This document discusses labour and its stages. Labour is defined as the process by which uterine contractions bring about cervical dilation and effacement, resulting in delivery of the fetus and placenta. It has three components: the passenger (fetus), the passageway (birth canal), and the power (uterine contractions). Labour normally occurs between 37-42 weeks and has three stages: 1) cervical dilation from 0-10cm, 2) delivery of the fetus, 3) delivery of the placenta. The first stage has latent and active phases, and factors like contractions and fetal position affect dilation. The second stage involves descent and rotation of the fetus for delivery.
This document provides an overview of normal labor, including its definition, physiology, mechanisms, and management. Labor is defined as the process of expelling the fetus from the uterus to the outside world, characterized by uterine contractions, cervical effacement and dilation, and bloody show. The physiology of labor involves hormonal and mechanical factors that work to initiate contractions. Labor progresses through three stages - first stage from onset to full dilation, second stage from full dilation until delivery, and third stage from delivery until delivery of the placenta. Management of normal labor includes monitoring contractions, fetal heart rate, cervical changes, and vital signs at regular intervals through each stage.
1) Normal labour is defined as spontaneous onset of labour at term, with a vertex presentation and natural termination with minimal intervention.
2) It involves three stages: first stage of cervical dilation from 0-10cm; second stage of fetal expulsion; third stage of placental delivery.
3) The first stage has two phases - a latent phase of slow dilation to 3-4cm and an active phase of rapid dilation to 10cm. It is influenced by uterine contractions, membrane status, and fetal position.
This document discusses various abnormalities that can occur during labour and delivery, categorized as abnormalities of the power (uterine contractility), abnormalities involving the passenger (fetus), or abnormalities of the passage (pelvis). It provides details on specific issues like uterine dysfunction, fetopelvic disproportion, abnormal fetal presentations (breech, transverse lie), prolapsed umbilical cord, and shoulder dystocia. Management strategies are discussed for each abnormality, including oxytocin use, operative vaginal delivery, and Caesarean section when appropriate. The goal is to identify abnormalities early to guide management and prevent adverse maternal-fetal outcomes from difficult labor.
Abnormal labor or dystocia can be caused by problems with uterine contractions (uterine dysfunction), issues with the baby's size or position (fetopelvic disproportion), or a narrow pelvis (contracted pelvis). Common types include protracted or arrested dilation, shoulder dystocia, and breech presentation. Obstructed labor occurs when progress stalls despite adequate contractions, typically due to a mechanical obstruction, and can lead to serious maternal complications if not addressed. Management may involve resuscitation, expedited delivery depending on fetal/maternal status, and transfer to a higher level facility for those in advanced labor.
This document discusses pelvic organ prolapse (POP). It defines POP as the herniation of pelvic organs into or beyond the vaginal walls. POP can occur in the anterior, posterior, apical, or total compartments. Risk factors include vaginal childbirth, advancing age, obesity, and connective tissue disorders. Clinically, POP presents with a feeling of pressure or fullness in the pelvis. Examination involves quantifying the degree of prolapse. Conservative management includes pelvic floor exercises while surgical options depend on the compartment involved. The document provides details on POP etiology, clinical assessment, differential diagnosis, and treatment approaches.
The document discusses various types of abnormal uterine action during labor including inefficient contractions, hyperactive contractions, and abnormal patterns of contraction. Specific conditions like uterine inertia, hypertonic uterus, constriction rings, and cervical dystocia are described along with their causes, clinical features, and management. Overall the document provides an overview of deviations from normal uterine function during labor and delivery.
