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NORMAL LABOUR
DR KISHWAR
ASSIST PROF GYNAE /OBS
PAK RED CRESCENT MEDICAL AND DENTAL
COLLEGE
REGULAR UTERINE CONTRACTION
LEADING TO PROGRESSIVE
DILATATION OF CERVIX AND
DESCENT OF FETUS
LABOUR
INTERACTION OF
3 Ps
ANATOMY OF PELVIS
• pelvic inlet
• mid cavity
• pelvic outlet
PELVIC INLET
MID CAVITY
PELVIC OUTLET
TYPES OF PELVIS
FETAL SKULL
• vault
• face
• base
• SUTURES
• lines formed where individual bony plates
meet
• sutures of skull are soft ,...
• FONTONELLES
• junction of various sutures
• ANT FONTANELLE/BREGMA
• POST FONTANELLE
FETAL SKULL
FETAL DIAMETERS
EFFECTS OF FETAL ATTITUDE ON
PRESENTING PART
STAGES OF LABOUR
• FIRST STAGE
• SECOND STAGE
• THIRD STAGE
MECHANISM OF LABOUR
• ENGAGEMENT
• DESCENT
• FLEXION
• INTERNAL ROTATION
• EXTENSION
• RESTITUTION
• EXTERNAL ROTATION
• D...
aaaaaaaaaaaaa
• EFFACEMENT
• It relates to the length of the cervix .It is useful
during latent phase,during induction of
labour,in thre...
MALPRESENTATION
• anything other than a vertex
• presentation that are not deliverable vaginally
at term will include
• fa...
• It is defined in cm.
• full dilatation where no cervix is palpable is
taken as 10 cm
• PRESENTATION:
• is the part of th...
POSITION
• it is relationship of the denominatorof the
presenting part of the fetus to fixed points of
the fetus to fixed ...
• fixed points on the maternal pelvis are
• the symphysis pubis anteriorly
• the sacrum posteriorly
• STATION
• of the pre...
• it is an important part of vaginal
examination
• easiest is to palpate the saggital suture and
note the following
• no m...
• CAPUT:
• it is reflection of scalp oedema
• it is seen in prolonged labour but it is
alsoresent in normal labour
• all o...
LABOUR
• DEFINITION
• STAGES OF LABOUR
• FIRST STAGE ...latent....3-8 hrs
• Active ......2-6 hrs
• 1cm per hr
• SECOND STA...
MANAGEMENT OF NORMAL LABOUR
• HISTORY
past obstetrical history, frequency duration and
strength of uterine contraction.
ru...
VAGINAL EXAMINATION
• cervix is assesed for cervical
dilatation,effacement and application to the
presenting part,conditio...
• STATION
• relation of lowest part of head to the ischial
spine
• vaginal assesment of station should be taken
along with...
• condition of fetal membranes should be
assesed .if they have ruptured note the colour
and amount of fluid draining .
• c...
MANAGEMENT OF LATENT PHASE OF
LABOUR
• appropriate analgesia and support should be
offered.
• Most can safely go home come...
MANAGEMENT OF ACTIVE STAGE OF FIRST
STAGE OF LABOUR
• pulse measured hrly,temp and BP 4
hrly,frequency of contraction afte...
PARTOGRAM
• Graphic record of labour
• it allows an instant visual assesment of rate of
cervical dilatation and comparison...
• mobility is encouraged
• vaginal examination after 4hrs
• 1cm dilatation per hr
• descent of presenting part during each...
• foetal monitoring should be done
• women can drink or have iv fluids tobprevent
ketosis.
• light food is acceptable if n...
• Variety of methods of pain relief are available
• ACTIVE MANAGEMENT
• its collection of intervention which was routinely...
ASSESMENT OF FETAL WELBEING
• observation of colour of liquor
• intermittent auscultTion of fetal heart by
pinard stethosc...
