Overview
While it takes nine months to grow a full-term baby, labor and delivery occurs in a matter of days or even hours. However, it’s the process of labor and delivery that tends to occupy the minds of expectant parents the most.
Read on if you have questions and concerns around the signs and length of labor, and how to manage pain.
Signs of labor
Labor has started or is coming soon if you experience symptoms such as:
increased pressure in the uterus
a change of energy levels
a bloody mucus discharge
Real labor has most likely arrived when contractions become regular and are painful.
Braxton Hicks contractions
Many women experience irregular contractions sometime after 20 weeks of pregnancy. Known as Braxton Hicks contractions, they’re typically painless. At most, they’re uncomfortable and are irregular.
Braxton Hicks contractions can sometimes be triggered by an increase in either mother or baby’s activity, or a full bladder. No one fully understands the role Braxton Hicks contractions play in pregnancy.
They may promote blood flow, help maintain uterine health during the pregnancy, or prepare the uterus for childbirth.
Braxton Hicks contractions don’t cause the cervix to dilate. Painful or regular contractions aren’t likely to be Braxton Hicks. Instead, they’re the type of contractions that should lead you to call your doctor.
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.
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.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Normal labor usually begins within 2 weeks (before or after) the estimated delivery date. In a first pregnancy, labor usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours.
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.
Irritable bowel syndrome is a common condition affecting the digestive system.
Symptoms of irritable bowel syndrome include stomach cramps, bloating, diarrhoea and constipation. These may come and go over time.
Making changes to your diet and lifestyle, like avoiding things that trigger your symptoms, can help ease irritable bowel syndrome.
blockage or problem in the urinary tract can mean urine is unable to drain from the kidneys or is able to flow the wrong way up into the kidneys. This can lead to a build-up of urine in the kidneys, causing them to become stretched and swollen.
An injury higher on the spinal cord can cause paralysis in most of your body and affect all limbs (tetraplegia or quadriplegia). A lower injury to the spinal cord may cause paralysis affecting your legs and lower body (paraplegia)
Scoliosis is the abnormal twisting and curvature of the spine. It is usually first noticed by a change in appearance of the back. Typical signs include: a visibly curved spine. one shoulder being higher than the other.
Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.
With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.
About 4 out of 5 cases of acute pancreatitis improve quickly and don't cause any serious further problems. However, 1 in 5 cases are severe and can result in life-threatening complications, such as multiple organ failure. In severe cases where complications develop, there's a high risk of the condition being fatal.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Normal Labor and Delivery: Introduction
• Childbirth period from the onset of
regular uterine contractions until expulsion
of the placenta
• Attendants to be supportive of the laboring
woman's needs
Effective pain relief.
• Spontaneous labor and delivery
• Ineffective labor requiring augmentation
• Medical and obstetrical complications
requiring induction of labor
• Cesarean delivery
3. Mechanisms of Labor
Onset of labor, position of the fetus with
respect to the birth canal is critical to the route of
delivery
Fetal Orientation
= Relative to the maternal pelvis is described in
terms of fetal lie, presentation, attitude, and
position
Fetal Lie
= Relation of the fetal long axis to that of the
mother
= Longitudinal, transverse, or oblique
Predisposing factors:
Multiparity, placenta previa,
hydramnios, and uterine anomalies
4. Fetal Presentation
Presenting part
=Portion of the fetal body that is either
foremost within the birth canal or in closest
prox-imity
Felt through the cervix on vaginal examination
Fetal head = cephalic presentations
Breech = breech presentations
Transverse = shoulder is the presenting part
5. Cephalic Presentation
95% of cases
Are classified according to the relationship between the head and body of the
fetus
Vertex or occiput presentation
• Occipital fontanel
• Head is flexed sharply so that the chin is in contact with the thorax
Face presentation
• Neck may be sharply extended so that the occiput and back come in contact,
and the face is foremost in the birth canal
Sinciput presentation
• The fetal head is partially flexed in some cases, with the anterior (large)
fontanel, or bregma
Brow presentation
Fetal head is partially extended
• Sinciput and brow presentations
• Almost always convert into vertex or face presentations by neck flexion or
extension
6.