Caesarean section is the delivery of a baby through surgical incisions in the mother's abdomen and uterus. It can be performed as an emergency procedure if there are threats to the mother or baby, or electively if there are risk factors present but no urgency. The most common reasons for C-section are prior C-section, non-progressing labor, abnormal fetal position, and fetal distress. Regional anesthesia is preferred to allow the mother to experience childbirth while remaining safe. The surgery involves making incisions in the abdomen and lower uterine segment to deliver the baby and placenta, followed by closure of the incisions. Complications can include hemorrhage, infection, and injury to nearby organs, but with
This document provides an overview of normal labor, including its definition, physiology, mechanisms, and management. Labor is defined as the process of expelling the fetus from the uterus to the outside world, characterized by uterine contractions, cervical effacement and dilation, and bloody show. The physiology of labor involves hormonal and mechanical factors that work to initiate contractions. Labor progresses through three stages - first stage from onset to full dilation, second stage from full dilation until delivery, and third stage from delivery until delivery of the placenta. Management of normal labor includes monitoring contractions, fetal heart rate, cervical changes, and vital signs at regular intervals through each stage.
1) Normal labour is defined as spontaneous onset of labour at term, with a vertex presentation and natural termination with minimal intervention.
2) It involves three stages: first stage of cervical dilation from 0-10cm; second stage of fetal expulsion; third stage of placental delivery.
3) The first stage has two phases - a latent phase of slow dilation to 3-4cm and an active phase of rapid dilation to 10cm. It is influenced by uterine contractions, membrane status, and fetal position.
This document discusses various abnormalities that can occur during labour and delivery, categorized as abnormalities of the power (uterine contractility), abnormalities involving the passenger (fetus), or abnormalities of the passage (pelvis). It provides details on specific issues like uterine dysfunction, fetopelvic disproportion, abnormal fetal presentations (breech, transverse lie), prolapsed umbilical cord, and shoulder dystocia. Management strategies are discussed for each abnormality, including oxytocin use, operative vaginal delivery, and Caesarean section when appropriate. The goal is to identify abnormalities early to guide management and prevent adverse maternal-fetal outcomes from difficult labor.
Abnormal labor or dystocia can be caused by problems with uterine contractions (uterine dysfunction), issues with the baby's size or position (fetopelvic disproportion), or a narrow pelvis (contracted pelvis). Common types include protracted or arrested dilation, shoulder dystocia, and breech presentation. Obstructed labor occurs when progress stalls despite adequate contractions, typically due to a mechanical obstruction, and can lead to serious maternal complications if not addressed. Management may involve resuscitation, expedited delivery depending on fetal/maternal status, and transfer to a higher level facility for those in advanced labor.
This document discusses pelvic organ prolapse (POP). It defines POP as the herniation of pelvic organs into or beyond the vaginal walls. POP can occur in the anterior, posterior, apical, or total compartments. Risk factors include vaginal childbirth, advancing age, obesity, and connective tissue disorders. Clinically, POP presents with a feeling of pressure or fullness in the pelvis. Examination involves quantifying the degree of prolapse. Conservative management includes pelvic floor exercises while surgical options depend on the compartment involved. The document provides details on POP etiology, clinical assessment, differential diagnosis, and treatment approaches.
The document discusses various types of abnormal uterine action during labor including inefficient contractions, hyperactive contractions, and abnormal patterns of contraction. Specific conditions like uterine inertia, hypertonic uterus, constriction rings, and cervical dystocia are described along with their causes, clinical features, and management. Overall the document provides an overview of deviations from normal uterine function during labor and delivery.
Caesarean section is the delivery of a baby through surgical incisions in the mother's abdomen and uterus. It can be performed as an emergency procedure if there are threats to the mother or baby, or electively if there are risk factors present but no urgency. The most common reasons for C-section are prior C-section, non-progressing labor, abnormal fetal position, and fetal distress. Regional anesthesia is preferred to allow the mother to experience childbirth while remaining safe. The surgery involves making incisions in the abdomen and lower uterine segment to deliver the baby and placenta, followed by closure of the incisions. Complications can include hemorrhage, infection, and injury to nearby organs, but with
This document summarizes abnormal labor and dystocia. It defines difficult labor as abnormal slow progress and lists the main indications as prolonged latent phase, protraction disorders of the active phase, and arrest disorders of the active phase. It evaluates labor based on cervical dilation and fetal descent, using Friedman's curve as a guideline. It then describes the main types of abnormal labor patterns and dystocia, which can be due to abnormalities of power (uterine dysfunction), passage (pelvic abnormalities), or passenger (fetal malpositions and sizes).
