Copyright © Wondershare Software
Normal Labor
Copyright © Wondershare Software
Definition
• The series of the events that takes place from
the uterine contraction to th...
Copyright © Wondershare Software
Stages of Labor
• Four stages
1. First stage of labor
a. Latent Phase
b. Active Phase
2. ...
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First Stage of Labor
• Begins with onset of
regular uterine
contraction
• Ends with compl...
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Latent Phase
• Contractions become progressively stronger
longer and more frequent and be...
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Active Phase
• Cervix dilates usually from 3-4 cm to full
dilation i.e. 10 cm
• Duration ...
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Second Phase
• Begins with
complete cervical
dilation
• Ends with delivery
of the baby
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Third Stage
• Begins with the delivery of
baby
• Ends with delivery of placenta
• Placent...
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Fourth Stage
• First one hour after delivery
• Vital signs and any evidence of uterine at...
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Cardinal Movement of Labor
1. Engagement
2. Descent
3. Flexion
4. Internal Rotation
5. Ex...
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Engagement
• Movement of the
presenting part below the
plane of the pelvic inlet
• Engagi...
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Descent
• Movement of presenting
part down through the
curve of the birth canal
• Result ...
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Flexion
• Placement of fetal
chin on the thorax
• Result from resistant
of cervix , wall ...
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Internal Rotation
• Rotation of the position
of the fetal head in the
mid pelvis from
tra...
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Extension
• Movement of fetal chin
away from the thorax as it
reaches to vulva
• Forces a...
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External Rotation(Restitution)
• Rotation of the fetal head
outside the mother as the
hea...
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Expulsion
• Delivery of fetal
shoulders and body
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Fetal Skull
Figure. Fetal skull from lateral view
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Figure. Fetal skull superior view
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Diameter of fetal skull(Lateral view)
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Diameter of fetal skull(Superior view)
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Abnormal fetal head presentation
• Face Presentation
• Brow Presentation
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Face presentation
• The head is hyperextended so that the occiput is in
contact with the ...
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Brow Presentation
• Diagnosed when the portion of the fetal head
between the orbital ridg...
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Abnormal labour
• Shoulder dystocia
Means difficult labor: slow labor
progress
Causes
1.U...
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 Prolonged latent phase: N:>20hr M:>14hr
 Protracted disorder: active phase: N: <1.2cm/...
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 Precipitous labor: expulsion of fetus in <3hr (cervical dilatation: N: >5cm/hr
M:>10cm/...
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References
• Kevin p. Henretty. Obstratics Anatomy. Obstetrics illustrated.
Churchill Liv...
Copyright © Wondershare Software
Thank You!
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Normal labor

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This is based on the normal and abnormal labor.

