation . iii) Phase of deceleration of (9-10cm) dilatation .

  10. Active Phase • Begins when cervix is dilated 4 cm, ends when the cervix is dilated 8 cm. • Contractions occur every 3 to 5 minutes with a duration of 40 to 60 seconds. • Intensity progresses to strong. • The client focuses more on breathing techniques in contractions, less talkative. • Unable to walk • This phase is considered the onset of true labor.

  11. 2ND STAGE • Interval between full cervical dilatation and delivery • Duration • primiparous – 2 hrs • Multiparous – 30 min • 3RD STAGE • Delivery of the placenta and membranes • Duration –15 minutes • 4TH STAGE From the delivery of the placenta and membranes till 2hours

  12. FACTORS THAT MAY EXTEND OR INFLUENCE THE DURATION OF LABOR - 4 Ps • Passage: Birth Passage: size and morphology of true pelvis, uterus, cervix, vagina, and perineum. Parity of woman. • The True Pelvis is primarily important when a vaginal delivery is expected. • Passenger:Presentation of the fetus “part of the fetus that enters the pelvis first” (breech, transverse). Size of the fetus, mouldabilityof the fetal skull.

  13. Powers:Quality, force and frequency of uterine contractions • Psyche: Mother’s attitude towards labor and her preparation for labor. Culture, Anxiety/Fear

  14. True Labor • Contractions produce progressive dilatation and effacement of the cervix. • Occurs regularly and increase in frequency, duration and intensity. • The discomfort of true labor contractions usually starts in the back and radiates around to the abdomen • Not relieved by walking.

  15. False Labor/niggling • Braxton Hicks contractions. • They do not produce progressive cervical effacement and dilatation. • They are irregular and do not increase in frequency, duration, and intensity. • Discomfort is located chiefly in the lower abdomen and groin area. • Walking often offers relief.

  16. True Labor versus False Labor .

  17. Causes of onset of labor • Uterine distension-”Optimal distension theory” • Fetoplacentalfactors • Oestrogen • Progesterone • Prostaglandins • Oxytocin • Neurological factor:alpha $ beta adrenergic receptor in myometrium is activated by estrogen $ progestrone respectively.

  18. Contractile system of the myometrium • Actin • Myosin • ATP • MLCK (Myocin light chain kinase) • Calcium • Adrenergic receptors of alpha and beta

  19. Contraction Relaxation Myosin light chain 1) Decreased intracellular Ca2+; Ca2+ sequestration 2) Dephosphorylation of myosin light chain 3) Inactivation of myosin light chain kinase (e.g., by cyclic AMP- dependent phosphorylation) Myosin light chain kinase Ca2+ activated Phosphorylated Myosin light chain Actin Actin-Phosphorylated Myowin ATPase ATP ADP Biochemistry of Smooth Muscle Contractions

  20. PRELABOUR: IT IS THE TERM GIVEN TO THE LAST FEW WEEKS OF PREGNANCY DURING WHICH TIME A NUMBER OF CHANGES OCCUR LIGHTENING: 2-3 WEEKS BEFORE THE ONSET OF LABOUR THE LOWER UTERINE SEGMENT EXPANDS AND ALLOWS THE FETAL HEAD TO SINK LOWER; IT MAY ENGAGE. THE FUNDUS NO LONGER CROWDS THE LUNGS, BREATHING IS EASIER, THE HEART AND STOMACH CAN FUNCTION MORE EASILY AND THE WOMAN EXPERIENCES A RELIEF WHICH IS KNOWN AS LIGHTENING

  21. FREQUENCY OF MICTURITION CONGESTION OF PELVIS LIMITS THE CAPACITY OF THE BLADDER, REQUIRING IT TO BE EMPTIED MORE OFTEN SPURIOUS LABOUR MANY WOMEN MAY EXPERIENCE CONTRACTIONS BEFORE THE ONSET OF TRUE LABOUR, WHICH MAY BE PAINFUL AND MAY EVEN BE REGULAR FOR A TIME. ABSENCE OF RETRACTION AND DILATATION OF CERVIX

  22. First stage of labor

  23. Physiology of FIRST STAGE OF labour • DURATION Birth interval, psychological state, presentation, position, pelvis shape, size and characteristics of contractions. • UTERINE ACTION -FUNDAL DOMINANCE

  24. FUNDAL DOMINANCE

  25. POLARITY Term used to determine the neuromuscular harmony that prevails between the two poles or segments of the uterus Upper segment- contracts strongly and retracts to expel the fetus Lower segment – contracts slightly and dilates to allow expulsion of fetus

  26. POLARITY

  27. CONTRACTION AND RETRACTION • Uterine muscle –Muscle retain some of the shortening during contraction instead of completely getting relaxed – RETRACTION. Therefore upper segment – thickens and shortens and cavity diminishes. • CONTRACTION-Temporary reduction in length of the muscle fibres. Regular intensity, duration, frequency

  28. PAIN Cause of pain (not known definitely) ① hypoxia of contracted myometrium ② compression of nerve ganglia in cervix & lower uterus by the tightly interlocking muscle bundles ③ stretching of cervix during dilatation ④ stretching of peritoneum overlying the fundus

  29. FORMATION –UPPER & LOWER UTERINE SEGMENT • By end of pregnancy uterus divided into upper & lower segment • Upper – formed by body of the uterus, concerned with contraction and retraction , thick and muscular. • Lower – formed of the isthmus and cervix (8-10cm), distension and dilatation.

  30. RETRACTION RING : A ridge formed between upper & lower segment – retraction or bandls ring. • CERVICAL EFFACEMENT • CERVICAL DILATATION SHOW

  31. RETRACTION RING :

  32. Fetal Descent Stations • How far the baby is "down" in the pelvis, measured by the relationship of the fetal head to the ischial spine . • Measured in neg. & pos. numbers. (Centimeters) • The ischial spine is in (0) Station • If the presenting part is higher than the ischial spine, the station has a (-) neg. #. • Positive #s = presenting part has passed the ischial spine. • Positive (+) 4 is at the outlet.

  33. SHOW

  34. Mechanical factors • FORMATION OF FOREWATERS • GENERAL FLUID PRESSURE • RUPTURE OF MEMBRANES • FETAL AXIS PRESSURE

  35. FORMATION OF FOREWATERS

  36. GENERAL FLUID PRESSURE

  37. RUPTURE OF MEMBRANES

  38. FETAL AXIS PRESSURE

  39. SECOND stage of labor

  40. Events in second stage • Complete dilatation of the cervix for the expulsion of fetus. • Concerned with descent and delivery of fetus • uterine Contraction : stronger and longer • Membranes rupture- spontaneously • Drainage of liquor – allows hard round fetal head – directly on vaginal tissues and aid distension.

  41. Contractions – expulsive , fetus descends down into the vagina , pressure from presenting part stimulates nerve receptors in pelvic floor and women experience the need to push (Furguson’s reflex) • Soft tissue displacement :

  42. Soft tissue displacement : • fetal head descends soft tissue displaced • Anteriorly , bladder pushed upwards into abdomen • Stretching and thinning of urethra – lumen reduced • Posteriorly , rectum flattened into the sacral curve • Levatorani muscle - dilate , thin out and displace laterally. • Fetal head will be visible at vulva till crowning and head is born. • Followed by shoulders

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