Obstructed labour occurs when the vaginal delivery of the fetus is arrested due to a mechanical obstruction. It can be caused by maternal factors like a contracted pelvis or fetal macrosomia. Diagnosis involves a clinical examination showing signs of maternal distress, frequent contractions with no relaxation, and an inability to feel or engage the fetal presenting part. Management involves preventative measures and early detection of potential obstructions, as well as curative measures like caesarean section to immediately terminate labour and prevent complications like rupture of the uterus.
Uterine prolapse was first documented in ancient Egypt. The first successful vaginal hysterectomy to treat uterine prolapse was self-performed in 1670. Pelvic organ prolapse has a lifetime risk of around 11% requiring surgery. The uterus is normally supported by the endopelvic fascia, ligaments, and pelvic floor muscles. Prolapse can involve the bladder, uterus, rectum, or vagina descending from their normal positions. Conservative treatment includes pessaries while surgical repair is also used to manage uterine prolapse.
Labour is the process by which the fetus and placenta are expelled from the uterus through the birth canal. It involves involuntary uterine contractions that cause effacement and dilation of the cervix, allowing the fetus to descend and be delivered. Normal labour has three stages - the first stage involves cervical dilation, the second stage is expulsion of the fetus, and the third stage is expulsion of the placenta. Multiple factors influence the progress of labour, including the size and position of the fetus, strength of uterine contractions, and psychological state of the mother.
This document discusses various types of genital tract injuries that can occur during childbirth, including classifications and causes. It describes perineal trauma such as perineal tears of different degrees, obstetric anal sphincter injuries, and injuries to other parts of the genital tract. The document also discusses prevention and management of these injuries, as well as other complications during childbirth like ruptured uterus, cervical tears, and fistulas.
Induction of labour involves artificially initiating uterine contractions in a quiescent uterus prior to spontaneous labour. It requires an indication and favourable cervical conditions. The document discusses evaluating maternal and fetal conditions before induction, WHO recommendations, indications and contraindications. It also discusses risks of induction like increased caesarean rates. Methods of cervical ripening discussed include membrane stripping, hygroscopic dilators, prostaglandins and balloon devices. Having an unfavourable cervix requires ripening to improve outcomes of labour induction.
Uterine prolapse occurs when the uterus descends from its normal position due to weakened pelvic muscles and tissues. It is often caused by pregnancy, childbirth, obesity, menopause, or chronic conditions like coughing or constipation. Symptoms range from a feeling of heaviness to organs protruding from the vagina. Treatment options include pelvic floor exercises, pessaries, hormone therapy, and surgery to repair damaged tissues or remove the uterus. Surgical risks include infection, incontinence, and prolapse recurrence.
This document discusses unstable lie, which occurs when the fetal lie repeatedly changes beyond 36 weeks of gestation. It lists the main causes as maternal factors like multiparity or uterine abnormalities, and fetal factors such as polyhydramnioas or abnormalities. The assessment involves taking a history, examining the patient, and conducting an ultrasound to check the fetal lie, pelvic structures, and placenta. Management options are expectant monitoring for a longitudinal lie, or active management like c-section if the cause is found or risks of obstructed labor are present. The risk of non-longitudinal lie at labor is obstructed labor and potential uterine rupture.
This document discusses induction of labor. It begins by defining induction of labor and listing its objectives. It then covers the indications and contraindications for induction, including maternal and fetal indications. It describes methods of induction, including natural non-medical methods, mechanical methods like hygroscopic dilators and balloon catheters, surgical methods like membrane stripping and amniotomy, and pharmacological methods using prostaglandins, misoprostol, mifepristone, and oxytocin. It provides details on techniques and risks of different methods. It emphasizes monitoring during inductions and lists side effects of pharmacological agents. The overall document is a guide for health professionals on selecting and performing appropriate induction methods for individual patients.
