The document discusses the first stage of labor, including its definition, phases, and physiological changes. The first stage begins with regular uterine contractions and ends with full cervical dilation. It is divided into latent, active, and transition phases. During this stage, the cervix effaces and dilates due to uterine contractions and mechanical factors like pressure from the amniotic sac. Midwives should monitor labor using a partograph to assess progress and fetal wellbeing.
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
Postpartum blues includes an array of psychiatric manifestations occurring in the period of post-partum, due to hormonal imbalance. Knowing in detail will help for quicker diagnosis and better outcomes.
Prepared in December, 2017.
Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
Normal Labour & Nursing Management of First stage of LabourNeha Parmar
Definition of normal labor, Terminology , events of labour, causes of labour, signs , stages of labour , signs and symptoms of labour, diagnosis in first stage of labour, Partograph, difference between true labour and false labour ,nursing management of first stage of labour.
Postpartum blues includes an array of psychiatric manifestations occurring in the period of post-partum, due to hormonal imbalance. Knowing in detail will help for quicker diagnosis and better outcomes.
Prepared in December, 2017.
Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
Normal Labour & Nursing Management of First stage of LabourNeha Parmar
Definition of normal labor, Terminology , events of labour, causes of labour, signs , stages of labour , signs and symptoms of labour, diagnosis in first stage of labour, Partograph, difference between true labour and false labour ,nursing management of first stage of labour.
Stages of normal labor- easy explanation for Nursing Students(B.Sc & GNM)...
Introduction, definition of normal labor, definition of normal labor by WHO, Mechanism of labor, stages of labor, Intrapartum management of Labor, pain control.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
This presentation includes all the events , its sign and symptoms about IOL as well as management of women in the first stage of labor and how to assess the women in labor with the help of partograph.
A Partograph is a graphical record of progress during labor.
Progress is measured by cervical dilatation against time in hours, as well as by providing a record of the important conditions of the mother and fetus that may arise during the process
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
THIRD STAGE OF LABOUR AND ITS MANAGEMENT.pdfDolisha Warbi
definition, duration, events, (placenta separation, descend of placenta, expulsion of placenta , the Schultz mechanisms, Mathew Duncan mechanisms, signs of separation, expectant management, active management, complexion , examination of placenta and its membrane, complication.
Observation of Io’s Resurfacing via Plume Deposition Using Ground-based Adapt...Sérgio Sacani
Since volcanic activity was first discovered on Io from Voyager images in 1979, changes
on Io’s surface have been monitored from both spacecraft and ground-based telescopes.
Here, we present the highest spatial resolution images of Io ever obtained from a groundbased telescope. These images, acquired by the SHARK-VIS instrument on the Large
Binocular Telescope, show evidence of a major resurfacing event on Io’s trailing hemisphere. When compared to the most recent spacecraft images, the SHARK-VIS images
show that a plume deposit from a powerful eruption at Pillan Patera has covered part
of the long-lived Pele plume deposit. Although this type of resurfacing event may be common on Io, few have been detected due to the rarity of spacecraft visits and the previously low spatial resolution available from Earth-based telescopes. The SHARK-VIS instrument ushers in a new era of high resolution imaging of Io’s surface using adaptive
optics at visible wavelengths.
This pdf is about the Schizophrenia.
For more details visit on YouTube; @SELF-EXPLANATORY;
https://www.youtube.com/channel/UCAiarMZDNhe1A3Rnpr_WkzA/videos
Thanks...!
Richard's aventures in two entangled wonderlandsRichard Gill
Since the loophole-free Bell experiments of 2020 and the Nobel prizes in physics of 2022, critics of Bell's work have retreated to the fortress of super-determinism. Now, super-determinism is a derogatory word - it just means "determinism". Palmer, Hance and Hossenfelder argue that quantum mechanics and determinism are not incompatible, using a sophisticated mathematical construction based on a subtle thinning of allowed states and measurements in quantum mechanics, such that what is left appears to make Bell's argument fail, without altering the empirical predictions of quantum mechanics. I think however that it is a smoke screen, and the slogan "lost in math" comes to my mind. I will discuss some other recent disproofs of Bell's theorem using the language of causality based on causal graphs. Causal thinking is also central to law and justice. I will mention surprising connections to my work on serial killer nurse cases, in particular the Dutch case of Lucia de Berk and the current UK case of Lucy Letby.
Professional air quality monitoring systems provide immediate, on-site data for analysis, compliance, and decision-making.
Monitor common gases, weather parameters, particulates.
