Labour process


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Labour process

  2. 2. NORMAL LABOUR  Series of events that takes place in the genital organs,is an effort to expel the viable products of conception out of the womb through the vagina into the outer world.
  3. 3. STAGES OF LABOUR Ist STAGE:- From onset of true labour pains till the full dilatation of cervix.Its 12 hrs in primigravida and 6 hrs in multiparae.
  4. 4. Contd… IInd STAGE:- From full dilatation of cervix till fetus is delivered.Its 2 hrs in primigravidae and 30 min. in multiparae.
  5. 5. Contd… IIIrd STAGE:- From delivery of fetus till delivery of placenta.Its of average 15 mins.
  6. 6. PARAMETERS FOR CONSIDERATION LIE:-The relationship between the long axis of fetus with long axis of uterus. E.g.:Longitudnal Transverse Oblique
  7. 7. Contd… ATTITUDE:- The relationship of fetal head & its trunk. E.g.:- Flexion.
  8. 8. Contd… PRESENTATION:- The part of fetus which lies at pelvis or lower pole of uterus. Vertex:- 98.6% Breech:- 2.5% Shoulder:- 0.4% Face:- 0.2% Brow:- 1%
  9. 9. Contd…  DENOMINATOR:- It is the leading point of presentation. In Vertex:- Occiput In Breech:- Sacrum In Face:- Chin
  10. 10. Contd…  POSITION:- The relationship of denominator with pelvic brim. L.O.A:- Left Occipito Anterior R.O.A:- Right Occipito Ant. L.O.P:- Lt. Occipito Posterior. R.O.P:- Rt. Occipito Post. L.S.A:- Lt. Sacro Ant. R.S.A:- Rt. Sacro Ant. L.S.P:- Lt. Sacro Post. R.S.P:- Rt. Sacro Post.
  11. 11. PHYSIOLOGY OF Ist STAGE OF LABOUR   Duration   Uterine action   Fundal dominance   Polarity   Contraction and Retraction   Formation of Retraction Ring A ridge on the inner uterine surface at the boundary between the upper and lower uterine segments that occurs in the course of normal labor.   Dilatation of cervix   Effacement of cervix   Show   Rupture of Membranes/Formation of Bag
  13. 13. MANAGEMENT OF Ist STAGE  Non interference with watchful expectancy.  To monitor carefully:- a) General management b) Bowel And Bladder Care c) Rest d) Diet e) Relief of pain
  14. 14. Contd…  Note Progress Of Labour:- a) Abdominal Findings b) Pelvic Grip c) Vaginal Examination d) Fetal And Maternal Condition
  15. 15. First maneuver: Fundal Grip  While facing the woman, palpate the woman's upper abdomen with both hands. often determine the size, consistency, shape, and mobility of the form. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and the shoulders and limbs have small bony processes;
  16. 16. Second maneuver: Umbilical Grip  Still facing the woman, the health care provider palpates the abdomen with gentle. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands.
  17. 17. Third maneuver: Pawlick's Grip  In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen.[2] The individual performing the maneuver first grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand.
  18. 18. Fourth maneuver: Pelvic Grip  The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis.
  19. 19. PHYSIOLOGY OF IInd STAGE OF LABOUR  Contractions become stronger & longer.  Continous contraction & retraction of upper uterine segment & lower uterine segment thins.  Nature of contraction become more expulsive & pressure is extended on the rectum & perineal floor.  There is soft tissue displacement.  Bladder is pushed up.  Rectum becomes flattened into sacral curve & pressure of advancing head expels any residue
  20. 20. SIGNS OF IInd STAGE OF LABOUR  Contractions become longer & stronger.  Full dilatation of cervix.  Presenting part is seen at vulva.  There is pouting & gapping of anus.  Buldging of perineum.
  21. 21. MECHANISM OF LABOUR The series of movements that occur on the head in the process of adaptation,during its journey through the pelvis.
  22. 22. The Principle Movements Are:-  Engagement  Descent  Flexion  Internal Rotation Of Head  Extension Of Head  Restitution  External Rotation Of Head & Internal Rotation Of Shoulders  Expulsion Of Head & Trunk
  23. 23. ENGAGEMENT  Mechanism by which fetal nestles into the pelvis.also termed as LIGHTENING or DROPPING.In primigravida it occurs before the onset of labour while in multigravida occurs in late Ist stage with rupture of membranes.