7. Breech Presentation
=Fetus often changes polarity to make use of the roomier fundus for its
bulkier and more mobile podalic pole
• Three general configurations:
1. Frank= thighs flexed, legs extended over anterior surface of the body
2. Complete = thighs flexed, legs flexed upon thighs
3. Footling/ Incomplete = one or both feet or one or both knees maybe
lowermost
8.
9. Fetal attitude or posture or habitus
• As a rule, the fetus forms an ovoid mass that
corresponds roughly to the shape of the uterine cavity
10. Fetal Position
• Position refers to the relationship of an arbitrary chosen
portion of the fetal presenting part to the right or left side
of the birth canal
• Approximately two thirds of all vertex presentations are in
the left occiput position, and one third in the right
11. Diagnosis of Fetal Presentation and
Positions
• Several methods can be used to diagnose fetal
presentation and positions
• These include abdominal palpation, vaginal examination,
auscultation, and, in certain doubtful cases, sonography.
• Occasionally plain radiographs, computed tomography or
MRI may be used
13. L1 fundal grip
• Cephalic or podalic pole
• The breech gives the sensation of a large, nodular mass
• Head feels hard and round and is more mobile and
ballotable
14. L2 umbilical grip
• Palms are placed on either side of the maternal
abdomen, and gentle but deep pressure is exerted
• The back-a hard, resistant structure is felt
• The fetal extremities- numerous small, irregular, mobile
parts are felt
15. L3 pawlik’s grip
• Grasping with the thumb and fingers of one hand and
lower portion of the maternal abdomen just above the
symphysis pubis
16. L4 pelvic grip
• The examiner faces the mother’s feet and, with the tips of
the first three fingers of each hand, exerts deep pressure
in the direction of the axis of the pelvic inlet
• Flexion-same as the fetal parts
• Extension-same as the fetal back
17. Four Phases of Parturition
• Phase 0 (prelude to parturition Quiescence)
– Time of contractile tranquility and uterine unresponsiveness
– Before implantation until about 35-38 weeks
– Progesterone: principal mediator
– Cervix: remains rigid and unyielding
18. • PHASE 1 (Preparation for labor)
– Uterus and cervix undergo anatomic and functional changes:
• Increase oxytocin receptors in myometrial cells, inc. number and size
of gap junctions, inc. responsiveness to uterotonins, inc frequency of
painless contractions
– Dependent on uterotonins or uterotropin-stimulating agents
– Cervix ripens: soften, yield and more readily dilatable
19. • PHASE 2(Process of Labor)
– Active uterine contractions brings about cervical effacement
and dilatation, fetal descent and delivery
20. • PHASE 3(Recovery period)
– Uterine contraction and involution to prevent hemorrhage
– Initiation of lactation and milk ejection for breastfeeding
– Regulators: uterotonins(oxytocin and endothelin-1)
21. EARLY SIGNS OF LABOR
1. “Lightening” or “Baby Drop”
- dec. fundic ht due to formation of lower uterine segment allowing fetal
head to descend and dec. in amount of AF
2. “show” or “Bloody show”
- small amount of blood-tinged mucus from vagina
-considered a late sign because labor may ensue in the next few hrs or
days or at times labor has begun.
3. False labor
- contractions of irregular interval, shorter duration, and discomfort,
confined to the lower abdomen or groin.
22. DEGREE OF EFFACEMENT
• Synonymous to “obliteration” or “taking up” of the cervix
• Shortening of the cervical canal from length of about 2cm to a
circular orifice of paper-thin edges(100% effaced)
• Upward pulling of muscular fibers of internal os while the external
os remains temporarily unchanged
• No fetal descent occurs but the presenting part descends
23.
24. STATION
• Refers to the level to which the fetal presenting part has
descended into the maternal pelvis
• Point of reference is ischial spine: station 0
• From the ischial spine up: station -1 to -3
• From the ischial spine down: station +1 to +3
• Progressive dilatation with no change in station in woman of low
parity may signify fetopelvic disproportion
25. CERVICAL DILATATION
• Degree of opening of the external os
• True indicator of labor
• Examining fingers are swept from one margin of the
cervix to the other: max. diameter is 10cm approx 5 finger
width
26. PATTERN OF CERVICAL DILATATION
• 2 PHASES:
– 1. LATENT PHASE(0-3cm)
• Begins when mother perceives regular contraction
• 8-12hrs with irregular contactions(every 5-30mins and lasts 30sec
– 2. ACTIVE PHASE(starts at 4cm dilatation to 7cm)
• Lasts 3-5hrs with regular contactions(every 3-5 mins and lasts 1min
or more
a. Acceleration phase
-predictive of the outcome of a particular labor
b. Phase of maximum slope
-measure of the overall efficiency
a. Deceleration phase
3. Transition phase(8-10cms)
- primipara 3.6hrs
- multipara variable
- uterine contractiom every 1 and half-2 min, 60-90 sec.