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Normal labor

  1. 1. Copyright © Wondershare Software Normal Labor
  2. 2. Copyright © Wondershare Software Definition • The series of the events that takes place from the uterine contraction to the expulsion of placenta normally.
  3. 3. Copyright © Wondershare Software Stages of Labor • Four stages 1. First stage of labor a. Latent Phase b. Active Phase 2. Second stage of Labor 3. Third stage of Labor 4. Fourth stage of Labor
  4. 4. Copyright © Wondershare Software First Stage of Labor • Begins with onset of regular uterine contraction • Ends with complete cervical dilation at 10 cm
  5. 5. Copyright © Wondershare Software Latent Phase • Contractions become progressively stronger longer and more frequent and better coordinated • Cervix effaces but shows minimal dilation • Duration: (May be intermittent over several days or may last only few hours) – Nulliparas: Average 8 hours – Multiparas: Average 5 hours
  6. 6. Copyright © Wondershare Software Active Phase • Cervix dilates usually from 3-4 cm to full dilation i.e. 10 cm • Duration more predictable • Duration and Rates – Nullipara: 5 hours; 1.2 cm/hour – Multipara: 2 hours; 1.5 cm/hour
  7. 7. Copyright © Wondershare Software Second Phase • Begins with complete cervical dilation • Ends with delivery of the baby
  8. 8. Copyright © Wondershare Software Third Stage • Begins with the delivery of baby • Ends with delivery of placenta • Placenta separation from uterine wall occurs as the result of myometrium contraction shear off anchoring villi • Duration: – <30 minutes in all women
  9. 9. Copyright © Wondershare Software Fourth Stage • First one hour after delivery • Vital signs and any evidence of uterine atony or postpartum hemorrhage • Perineum inspection for any signs of hematoma formation • Mother should be seen every 15 mins • Newborn undergoes initial assessment
  10. 10. Copyright © Wondershare Software Cardinal Movement of Labor 1. Engagement 2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. External Rotation 7. Expulsion
  11. 11. Copyright © Wondershare Software Engagement • Movement of the presenting part below the plane of the pelvic inlet • Engaging process start at the last few weeks of pregnancy to the period of starting of labor
  12. 12. Copyright © Wondershare Software Descent • Movement of presenting part down through the curve of the birth canal • Result of : – Pressure of amniotic fluid – Direct pressure of the fundus upon the breech with contraction – Bearing down effect of maternal abdominal muscle – Extension and straightening of fetal body
  13. 13. Copyright © Wondershare Software Flexion • Placement of fetal chin on the thorax • Result from resistant of cervix , wall of pelvis or pelvic floor
  14. 14. Copyright © Wondershare Software Internal Rotation • Rotation of the position of the fetal head in the mid pelvis from transverse to anterior- posterior • Essential for the completion of labor
  15. 15. Copyright © Wondershare Software Extension • Movement of fetal chin away from the thorax as it reaches to vulva • Forces acting: – First force-exerted by uterus - acts posteriorly – Second force by resistant pelvic floor and symphysis- acts anteriorly (Resultant vector is in the direction of vulvar opening, causing extension)
  16. 16. Copyright © Wondershare Software External Rotation(Restitution) • Rotation of the fetal head outside the mother as the head passes through the pelvic outlet • One shoulder is anterior behind the symphysis and other is posterior due to external rotation
  17. 17. Copyright © Wondershare Software Expulsion • Delivery of fetal shoulders and body
  18. 18. Copyright © Wondershare Software Fetal Skull Figure. Fetal skull from lateral view
  19. 19. Copyright © Wondershare Software Figure. Fetal skull superior view
  20. 20. Copyright © Wondershare Software Diameter of fetal skull(Lateral view)
  21. 21. Copyright © Wondershare Software Diameter of fetal skull(Superior view)
  22. 22. Copyright © Wondershare Software Abnormal fetal head presentation • Face Presentation • Brow Presentation
  23. 23. Copyright © Wondershare Software Face presentation • The head is hyperextended so that the occiput is in contact with the fetal back, and the chin is present • Causes include – Preterm infant with smaller head dimension – Enlargement of neck due to coiling of the cord – Anencephalic fetus naturally present with this • Diagnosis – The radiographic demonstration of the hyper extended head with facial bone at or below the pelvic inlet(characterstic)
  24. 24. Copyright © Wondershare Software Brow Presentation • Diagnosed when the portion of the fetal head between the orbital ridge and anterior fontanel presents at pelvic inlet • Causes: • Same as face presentation • Usually on vaginal examination the frontal suture, large anterior fontanel orbital ridges and root of the nose are felt but never mouth and chin is palpable
  25. 25. Copyright © Wondershare Software Abnormal labour • Shoulder dystocia Means difficult labor: slow labor progress Causes 1.Uterine contraction problem 2.Abnormal presentation, position 3.Contracted bony pelvis 4.Soft tissue obstruction i.e. power, passenger and passage’s problem
  26. 26. Copyright © Wondershare Software  Prolonged latent phase: N:>20hr M:>14hr  Protracted disorder: active phase: N: <1.2cm/hr M:<1.5cm/hr for more than 4 hr Descent: N: <1cm/hr M:<2cm/hr  Arrest disorder: failure of descent, no dilation for 2hr  To call protracted or arrest, cervical dilatation should be >3 or 4cm Fundus and cervix has different intensity and time differential in onset of contraction. Uterine dysfunction: 1. hypotonic: synchronous but less powerful contraction 2. Hypertonic or incoordinated: gradient distortion present Cause: chorioamnionitis, epidural analgesia, back lying of mother, First stage disorder: uterine dysfunction mainly 2nd stage disorder: obvious for passage and passenger disproportion High station is also a risk factor for dystocia
  27. 27. Copyright © Wondershare Software  Precipitous labor: expulsion of fetus in <3hr (cervical dilatation: N: >5cm/hr M:>10cm/hr  No complication occur when cervix dilated, vagina stretched and perineum relaxed. If not then uterine rupture or severe injury to birth canal can occur. Amnionic fluid embolism can also occur.  much Chance of uterine atony- PPH  Fetal effect: hematoma, anoxia due to contracted uterus, erb palsy or Duchenne brachial palsy  Ttmnt: tocolytics such as Mag salt Fetopelvic disproportion:  due to contracted pelvis: if shortest AP distance <10cm and transverse <12cm
  28. 28. Copyright © Wondershare Software References • Kevin p. Henretty. Obstratics Anatomy. Obstetrics illustrated. Churchill Livingstone. Elsiver. Page no. 54-5. • Oxford Handbook of Clinical Specialties, 5th edn (ed. Collier J, Longmore M, Brown TD), p. 87. • Rouse, Hauth, et.al. William Obstetrics. 23rd Edition. Normal Labour.
  29. 29. Copyright © Wondershare Software Thank You!
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