Introduction:
RNA interference (RNAi) or Post-Transcriptional Gene Silencing (PTGS) is an important biological process for modulating eukaryotic gene expression.
It is highly conserved process of posttranscriptional gene silencing by which double stranded RNA (dsRNA) causes sequence-specific degradation of mRNA sequences.
dsRNA-induced gene silencing (RNAi) is reported in a wide range of eukaryotes ranging from worms, insects, mammals and plants.
This process mediates resistance to both endogenous parasitic and exogenous pathogenic nucleic acids, and regulates the expression of protein-coding genes.
What are small ncRNAs?
micro RNA (miRNA)
short interfering RNA (siRNA)
Properties of small non-coding RNA:
Involved in silencing mRNA transcripts.
Called “small” because they are usually only about 21-24 nucleotides long.
Synthesized by first cutting up longer precursor sequences (like the 61nt one that Lee discovered).
Silence an mRNA by base pairing with some sequence on the mRNA.
Discovery of siRNA?
The first small RNA:
In 1993 Rosalind Lee (Victor Ambros lab) was studying a non- coding gene in C. elegans, lin-4, that was involved in silencing of another gene, lin-14, at the appropriate time in the
development of the worm C. elegans.
Two small transcripts of lin-4 (22nt and 61nt) were found to be complementary to a sequence in the 3' UTR of lin-14.
Because lin-4 encoded no protein, she deduced that it must be these transcripts that are causing the silencing by RNA-RNA interactions.
Types of RNAi ( non coding RNA)
MiRNA
Length (23-25 nt)
Trans acting
Binds with target MRNA in mismatch
Translation inhibition
Si RNA
Length 21 nt.
Cis acting
Bind with target Mrna in perfect complementary sequence
Piwi-RNA
Length ; 25 to 36 nt.
Expressed in Germ Cells
Regulates trnasposomes activity
MECHANISM OF RNAI:
First the double-stranded RNA teams up with a protein complex named Dicer, which cuts the long RNA into short pieces.
Then another protein complex called RISC (RNA-induced silencing complex) discards one of the two RNA strands.
The RISC-docked, single-stranded RNA then pairs with the homologous mRNA and destroys it.
THE RISC COMPLEX:
RISC is large(>500kD) RNA multi- protein Binding complex which triggers MRNA degradation in response to MRNA
Unwinding of double stranded Si RNA by ATP independent Helicase
Active component of RISC is Ago proteins( ENDONUCLEASE) which cleave target MRNA.
DICER: endonuclease (RNase Family III)
Argonaute: Central Component of the RNA-Induced Silencing Complex (RISC)
One strand of the dsRNA produced by Dicer is retained in the RISC complex in association with Argonaute
ARGONAUTE PROTEIN :
1.PAZ(PIWI/Argonaute/ Zwille)- Recognition of target MRNA
2.PIWI (p-element induced wimpy Testis)- breaks Phosphodiester bond of mRNA.)RNAse H activity.
MiRNA:
The Double-stranded RNAs are naturally produced in eukaryotic cells during development, and they have a key role in regulating gene expression .
2. INTRODUCTION:
• The first stage of labor usually starts with the onset of regular iterine
contractions and culminates the complete dilatationof the cervix.Its
average duration is 12 hours in primigravida and 6 hours in multipara.
• There are number of premonitory signs and symptoms that may alert a
midwife to a womans approaching labor.
3. DEFINITION OF LABOR:
• Labor may be defined as rhythmic contraction and relaxation of the
uterine muscles with progressive effacement (thinning) and dilatation
(opening) of the cervix leadind to expulsion of the products of
conception.
-CLAUSENTAL 1993
• Labor is defined as the process by which the fetus ,placenta and
membranes are expelled through the birth canal.
-CASSIDY 1999
4. NORMAL LABOR:
• Normal labor occurs at term and is spontaneous in onset with the fetus
presenting by the vertex.The process is completed within 18 hours
and no complications arise.
5. THREE P”S OF NORMAL LABOR:
• P-Powers or uterine contractions
• P-The pelvis including size and shape
• P-Passanger which includes the size,position and presentation of the
fetus
6. ABNORMAL LABOR:
• Abnormal or difficult labor ,or delivery .Used to refer weak or
ineffective uterine contractions may also be used to describe the
situation in which the shoulders of a baby in vertex presentation
become trapped after delivery of the head.
7. STAGES OF LABOR:
• First stage:It begins with regular rhythmic uterine contractions and is
complete when the cervix is fully dilated.
• SECOND STAGE:Complete dilatation of the cervix and through
complete birth of the baby.