moderate-strong
27. Second stage(pushing)
Complete dilatation 10cm) to delivery of fetus
• Primipara: 60 mins
• Multipara: 30mins
• Affected by epidural anesthesia, maternal pushing, position of presenting
part, size of pelvis
3 P’s
1. Power – forceful uterine contractions
2. Passenger – fetus
3. Passage – Route of fetus through Bony Pelvis
28. a. Delivery of the head
• Crowning- fetal head is seen encircled by the vulvar ring;
episiotomy prevents perineal lacerations
b. Ritgen’s maneuver
• Contols delivery of the head with extension so that
smallest diameters of the head pass over the introitus
• When the vulvar opening reaches a diameter of 5cm, a
towel draped-hand should be used to exert forward
pressure on the chin of the fetus through the perineum
• Other hand placed on the occiput
• Prevents extension of episiotomy
c. Nasopharyngeal toilette
• After delivery of the head, the face of the fetus is wiped and the
nares and throat quickly suctioned
• To prevent aspiration of amniotic fluid and blood
d. Nuchal cord care
29. Third Stage
Delivery of fetus to deliver of placenta
Usually within 5 mins after delivery of fetus(may be upto
30mins). Retained after 30mins
30. Fourth stage
• Adaptation to blood loss
• Start of uterine involution(returning to prepregnant state
31. Patterns of descent
• Active descent takes place when the cervical dilatation
has already advanced but the maximum slope of descent
occurs during the maximum slope of cervical dilatation
32. Three functional divisions of labor
• 1. Preparatory division
– Little cervical dilatation; affected by sedation
2. Dilatational division
- Dilatation occurs at its most rapid rate
- Unaffected by sedation or conduction analgesia
3. Pelvic division
- Starts at deceleration phase of cervical dilatation
- Cardinal movements of the fetus takes place
33. WHO PRINCIPLES OF PARTOGRAPH
a. Active phase of labor begins at 4cm cervical dilatation
b. Latent phase of labor should last longer than 8 hrs
c. Rate of cervical dilatation during the active phase of labor should not be
slower than 1cm/hr
d. 4-hour lag between slowing of labor and the need for intervention is
unlikely to compromise the fetus
e. 4 hourly vaginal examination is recommended
34. The cardinal movements of labor
• Engagement, descent, flexion, internal rotation,
extension, external rotation and expulsion
35. engagement
• The mechanism by which the biparietal diameter,
average from 9.5 to as much as 9.8cm-the greatest
transverse diameter in an occiput presentation—passes
through the pelvic inlet in designated.
36. Descent
• This movement is the first requisite for birth of the
newborn
• In nulliparas, engagement may take place before the
onset of labor, and futher descent may not follow until
the onset of the second stage
• In multiparous women, descent usually begins with
engagement
• Descent is brought about by one or more of four forces:
1. pressure of the amniotic fluid
2. direct pressure of the fundus upon the breech
with contractions
3. bearing-down efforts of maternal abdominal
muscles
4. extension and straightening of the fetal body
37. Flexion
• As soon as the descending head meets
resistance whether from the cervix, walls
of the pelvis, or pelvic floor, then flexion of
the head normally results.
• In the movement, the chin is brought into
more intimate contact with the fetal thorax,
and the appreciably shorter
suboccipitobregmatic diameter is
substituted for the longer occipitofrontal
diameter
38. Internal rotation
• Two thirds, internal rotation is completed by the time the head reaches the
pelvic floor
• In about another fourth, internal rotation is completed very shortly after the
head reaches the pelvic floor
• And in the remaining 5%, anterior rotation does not take place
• When the fetal head fails to turn until reaching the pelvic floor, it typically
rotates during the next one or two contractions in multiparas. In nullipara,
rotation usually occurs during the next three to 5 contractions
39. Extension
• The first force, exerted by the uterus, acts more
posteriorly, and the second, supplied by the resistant
pelvic floor and the symphysis, acts more anteriorly. The
resultant vector is in the direction of the vulvar opening,
thereby causing head extension.