• baseline fetal heart 110-160
• variability of 5 to 25 bpm
• accaleartion
• no deceleration
• uterine contraction
• fetal...
• normal CTG
• suspicious CTG
• pathological CTG
FETAL BLOOD SAMPLING
DELIVER THE PATIENT
SECOND STAGE
• CROWNING
• delivery of fetus
• neonatal care
• THIRD STAGE OF LABOUR
• signs of placental separation
• acti...
ABNORMAL LABOUR
• Labour is abnormal when there is poor
progress and / or the fetus shows signs of
compromise.If there is ...
DEFINITION
• It is defined as cervical dilatation of less then 2
cm in 4 hrs .It is associated with failure of
descent and...
• abnormalities in one or more of these factors
can slow the progress of labour.
• plotting of serial vaginal examination ...
PROLONGED LATENT PHASE
• During latent phase changes occur in ground
substance ,glycoprotein,collagen content and
hydratio...
PRIMARY DYSFUNCTIONAL LABOUR
• It is defined as poor progress during the active
phase of labour .
• poor and inco-ordinate...
• optimization of maternal
welbeing.hydration,pain relief
• provision of one to one care
• mobilization
• augmentation wit...
SECONDARY ARREST
• cessation of cervical dilatation following
abnormal period of active phase dilatation
• CAUSES
• Cephal...
• CPD is suspected in labour
• if there is slow progress despite efficient
contraction.
• fetal head is not engaged
• vagi...
• CPD is suspected in labour
• if there is slow progress despite efficient
contraction.
• fetal head is not engaged
• vagi...
• oxytocin can be given carefully to
primigravida with mild to moderate CPD as
long as CTG is reactive
• Oxytocin must nev...
• Tight application of the presenting part on the
cervix is vital to good progress in labour.
• Face presentation may appl...
THANK YOU
57
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Normal and abnormal labour
Normal and abnormal labour
Normal and abnormal labour
Normal and abnormal labour
Normal and abnormal labour
Normal and abnormal labour
Normal and abnormal labour
Normal and abnormal labour
Normal and abnormal labour
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Normal and abnormal labour

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Normal and abnormal labour

  1. 1. NORMAL LABOUR DR KISHWAR ASSIST PROF GYNAE /OBS PAK RED CRESCENT MEDICAL AND DENTAL COLLEGE
  2. 2. REGULAR UTERINE CONTRACTION LEADING TO PROGRESSIVE DILATATION OF CERVIX AND DESCENT OF FETUS
  3. 3. LABOUR INTERACTION OF 3 Ps
  4. 4. ANATOMY OF PELVIS • pelvic inlet • mid cavity • pelvic outlet
  5. 5. PELVIC INLET
  6. 6. MID CAVITY
  7. 7. PELVIC OUTLET
  8. 8. TYPES OF PELVIS
  9. 9. FETAL SKULL • vault • face • base • SUTURES • lines formed where individual bony plates meet • sutures of skull are soft ,unossified membranes
  10. 10. • FONTONELLES • junction of various sutures • ANT FONTANELLE/BREGMA • POST FONTANELLE
  11. 11. FETAL SKULL
  12. 12. FETAL DIAMETERS
  13. 13. EFFECTS OF FETAL ATTITUDE ON PRESENTING PART
  14. 14. STAGES OF LABOUR • FIRST STAGE • SECOND STAGE • THIRD STAGE
  15. 15. MECHANISM OF LABOUR • ENGAGEMENT • DESCENT • FLEXION • INTERNAL ROTATION • EXTENSION • RESTITUTION • EXTERNAL ROTATION • DELIVERY OF SHOULDERS AND FETAL BODY
  16. 16. aaaaaaaaaaaaa
  17. 17. • EFFACEMENT • It relates to the length of the cervix .It is useful during latent phase,during induction of labour,in threatened preterm labour. It reflects cervical remodelling and is defined either as cervical length in cm or as no ,partial or full effacement. DEFINITION
  18. 18. MALPRESENTATION • anything other than a vertex • presentation that are not deliverable vaginally at term will include • face(mento posterior) • brow • shoulder
  19. 19. • It is defined in cm. • full dilatation where no cervix is palpable is taken as 10 cm • PRESENTATION: • is the part of the fetus within the pelvis adjacent to the cervix .presentation can be delivered vaginally at term are: • vertex ,face(mento ant) ,breech DILATATION
  20. 20. POSITION • it is relationship of the denominatorof the presenting part of the fetus to fixed points of the fetus to fixed points of the maternal pelvis • the denominator is the most definable point of the presenting part • occiput for vertex presentation • sacrum for breech presentation • mentum for face presentation
  21. 21. • fixed points on the maternal pelvis are • the symphysis pubis anteriorly • the sacrum posteriorly • STATION • of the presenting part relates to descent within the pelvis .