• THIRD STAGE:Separation and expulsion of the placenta and
membranes.
• FOURTH STAGE:First 4 hours after the delivery of the placenta.
8. FIRST STAGE OF LABOR:
• The first stage is divided in to tree phases
• latent phase
• active phase
• transition phase
9. LATENT PHASE:
• Begins with the onset of true labor contractions
• Contraction may be between 15 -20 minutes apart,lasting 20-30
seconds
• As this progress the contraction will occur every 5-7 minutes and the
duratio lengthen for 30-40 seconds .
• 3-4cm dilatation
• Primigravida 9 hours
• Multigravida 5 hours
10. ACTIVE PHASE:
• Begins when the cervix is 3-4 cm dilated and ends when she is 8 cm
dilated.
• Contraction occurs every 3-5 minutes and last for 60 seconds.
• primigravida -6 hours
• Multigravida-4 hours
• Dilatation rate atleast 1.2 -1.5 cm/hr.
11. TRANSITION PHASE:
• Contraction occur every 2-3 minutes and lasting 60-90 seconds.
• Contractiion is very strong.
• Woman become more restless and agitated.
• primigravida 2 hours
• Multigravida 1 hours
• The nurse need to prepare the patient for second stage of labor.
12. PHYSIOLOGICAL CHANGES OR EVENTS IN THE FIRST
STAGE OF LABOR:
• UTERINE FACTOR
• MECHANICAL FACTOR
13. UTERINE FACTOR:
• Contraction and retraction of uterine muscles
• Formation of upper and lower segment
• Development of retraction ring
• Taking up of the cervix or effacement of the cervix
• Dilatation of the cervix
• Show presentation
15. UTERINE FACTOR :
contraction and retraction of uterine muscles
• Contractions are involuntary movements which are palpable and
painful.
• NATURE OF UTERINE CONTRACTIONS ARE:
• Painful uterine contration
• Fundal dominance
• Raised intra amniotic pressure
• Retraction
• Polarity
16. A.painful uterine contraction
• The contractions are intermittent regular intervals which arre painful.
• following characters of uterine contraction:
• FREQUENCY:Contraction occur immediately throughout the labor.
• 20-30m apart and become closer until
• They as frequent as every 2-3min.
REGULARIT:Contraction occur more and more regularly as labor becomes well
established.
DURATION:Increases from 30s to between 60-90s near full dilatation of the
cervix.then becomes about 60s until delivery of the fetus.
INTENSITY:Contraction also increases as the labor progress.
17. C.raised intra amniotic pressure:
• 3 to 5 mmm/hg
• During contraction it raises up to 40 to 50 mm/hg infirst stage.
• 80 to 100 m/hg in the second stage of labor.
• Good relaxation occurs to bring down intra amniotic pressure less than
8 mm/hg.
18. D.retraction :
During labor the contraction does not passess off entirely,the muscle
fibre retain some of the shortening of contraction instead of becoming
completely relaxed.This is termed retraction.
THE EFFECTS OF RETRACTION WHICH IS ESSENTIAL IN NORMAL
LABOR:
Formation of upper and lower segment
Dilatation and taking up of the cervix
Expulsion of the fetus
Effective hemostasis after separation of placenta
19. E.polarity:
• co ordination between the upper and the lower uterine segment is
called polarity which brings cervical dilatation.
20. FORMATION OF UPPER AND LOWER UTERINE
SEGMENT:
• By the end of the pregnancy the body of the uterus is divided in to the
anatomically distinct ie ,the upper and lower uterine segment.
• The upper uterine segment is mainly concerned with contraction and is
thick and muscular.
• The lower segment is prepared for distension and dilatation and is
thinner.
• The lower segment develops from the isthumus and is about 8 to 10
cm in length.
21. DEVELOPMENT OF RETRACTION RING:
• A ridge form between the upper
and lower uterine segment which
isknown as retraction ring.
• The physiological retraction ring
gradually rises as the upper
uterine segment contracts and
retracts and the lower uterine
segment thins out to accomodate
the descending fetus.
• The retraction ring becomes
visible above the symphysis
pubis it is termed as bandl's ring.
22. TAKING UP OF THE CERVIX OR EFFACEMENT:
• Thinning of The cervix.
• Normally ina primigravida the
effacement preceds cervical
dilatation, but in multigravida
both occur simultaneously.
• Uneffaced cervix measures 4cm
and 50% effaced cervix measures
2cm on vaginal examination.
23. dilatation of the cervix:
• Dilatation occurs as a result of
good and progressive uterine
contraction and retraction and
pressure applied by the bag of
membrane.