Vaginal delivery
DescriptionA vaginal delivery is the giving birth to offspring in mammals through the vagina. It is the natural method of birth for all mammals except monotremes, which lay eggs into the external environment.
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
The document discusses the normal puerperium period following childbirth. It defines key terms like puerperium, involution, lochia, lactation, and others. It describes the physiological changes that occur in the reproductive system like the involution of the uterus returning to its pre-pregnancy size over 6 weeks and changes in the cervix, ovaries, and vaginal canal. It also discusses general physiological changes like changes in pulse, temperature, the urinary tract, and gastrointestinal tract. Blood values and the return of menstruation and ovulation are also summarized.
This document discusses genitourinary fistulas, including their classification, causes, symptoms, investigations, management, and prevention. The main types of fistulas are vesicovaginal, urethrovaginal, and ureterovaginal. Obstetric causes like obstructed labor are common in developing countries, while surgical trauma is more common in developed countries. Symptoms include continuous urine leakage. Investigations include dye tests and imaging. Management depends on the fistula type and complexity, and may involve surgical repair techniques like saucerization. Prevention focuses on adequate obstetric and surgical care to avoid injury.
This document contains notes from Mariechen Puchert's second year of study related to obstetrics and gynaecology. It covers topics such as failure to progress in labour, caesarean section, genital injuries, episiotomy, uterine rupture, induction of labour, instrumental delivery, and preterm labour. For each topic, it lists various causes, indications, contraindications, complications and management techniques.
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
Normal labour is defined as spontaneous onset at term, with a single vertex fetus and no complications. Labour progresses through three stages: cervical dilation, birth of fetus, and delivery of placenta. Cervical dilation occurs in latent and active phases, with the active phase involving accelerated, maximum, and decelerated dilation. Uterine contractions and retraction of the upper uterine segment apply force to dilate the cervix around the presenting fetal part. Moulding of the fetal skull allows adaptation to the pelvis during birth.
Caesarean section is a surgical procedure used to deliver babies through incisions in the abdominal wall and uterus. It is performed when vaginal delivery would put the mother or baby's health at risk. The document discusses the history of c-sections and various techniques for performing them, including types of incisions, anesthesia methods, and post-operative care recommendations. Key aspects are a lower transverse uterine incision, controlled cord traction to deliver the placenta, a two-layer closure of the uterine incision, and facilitating early skin-to-skin contact between mother and baby.
The document discusses human embryology and development from fertilization through the prenatal period. It describes the major stages and events of embryogenesis including cleavage, blastocyst formation, implantation, gastrulation which establishes the three germ layers, and the formation of extraembryonic membranes and placenta. The embryonic period is outlined where the main organ systems develop by week 8. Gametogenesis and the processes of oogenesis and spermatogenesis which produce eggs and sperm are also summarized.
The document outlines how to take a gynaecological history using the ABCD(I)F framework and how to perform a full gynaecological examination, including abdominal palpation, speculum examination of the vagina and cervix, and bimanual palpation of the uterus and adnexa. It also provides guidance on asking targeted questions regarding specific complaints like bleeding, pain, discharge, incontinence, and fertility. The goal is to obtain all relevant information from the history and physical exam in order to generate a differential diagnosis and plan appropriate next steps like labs, imaging, or procedures.
This document summarizes abnormal labor and dystocia. It defines difficult labor as abnormal slow progress and lists the main indications as prolonged latent phase, protraction disorders of the active phase, and arrest disorders of the active phase. It evaluates labor based on cervical dilation and fetal descent, using Friedman's curve as a guideline. It then describes the main types of abnormal labor patterns and dystocia, which can be due to abnormalities of power (uterine dysfunction), passage (pelvic abnormalities), or passenger (fetal malpositions and sizes).