  22. 22. • it is an important part of vaginal examination • easiest is to palpate the saggital suture and note the following • no moulding • +1suture together with no gap • +2 sutures overlap but reduce with gentle pressure • +3 sutures overlap but donot reduce with gentle pressure MOULDING
  23. 23. • CAPUT: • it is reflection of scalp oedema • it is seen in prolonged labour but it is alsoresent in normal labour • all of the above features should be represented graphically at every vaginal examination.
  24. 24. LABOUR • DEFINITION • STAGES OF LABOUR • FIRST STAGE ...latent....3-8 hrs • Active ......2-6 hrs • 1cm per hr • SECOND STAGE • 2hr... primigravida • 1hr ...multigravida
  25. 25. MANAGEMENT OF NORMAL LABOUR • HISTORY past obstetrical history, frequency duration and strength of uterine contraction. rupture of membrane ,colour and amount of liquor fetal movements any medical problem GENERAL PHYSICAL EXAMINATION ABDOMINAL EXAMINATION Presentation,lie , palpation for uterine contraction a
  26. 26. VAGINAL EXAMINATION • cervix is assesed for cervical dilatation,effacement and application to the presenting part,condition of membrane • in normal labour vertex is presenting part and position is determined by locating posterior fontanelle • if posterior fontanelle is not palpable it indicate prolonged labour.
  27. 27. • STATION • relation of lowest part of head to the ischial spine • vaginal assesment of station should be taken along with assesment of degree of engagement on abdominal examination. • if the head is below ischial spine and occiput is anterior then outlook is favourable for the vaginal delivery.
  28. 28. • condition of fetal membranes should be assesed .if they have ruptured note the colour and amount of fluid draining . • copious amount of clear fluid are good prognostic feature . • scanty ,heavy blood stained or meconium stained is warning sign for fetal compromise.
  29. 29. MANAGEMENT OF LATENT PHASE OF LABOUR • appropriate analgesia and support should be offered. • Most can safely go home come when the contractions increase in strength and frequency • patients are encourged to mobilize. • encouragement and reassurance are extremely important. • intervention during this phase should be avoided • light food and drinking is allowed • vaginal examination after 4 hrs to determine whether active phase has been reached.
  30. 30. MANAGEMENT OF ACTIVE STAGE OF FIRST STAGE OF LABOUR • pulse measured hrly,temp and BP 4 hrly,frequency of contraction after 30 min • vaginal examination after 4 hr.urine tested for ketosis and pr. • progress of labour should be recorded on partograph.
  31. 31. PARTOGRAM • Graphic record of labour • it allows an instant visual assesment of rate of cervical dilatation and comparison with expected norm so that slow progress can be recognized early and appropriate actions can be taken.
  32. 32. • mobility is encouraged • vaginal examination after 4hrs • 1cm dilatation per hr • descent of presenting part during each pelvic examination • membranes may be intact,may have ruptured or intact. • pt should have one to one care
  33. 33. • foetal monitoring should be done • women can drink or have iv fluids tobprevent ketosis. • light food is acceptable if no risk factor for operations • shaving and enemas are not required • antacids are required if there are complications.
