Physiology of labor. Anaesthesia in labor

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Labor, anaesthesia, education

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Physiology of labor. Anaesthesia in labor

  1. 1. Physiology of labor. Anesthesia in labor
  2. 2. LABOR–is the physiology process whereby regular uterine activity causes progressive cervical dilatation and usually results in delivery of the fetus, after 22 weeks of pregnancy.
  3. 3. - Labor is a physiologic process that permits a series of extensive physiologic changes in the mother to allow for the delivery of her fetus through the birth canal. - It is defined as progressive cervical effacement, dilatation, or both, resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds.
  4. 4. Classification of labor  PRETERM LABOR– delivery the fetus from the cavity of uterus in 22-36 weeks of pregnancy.  TERM LABOR- delivery the fetus from the cavity of uterus in 37-42 weeks of pregnancy.  Delayed labor- delivery the fetus from the cavity of uterus after 42 weeks of pregnancy.
  5. 5. Theories, which explain the mechanism of birth beginning       Mechanical Immune Placenta Chemical Endocrine Modern
  6. 6. Forerunners of labor      The bottom of uterus is lowering Insertion of pre-lying part Krestellers cork is going away. Reductions of woman’s weight. Irregular muscular contractions of uterus.  Maturity of uterus’s cervix
  7. 7. BISHOP’S SCALE Signs Score 0 1 2 Consistency of uterus’ cervix Thick Softened, but thick in the area of internal os Soft Length and effacement of cervix More than 2 сm 1-2 сv Less than 1 cm or effaced Permeability of cervical canal or cervical os External os is closed or lets pass trough fingertip only Cervical canal lets pass one finger freely. Internal os is still present Cervical canal lets pass more than one finger freely. If the cervix is effaced – dilatation more than 2 cm Disposition of the cervix Posterior Anterior Medial 0-2 points – uterus’ cervix is “immature” 3-4 points – cervix is “mature but not enough” 5-8 points – cervix is “mature”
  8. 8. Cervical effacement in nullipara women
  9. 9. Cervical dilataton in multipara women
  10. 10. Physiological Preliminary period Characteristics: 1. Irregular uterine contractions. 2. There are no structure changes in the cervix of uterus. 3. Duration 6-8 hours
  11. 11. Labor begins with  Regular muscular contractions.  Cervical effacement.  Forming of amniotic vial.
  12. 12. Forewaters
  13. 13. Labor stages  І stage (cervical) – dilatation of the cervix (12-15 hrs.)  ІІ stage (pelvic) – starts from complete dilatation of cervix to the delivery of baby (1-2 hrs.).  ІІІ stage (placental)- starts from the birth of baby till delivery of the placenta. (5-30 min.).
  14. 14. The first period of labor
  15. 15. Uterine contractions – regular contractions of uteri musculature. Typically, contractions occur every 5-10 minutes and last for 20-25 seconds in the onset of labor. As labor progresses, the contractions become more frequent, more intense, and last longer.
  16. 16. Characteristics of uterine contractions  Tonus – minimal pressure between contractions – 10-12 mm Hg.  Intensivity – difference between amplitude and basal tonus of uterus 30-50-70 mm Hg.  Frequency per 10 min – 3-4 за 10 хв.  Duration – 35 - 93 сек.  Rhythm - intervals between contractions – equal.  Activity = intensivity х frequency per 10 min = 280340 Montevideo units
  17. 17. The second stage of labor
  18. 18. Bearing-down efforts (or pushing)  Is the periodic contractions of diaphragm, pelvic floor muscles and front abdominal which are add to the force of uterine contractions.
  19. 19. The birth canal
  20. 20. Record methods of labor     Tocography (external and inernal) Radiotelemetry. Electrogisterography. Cardiotocography.
  21. 21. Friedman’s curve А – dynamic of cervical effacement Б – advancement of the presenting part of fetus
  22. 22. The partogram
  23. 23. Cardiotocography
  24. 24. Cardiotocography
  25. 25. Fetal blood sampling
  26. 26. Types of placenta separation
  27. 27. Shreder’s sign
  28. 28. Kustner’s sign а) б)
  29. 29. Methods of obtainment of the separated placenta (afterbirth)  Abuladze.  Genter.  Krede-Lazarevich.
  30. 30. Method of Abuladze
  31. 31. Genter’s Method
  32. 32. Krede-Lazarevich’s method
  33. 33. Examination of placenta and membranes
  34. 34. Manual separation of placenta
  35. 35. Anesthesia in Labor Causes of labor pain: - Hypoxia of uterine muscle - Stretching of the uterus’ lower segment - Stretching of the uterus’ ligaments - Psychological causes
  36. 36. Modern methods of the pain relief: -Non-medicamental -Medicamental
  37. 37. Psychological training of pregnant women -Decreases phychological component of pain -Decreases fear of labor -Forms correct imagination about labor in patient
  38. 38. Lessons  1 lesson– anatomy and physiology, changes during pregnancy  2 lesson– 1st period of labor, correct behaviour of patient, role of partner;  3 lesson– 2nd and 3rd periods of labor;  4 lesson – port-partum period, breast feeding, caring of baby;  5th lesson - revision.
  39. 39. Medicamental pain relief must have  Good effect  Simplicity of usage  Safety for mother and fetus!
  40. 40. Indications to Anesthesia:  No effect from the psychoprophylaxis;  Gestoses of the second half of pregnancy  Hard extragenital patology  Operative interferences ;  Labor abnormalities
  41. 41. Conditions  Regular uterine contractions  Cervical dilation 4 cm+  Absence of contraindications
  42. 42. Drugs:  Promedol 1% - 1 ml  Sibasone 0,5% - 2 ml
  43. 43. Epidural anaesthesia
  44. 44. Epidural anaesthesia
  45. 45. Epidural anaesthesia
  46. 46. Epidural anesthesia  Anatomical abnormalities, such as spina bifida or scoliosis  Previous spinal surgery (where scar tissue may hamper the spread of medication, or may cause an acquired tethered spinal cord)  Certain problems of the central nervous system, including multiple sclerosis or syringomyelia  Certain heart-valve problems (such as aortic stenosis, where the vasodilation induced by the anaesthetic may impair blood supply to the thickened heart muscle.)  Bleeding disorder (coagulopathy) or anticoagulant medication (e.g. warfarin) - risk of spinal cord-compressing hematoma Infection near the point of intended insertion Infection in the bloodstream which may "seed" via the catheter into the (otherwise relatively impervious) central nervous system  Uncorrected hypovolemia (low circulating blood volume)
  47. 47. Local anaesthesia  Infiltrative anaesthesia (episiotomy, reparation of perineum  Lidocain2% 4-10 ml is used
  48. 48. Thank you!

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