Obstructed labour occurs when the vaginal delivery of the fetus is arrested due to a mechanical obstruction. It can be caused by maternal factors like a contracted pelvis or fetal macrosomia. Diagnosis involves a clinical examination showing signs of maternal distress, frequent contractions with no relaxation, and an inability to feel or engage the fetal presenting part. Management involves preventative measures and early detection of potential obstructions, as well as curative measures like caesarean section to immediately terminate labour and prevent complications like rupture of the uterus.
Uterine prolapse was first documented in ancient Egypt. The first successful vaginal hysterectomy to treat uterine prolapse was self-performed in 1670. Pelvic organ prolapse has a lifetime risk of around 11% requiring surgery. The uterus is normally supported by the endopelvic fascia, ligaments, and pelvic floor muscles. Prolapse can involve the bladder, uterus, rectum, or vagina descending from their normal positions. Conservative treatment includes pessaries while surgical repair is also used to manage uterine prolapse.
Labour is the process by which the fetus and placenta are expelled from the uterus through the birth canal. It involves involuntary uterine contractions that cause effacement and dilation of the cervix, allowing the fetus to descend and be delivered. Normal labour has three stages - the first stage involves cervical dilation, the second stage is expulsion of the fetus, and the third stage is expulsion of the placenta. Multiple factors influence the progress of labour, including the size and position of the fetus, strength of uterine contractions, and psychological state of the mother.
This document discusses various types of genital tract injuries that can occur during childbirth, including classifications and causes. It describes perineal trauma such as perineal tears of different degrees, obstetric anal sphincter injuries, and injuries to other parts of the genital tract. The document also discusses prevention and management of these injuries, as well as other complications during childbirth like ruptured uterus, cervical tears, and fistulas.
Induction of labour involves artificially initiating uterine contractions in a quiescent uterus prior to spontaneous labour. It requires an indication and favourable cervical conditions. The document discusses evaluating maternal and fetal conditions before induction, WHO recommendations, indications and contraindications. It also discusses risks of induction like increased caesarean rates. Methods of cervical ripening discussed include membrane stripping, hygroscopic dilators, prostaglandins and balloon devices. Having an unfavourable cervix requires ripening to improve outcomes of labour induction.
Uterine prolapse occurs when the uterus descends from its normal position due to weakened pelvic muscles and tissues. It is often caused by pregnancy, childbirth, obesity, menopause, or chronic conditions like coughing or constipation. Symptoms range from a feeling of heaviness to organs protruding from the vagina. Treatment options include pelvic floor exercises, pessaries, hormone therapy, and surgery to repair damaged tissues or remove the uterus. Surgical risks include infection, incontinence, and prolapse recurrence.
This document discusses unstable lie, which occurs when the fetal lie repeatedly changes beyond 36 weeks of gestation. It lists the main causes as maternal factors like multiparity or uterine abnormalities, and fetal factors such as polyhydramnioas or abnormalities. The assessment involves taking a history, examining the patient, and conducting an ultrasound to check the fetal lie, pelvic structures, and placenta. Management options are expectant monitoring for a longitudinal lie, or active management like c-section if the cause is found or risks of obstructed labor are present. The risk of non-longitudinal lie at labor is obstructed labor and potential uterine rupture.
This document discusses induction of labor. It begins by defining induction of labor and listing its objectives. It then covers the indications and contraindications for induction, including maternal and fetal indications. It describes methods of induction, including natural non-medical methods, mechanical methods like hygroscopic dilators and balloon catheters, surgical methods like membrane stripping and amniotomy, and pharmacological methods using prostaglandins, misoprostol, mifepristone, and oxytocin. It provides details on techniques and risks of different methods. It emphasizes monitoring during inductions and lists side effects of pharmacological agents. The overall document is a guide for health professionals on selecting and performing appropriate induction methods for individual patients.
Vaginal delivery
DescriptionA vaginal delivery is the giving birth to offspring in mammals through the vagina. It is the natural method of birth for all mammals except monotremes, which lay eggs into the external environment.