  34. 34. • Variety of methods of pain relief are available • ACTIVE MANAGEMENT • its collection of intervention which was routinely recommended to nulliparous women to maximize the chances of normal birth. • it includes one to one care • 2 hrly vaginal examination • early rupture of membranes • augmentation with oxytocin if slow progress • only one to one care is beneficial
  35. 35. ASSESMENT OF FETAL WELBEING • observation of colour of liquor • intermittent auscultTion of fetal heart by pinard stethoscope,hand held doppler • continuous external Electronic monitoring EFM by using CTG • fetal scalp sampling .
  36. 36. • baseline fetal heart 110-160 • variability of 5 to 25 bpm • accaleartion • no deceleration • uterine contraction • fetal movement
  37. 37. • normal CTG • suspicious CTG • pathological CTG FETAL BLOOD SAMPLING DELIVER THE PATIENT
  38. 38. SECOND STAGE • CROWNING • delivery of fetus • neonatal care • THIRD STAGE OF LABOUR • signs of placental separation • active management of third stage of labour • physiological management of third stage of labour • examination of placenta and vulva for tears.
  39. 39. ABNORMAL LABOUR • Labour is abnormal when there is poor progress and / or the fetus shows signs of compromise.If there is fetal malpresentation,a multiple gestation ,uterine scar, induced labour
  40. 40. DEFINITION • It is defined as cervical dilatation of less then 2 cm in 4 hrs .It is associated with failure of descent and rotation of head. • progress in labour is dependent on three variables . • powers : efficiency of uterine contractions • passengers:fetus ,size,presentation,position • passages:uterus,cervix,bony pelvis.
  41. 41. • abnormalities in one or more of these factors can slow the progress of labour. • plotting of serial vaginal examination on the partogram will help to heighlight poor progress during first stage of labour
  42. 42. PROLONGED LATENT PHASE • During latent phase changes occur in ground substance ,glycoprotein,collagen content and hydration state of cervix which result in remodelling and effacement. during this period women experience painful contraction and need support. unnecessary intervention to accelerate labour are not implemented at this stage. patient should be reassured and simple analgesia should be given.If there is any medical indication then induction protocol should be followed
  43. 43. PRIMARY DYSFUNCTIONAL LABOUR • It is defined as poor progress during the active phase of labour . • poor and inco-ordinate uterine activity is significant factor • it may culminate in obstructed labour, maternal infection ,uterine rupture and postpartum haemorrhage.
  44. 44. • optimization of maternal welbeing.hydration,pain relief • provision of one to one care • mobilization • augmentation with oxytocin • delivery by caessarian section.
  45. 45. SECONDARY ARREST • cessation of cervical dilatation following abnormal period of active phase dilatation • CAUSES • Cephalo pelvic disproportion(antomical disproportion between fetal head and maternal pelvis) • obstructive hydrocephalus,fetal thyroid,neck tumours ,malposition esp occipito posterior position.
  46. 46. • CPD is suspected in labour • if there is slow progress despite efficient contraction. • fetal head is not engaged • vaginal examination shows moulding • and caput formation • head is poorly applied to cervix.
  47. 47. • CPD is suspected in labour • if there is slow progress despite efficient contraction. • fetal head is not engaged • vaginal examination shows moulding • and caput formation • head is poorly applied to cervix.
  48. 48. • oxytocin can be given carefully to primigravida with mild to moderate CPD as long as CTG is reactive • Oxytocin must never be given in multiparous woman where CPD is suspected.
  49. 49. • Tight application of the presenting part on the cervix is vital to good progress in labour. • Face presentation may apply poorly to the cervix and resulting progress is poor although vaginal birth is possible.
  50. 50. THANK YOU
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  53. 53. 59 Body Level One Body Level Two Body Level Three Body Level Four Body Level Five Title text
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