24. SHOW PRESENTATION:
• It is a blood stained mucoid discharge,which is seen before few hours
of labor or within a few hours after laboe starts.
• Blood is stained due to the detached chorion fro the decidua and
dilating cervix.
29. PARTOGRAPH:
• Is a record of all the observations made on a woman in labor in
labor, the central feature of which is the graphic recording of the
dilatation of the cervix as assed by vaginal examination.
30. PRINCIPLES:
*The active phase of labor commences at 3cm cervical dilatation.
*The latent phase of labor should last no longer than 8 hours.
*During active labor therate of cervical dilation should not be lesser
than 1cm/hr.
• Four hourly vaginal examination is recommended..
31. PURPOSE:
*To record the clinical observation accurately.
* To identify the difference between latent phase and active phase of
labor.
*To interpret the recorded partograph.
* To monitor the well being of the mother as goes through labor.
32. USE AND CRITICAL ANALYSIS OF LABOR BY
PARTOGRAPH :
• Assessment of fetal condition
• FHR greater than or equal to 180 bts/ mim -tachycardia
• Less than or equal to 160 bts/min – bradycardia
• Membranes and liqour:
• Intact membrane
• Ruptured membrane + clear liquor c
• Ruptured membrane + meconium stained m
• Ruptured membrane+ blood stained liquor b
• Ruptured membrane + absent liquor a
33. •Moulding:
It is a state of reduction or loss of space between skull bones,
separated bones, sutures felt easily
34. 2.Progress of labor:
Latent phase
Active phase
Alert line
Action line
Descent of the fetal head
Frequency how often they felt
Duration how long do they last
35. MATERNAL CONDITION:
Oxytocin drip
Drugs and other fluids
Pulse every 30 mts
Blood pressure every 4 hourly
Temperature every 2 hours
36. EVIDENCED BASED STUDIES:
• The findings revealed that partographs were used by midwives at
the st anthony’s hospital with The majority of the material folders
fully completed.
• The use and completion of partograph were significantly associated
with a reduced incidence of birth asphyxia at the hospital.birth
asphyxia could be reduced if partographs are used and completed by
midwives during labor in all cases.
37. ANALGESIA AND ANESTHETIC IN LABOR:
• Analgesics refers to a technique or medication that reduces pain
Dermol- narcotic
Morphine- narcotic
Stadol- non narcotic
38. Anesthetic:
Anesthetics refers to a technique or medication that partially or
completely eliminates sensation.
Types of anesthetics used:
• Local
• Regional
• Paracervical block
• Pudendal block
• Saddle block
• Caudal or lumbar epidural
39. ACTIVE MANAGEMENT OF LABOR:
• PRINCIPLES
• Early diagnosis following strict criteria.
• vaginal examination hourly for three hours,then every two hours atleast.
• Amniotomy one hour after admission.
• woman not in labor should sent home and 50% are readmitted in 24 hours.
• personal and psychological support.
• Antenatal education
40. INDUCTION OF LABOR:
• induction is the process of stimulating the labor by uterine
stimulation.It should be used when it is thought that the baby wiil be
safer delivered than it is in utero.
REASONS:
Polonged pregnancy.
Suspected intra uterine growth retardation.
Hpertension and pre eclampsia.
Planned time of delivery in the best interest of the baby.
41. CHECK PRIOR TO INDUCTION:
• Lie and the position of the fetus.
• Volume of amniotic fluid
• Tone of uterus
• Ripness of cervix
CONTRAINDICATION:
Severe degree of placenta previa
transverse fetal lie
CPD
Bihop score less than 4
45. VAGINAL EXAMINATION
• PREVENTION OF INFECTION
• ARTIFICIAL RUPTURE OF MEMBRANES
• BACK RUB
• ABDOMINAL RUB
• EFFLEURAGE
• EMOTIONAL SUPPORT
46. • PREPARATION OF DELIVERY ROOM
• PREPARATION OF EQUIPMENTS FOR DELIVERY
47. MAINTAIN RECORD OR DOCUMENTATION OF
LABOR:
• General
• Bowel
• Rest and ambulation
• Diet
• Bladder care
• Relif of pain
• Fetal well being
• Vaginal examination
• Watch maternal condition
• Evidence of fetal and maternal distress
48. CONCLUSION:
• Labor is rhythmic contraction and relaxation of uterine muscles
with progressive effacement dilation of the cervix lead to expulsion
of fetus and first stage of labor starts and ended with full cervical
dilatation.
