This document discusses the first stage of labor and its management. The main events of the first stage are dilatation of the cervix and effacement of the cervix. It describes the processes involved like softening and thinning of the cervix. Management of the first stage focuses on monitoring the mother and fetus, providing comfort, and assessing progress. Complications that may arise include maternal distress, fetal distress, cephalopelvic disproportion, and prolonged labor.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. puerperium begins as soon as the placenta is expelled and lasts for approximately 6 weeks when the uterus becomes regressed almost to the non-pregnant size.
Hydatidiform Mole (HM) is a rare mass or growth that forms inside the uterus at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD).
When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
NORMAL LABOR.. (EUTOCIA) ABNORMAL LABOR ALSO EXPLAINED. Series of events that take place in the genital organs in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called LABOR.
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
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Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
2. INTRODUCTION
• Chiefly concerned with preparation of birth
canal.
• To facilitate expulsion of the fetus in the
second stage.
MAIN EVENTS:
a) Dilatation of cervix & effacement of cervix.
b) Full formation of lower uterine segment.
3. DILATATION OF CERVIX
• Occurs prior to the onset of labor(pre-labor phase)
PREDISPOSING FACTORS:
a)softening of the cervix.
b)fibromusculoglandular hypertrophy.
c)increased vascularity.
d)accumulation of fluid in b/w collagen fibres.
e)breaking down of collagen fibrils by enzymes.
f)change in glycosaminoglycans in the matrix of
cervix.
5. EFFACEMENT OF CERVIX
• Refers to the process by which the muscular
fibres of cervix are pulled upwards & merges
with the fibres of lower uterine segment.
• Cervix becomes thin.
• In primigravidae,effacement preceeds
dilatation of cervix.
• In multiparae,both occur simulatenously.
• Results in expulsion of mucus plug.
6. FULL FORMATION OF LOWER
UTERINE SEGMENT
• Demarcation of an active upper segment &
relatively passive lower segment is more
pronounced.
• Wall of Upper segment becomes progressively
thickened.
• Progressive thinning of Lower segment.
• A distinct ridge is produced at junction of two c/a
PHYSIOLOGICAL RETRACTION RING.
7.
8. MANAGEMENT OF FIRST STAGE
• PRINCIPLES:
1) Noninterference with watchful expectancy so as to
prepare the patient for natural birth.
2) To monitor careflly the progress of labor,maternal
conditions & fetal behavior.
3) So as to detect any intrapartum complication early.
9. PRELIMINARIES
• Evaluation of current clinical condition.
• Onset of labor pains or leakage of liquor,if any.
• General,obstetrical examinations including vaginal
examinaion.
• Record of antenatal visits,investigation report,if
available are to be reviewed.
13. 2. BOWEL:
*An enema with soap & water given in early stage.
*If rectum feels loaded on vaginal exmination
3.REST AND AMBULATION:
*If membranes are intact,patient is allowed to walk.
*Prevents venacaval compression & descent of head.
*Ambulation can reduce the duration of labor,need of
analgesia &improve maternal comfort.
*If,however analgesic drug is given,she should be in
bed.
14. 3. DIET:
• Delayed emptying of the stomach in labor.
• Low ph – danger sign if aspirated following gen.
anesthesia,when needed unexpectedly.
• So,food is withheld during active labor.
• I.V fluid with ringer solution is given where any
intervention is anticipated.
4.BLADDER CARE:
• Bladder should be empty as it often inhibits uterine
contraction and may lead to infection.
• If patient fails to pass urine especially in late first
stage,catheterization is to be done.
15. 5.RELIEF OF PAIN:
Analgesic drug is used : Pethidine 50-100mg i.m
(when the pain is well established in the active phase
of labor)
Metoclopramide 10mg IM is given to combat
voiting due to pethidine.
Pethidine should not be given if delievery is
anticipated .
16. 6.ASSESSMENT OFPROGRESS OF LABOR
AND PARTOGRAPH RECORDING.
2.BLOOD PRESSURE
(Every 1Hrs)
3.TEMPERATURE
(At every 2 Hrs)
4.URINE
OUTPUT(volume,protein
or acetone)
5.ANY DRUG(oxytocin or
other)
1.PULSE
(EVERY 30 MINS)
17. ABDOMINAL PALPITATION
• Uterine contractions: frequency,intensity &
duration.
• Pelvic grip :
1.Gradual disappearance of poles of head(sincipit
&occiput).
2. For descent of fetal head in terms of fifth felt above
the brim is to be used.
• Shifting of maximal intensity of fetal heart
downward & medially.
18. TO NOTE THE FETAL WELL- BEING
• Fetal heart rate : noted every half hour along with
rhythm & intensity.
• Observation should be made immediately following
uterine contraction.(count for 60 seconds)
• Maternal pulse should be counted .
• Normal :110 to 150 per minute.
19. VAGINAL EXAMINATION
• Dilatation of the cervix in cms in relation to hours of
labor.
• To note the position of head & degree of flexion.
• To note the station of the head in relation to ischial
spines.
• Color of the liquor(if membranes are ruptured)
• Degree of molding of the head (occurs at junction
of occipitoparietal bones)
• Caput formation- progressive increase is more imp.
21. CEPHALOPELVIC DISPROPORTION(CPD)
• Refers to the disproportion b/w the head of the
baby & the mother’s pelvis.
• Occurs if fetal head is too large or mother’s pelvis is
small.
• Causes of complications like:
a)prolonged labor
b)fetal distress
c)delayed second stage
22. EVIDENCE OF MATERNAL
DISTRESS
• Anxious look with sunken eyes.
• Dehydration ,dry tongue.
• Acetone smell in breath.
• Rising pulse rate.(100/minute or more)
• Hot,dry vagina with offensive discharge.
• Scanty high colored urine with presence of
acetone.
23. EVIDENCE OF FETAL DISTRESS
• Passage of meconium (fetal stool) in the
liquor amnii.
• Increase in FHR (160/min) or Decrease
to less than 110/min.
• FHR takes long time to come back to
normal.
• Irregularity