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
The document discusses the normal puerperium period following childbirth. It defines key terms like puerperium, involution, lochia, lactation, and others. It describes the physiological changes that occur in the reproductive system like the involution of the uterus returning to its pre-pregnancy size over 6 weeks and changes in the cervix, ovaries, and vaginal canal. It also discusses general physiological changes like changes in pulse, temperature, the urinary tract, and gastrointestinal tract. Blood values and the return of menstruation and ovulation are also summarized.
This document discusses genitourinary fistulas, including their classification, causes, symptoms, investigations, management, and prevention. The main types of fistulas are vesicovaginal, urethrovaginal, and ureterovaginal. Obstetric causes like obstructed labor are common in developing countries, while surgical trauma is more common in developed countries. Symptoms include continuous urine leakage. Investigations include dye tests and imaging. Management depends on the fistula type and complexity, and may involve surgical repair techniques like saucerization. Prevention focuses on adequate obstetric and surgical care to avoid injury.
This document contains notes from Mariechen Puchert's second year of study related to obstetrics and gynaecology. It covers topics such as failure to progress in labour, caesarean section, genital injuries, episiotomy, uterine rupture, induction of labour, instrumental delivery, and preterm labour. For each topic, it lists various causes, indications, contraindications, complications and management techniques.
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
Normal labour is defined as spontaneous onset at term, with a single vertex fetus and no complications. Labour progresses through three stages: cervical dilation, birth of fetus, and delivery of placenta. Cervical dilation occurs in latent and active phases, with the active phase involving accelerated, maximum, and decelerated dilation. Uterine contractions and retraction of the upper uterine segment apply force to dilate the cervix around the presenting fetal part. Moulding of the fetal skull allows adaptation to the pelvis during birth.
Caesarean section is a surgical procedure used to deliver babies through incisions in the abdominal wall and uterus. It is performed when vaginal delivery would put the mother or baby's health at risk. The document discusses the history of c-sections and various techniques for performing them, including types of incisions, anesthesia methods, and post-operative care recommendations. Key aspects are a lower transverse uterine incision, controlled cord traction to deliver the placenta, a two-layer closure of the uterine incision, and facilitating early skin-to-skin contact between mother and baby.
The document discusses human embryology and development from fertilization through the prenatal period. It describes the major stages and events of embryogenesis including cleavage, blastocyst formation, implantation, gastrulation which establishes the three germ layers, and the formation of extraembryonic membranes and placenta. The embryonic period is outlined where the main organ systems develop by week 8. Gametogenesis and the processes of oogenesis and spermatogenesis which produce eggs and sperm are also summarized.
The document outlines how to take a gynaecological history using the ABCD(I)F framework and how to perform a full gynaecological examination, including abdominal palpation, speculum examination of the vagina and cervix, and bimanual palpation of the uterus and adnexa. It also provides guidance on asking targeted questions regarding specific complaints like bleeding, pain, discharge, incontinence, and fertility. The goal is to obtain all relevant information from the history and physical exam in order to generate a differential diagnosis and plan appropriate next steps like labs, imaging, or procedures.
An obstetric physical examination involves a full examination of the pregnant woman, including abdominal and pelvic examinations. The abdominal examination assesses the size, shape, and position of the uterus to determine information like fetal presentation, position, and lie. The pelvic examination allows assessment of cervical dilation, effacement, and fetal station and engagement. Together these examinations provide important information about the fetus and progress of the pregnancy or labor.
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
This document discusses the skeletal system and bone structure. It covers the following key points:
1. The skeletal system includes bones, cartilage, ligaments and other connective tissues that support the body, protect organs, allow for movement, store minerals, and form blood cells.
2. There are three main types of cartilage - hyaline, fibrocartilage, and elastic cartilage - which provide support, allow for gliding, and serve as models for bone formation.