  24. 24. DESCENT  It is a continous process.It is slow in Ist stage & becomes pronounced in Iind stage.Descent is completed with expulsion of fetus.Head is expected to reach pelvic floor by the time cervix is fully dilated.
  25. 25. FACTORS FACILITATING DESCENT  Uterine Contractions & Retractions.  Bearing Down Effort.  Straightening Of Fetus Especially After Rupture Of Membranes.
  26. 26. FLEXION  Process of fetal head nodding forward towards the fetal chest.As the head meets the resistance of birth canal during descent,full flexion is achieved either due to resistance offered by unfolding of cervix walls of pelvic or by pelvic floor
  27. 27. INTERNAL ROTATION OF HEAD  In a well flexed vertex presentation, the occiput leads & meets the pelvic floor Ist & rotates ant. Through 1/8th of the circle.this causes slight twist in neck of fetus as head is no longer in alignment to shoulder.The head slips benesth sub- pubic arch &crowning occurs.
  28. 28. CROWNING  After internal rotation of head, further descent occurs,untill the sub- occiput lies underneath the pubic arch.At this stage the max. diameter of head stretches the vulval outlet without any recession of head even after contraction is over-It is called CROWNING.  Biparietal diameter:- 9.5cm.
  29. 29. EXTENSION OF HEAD  Once crowning has occurred the fetal head can extend.The driving force pushes the head in downward direction.The successive parts of fetal head to be born through stretched vulval outlet are VERTEX,BROW &FACE
  30. 30. RESTITUTION Visible passive movement of head due to untwisting of neck sustained during internal rotation.Movements of restitution occurs rotating the head through 1/8th of circle in direction opposite to internal rotation & comes in lateral flexion & faces towards thighs.
  31. 31. EXT. ROTATION OF HEAD &INT. ROTATION OF SHOULDER Movement of rotation of head visible externally due to internal rotation of shoulders.As the ant.shoulder rotates towards the symphysis pubis,it carries the head in a movement of ext. rotation through 1/8th of circle in same direction of restitution.
  32. 32. EXPULSION OF SHOULDER & TRUNK After the shoulders are positioned in ant.-post. Diameter of outlet,further descent takes place until the ant. Shoulder is born.By a movement of lat.flexion of spine,the post. shoulder sweeps over the perineum.Rest of the trunk is expelled out by lateral flexion.
  33. 33. PRINCIPLES OF MANAGEMENT OF IInd STAGE OF LABOUR  To assist in natural expulsion of fetus slowly & steadily.  To prevent perineal injuries.
  34. 34. MANAGEMENT OF IInd STAGE OF LABOUR  General Measures:- a)Patient should lie down in bed. b)Constant supervision for F.H.S. c)To note maternal vital signs every ½ hrly d)To administer analgesics. e) To advice & instruct the patient to keep up morale.
  35. 35. Vaginal examination It is done at early or beginning of 2nd stage of labour to rule out any accidental cord prolapse.Position & station of head should be once more noted to progressive descent of head. Nothing should be given to mother except sips of water.
  36. 36. PREPARATION OF DELIVERY  Shifting of patient to delivery table.  Positioning of patient.  Aseptic techniques.  Toileting of genitalia.  Emptying of bladder.  Supporting perineum while delivery.  Providing EPISIOTOMY to prevent tears.  Inj. METHERGIN 0.2 mg I/M after delivery of anterior shoulder of baby.
  37. 37. CONDUCTION OF DELIVERY  Delivery should be spontaneous & is divided into 3 phases:- a) Delivery of head. b) Delivery of shoulders. c) Delivery of trunk.
  38. 38. SIGNS OF IIIrd STAGE OF LABOUR  Lengthening of cord.  Gush of bleeding.  Uterus becomes full OR boggy uterus.
  39. 39. MANAGEMENT OF IIIrd STAGE OF LABOUR Control Cord Traction
  40. 40. Contd… Mannual Removal Of Placenta
  41. 41. IV th STAGE OF LABOUR  Stage of observation for at least 1 hr after expulsion of the after births.
  42. 42. Contd…  Check vital signs of mother & baby.  Bleeding per vagina.  Breast Feeding.  Comfortable position.  Observation for urine output.  Comfort of mother and newborn.