• This brings the base of the occiput into direct contact with
the inferior margin of the symphysis pubis
40. External rotation
• The delivered head next undergoes restitution.
• If the occiput was originally directed toward the left, it
rotates toward the left ischial tuberosity.
41. Expulsion
• Almost immediately after external rotation, the anterior
shoulder appears under the symphysis pubis, and the
perineum soon becomes distended by the posterior
shoulder.
• After delivery of the shoulders, the rest of the body
quickly passes.
42. Mechanisms of Labor with Occiput
Posterior Presentation
• In approximately 20 percent of labors, the fetus enters the pelvis
in an occiput posterior (OP) position.
• The right occiput posterior (ROP) is slightly more common than
the left (LOP)
• It appears likely from radiographic evidence that posterior
positions are more often associated with a narrow forepelvis.
• They also are more commonly seen in association with anterior
placentation
43. Changes in Shape of the Fetal Head
• Caput Succedaneum
• In prolonged labors before complete cervical dilatation,
the portion of the fetal scalp immediately over the cervical
os becomes edematous. This swelling known as the
caput succedaneum.
44. Molding
• The change in fetal head shape from external
compressive forces is referred to as molding.
• Most studies indicate that there is seldom overlapping of
the parietal bones. A "locking" mechanism at the coronal
and lambdoidal connections actually prevents such
overlapping
45. DIFFERENTIATION OF LABOR
PARAMETER FALSE LABOR TRUE LABOR
CONTRACTION
REGULARITY
INTERVAL
INTENSITY
Irregular
Long, may disappear
Unchanged
Regular
Increase gradually
Increase gradually
Radiation of pain Mostly hypogastric Hypogastic to
lumbosacral
Effect dilatation Long and closed Open and effacing
Effect effacement Does not occur Occurs and progresses
Effect of sedation May stop contraction Not stopped
46. Spontaneous Delivery:
• Crowning- encirclement of the largest head diameter by the vulvar
ring
• Episiotomy- increased risk of a tear into the external anal sphincter
and or rectum.
• Anterior tears in the urethra and vulva are common in women
without episiotomy.
RITGEN MANEUVER- forward pressure of the chin
• allow control of the delivery of the head
• favors extension.
47. PLACENTAL SEPARATION:
• results primarily from a disproportion created between the
unchanged size of the placenta and the reduced size of
the underlying Implantation site.
• Formation of a hematoma between the separating
placenta and the remaining deciduas is the result of the
separation. It can accelerate the process of cleavage.
48. Signs of Placenta Separation:
• 1. Change in the shape of the uterus becoming globular
and firmer (Calkin’s Sign)
• 2. Sudden gush of blood
• 3. Uterus rises in the abdomen
• 4. lengthening of the cord
49. • Mechanism:
• SHULTZ – blood from the placenta site pours into the
inverted sac, not escaping externally until after extrusion
of the placenta.
• Duncan- Separation of the placenta occurs first at the
periphery; blood collects between the membranes and
the uterine wall and escapes from the vagina.
50. LACERATION OF BIRTH CANAL:
• First degree= fourchette, perineal skin, and vaginal
mucous membrane but not the underlying fascia and
muscle.
• Second degree- fascia and muscle of the perineal body
but not the anal sphincter.
• Third degree- includes anal sphincter
• Fourth- rectal mucosa.
51. EPISIOTOMY TYPES:
midline mediolateral
• Surgical repair Easy More difficult
• Faulty Healing Rare More common
• Post OP pain Minimal Common
• Anatomical Results Excellent Occ faulty
• Blood loss Less More
• Dyspareunia Rare Occasional
• Extension common uncommon
52.
53. Suturing technique
• Vaginal mucosa – interlocking sutures until lower end of
hymenal ring; start 1cm above angle of mucosal defect
• Subcutaneous and fascial layers – interrupted sutures
• Skin – interrupted or subcuticular sutures