3. Bones have two types of tissue - compact bone and spongy bone. Long bones like the femur have a diaphysis, epiphyses, and metaphysis. Bone growth occurs through both interstitial and ap
The document describes several muscles of the human anatomy. It provides details on the origin, insertion, nerve supply and action of muscles like the pectoralis major, latissimus dorsi, trapezius, deltoid, biceps brachii, triceps brachii and various muscles of the forearm. The rotator cuff muscles that stabilize the shoulder joint are also discussed.
This document discusses the skeletal system and its components. It covers the definitions of osteology, arthrology, and the types of cartilage. It describes the functions of the skeletal system which include support, protection, movement, blood cell formation, mineral storage, and serving as an energy reserve. The document outlines the structures of long bones and flat bones. It explains the processes of ossification, including intramembranous ossification and endochondral ossification. In addition, it covers bone cells, bone growth and remodeling, blood supply, and the effects of hormones on bone.
Digestion and absorption review k&m chapter1Pave Medicine
The document summarizes key aspects of digestion and absorption in the gastrointestinal (GI) tract. It describes how the digestive system breaks down food into smaller components through mechanical and enzymatic processes. Nutrients are then absorbed through the walls of the small intestine and transported to the liver and bloodstream. Accessory organs like the pancreas, liver, and gallbladder aid digestion by secreting enzymes and bile.
This document provides an overview of hypertension in pregnancy. It begins with classifications of hypertensive disorders in pregnancy and risk factors. The pathophysiology involves placental insufficiency causing endothelial dysfunction and an imbalance of vasoactive substances. Clinical manifestations involve multiple organ systems due to failure of autoregulation from high blood pressure. Management involves monitoring, prevention of complications, and delivery when indicated to resolve the condition.
This document provides information on the appendicular muscles of the human body. It discusses how these muscles are organized into groups based on their location and the parts of the skeleton they move. The major muscle groups covered include: muscles that move the pectoral and pelvic girdles; muscles that move the arms, forearms, wrists and hands; muscles that move the thighs, hips and legs; and intrinsic hand muscles. For each group, the document identifies specific muscles and their functions, such as flexion, extension, abduction and rotation.
Digestion and absorption review k&m chapter1Pave Medicine
The document discusses the digestive system and process of digestion and absorption. It describes how the digestive system breaks down food into smaller molecules through mechanical and chemical breakdown. Various organs secrete enzymes that break down carbohydrates, proteins, and fats. Nutrients are then absorbed through the small intestine into blood or lymph and transported to the liver and cells. Accessory organs like the pancreas, liver, and gallbladder aid digestion through secretion of enzymes and bile.
This document summarizes the major muscles that move the upper extremities. It describes muscles that move the humerus, including the pectoralis major, latissimus dorsi, deltoid, supraspinatus, infraspinatus, teres minor, and teres major. It also describes muscles that act on the forearm, including the triceps brachii, biceps brachii, brachioradialis, and brachialis. Finally, it summarizes muscles that move the wrist, hand, and digits, such as the palmar and dorsal interosseous muscles, thenar group, and hypothenar group.
Musculoskeletal system – movements of the lower limb technologiesKareem Magar
A teaching resource I created for an assessment for university. It lists all the main movements of the lower limb (hip joint, leg/knee and leg/foot), the muscles associated with each movement and any other relevant information. At the end is a table summarizing all the information in depth, including origin and insertion. Included within the presentation are pictures of every movement and muscle involved, as well as links to useful resources such as a 3D anatomy model.
The document summarizes the major endocrine glands and hormones in the human body. It describes the location and functions of the thyroid gland, parathyroid glands, adrenal glands, pancreas, pineal gland, ovaries, testes, placenta and other minor hormone producing tissues. The key hormones produced by each gland are identified along with their targets and actions in regulating metabolism, growth, development, and other physiological processes throughout the body.
The document summarizes the anatomy and functions of the human digestive system. It describes the locations and roles of the stomach, small intestine, large intestine, and accessory organs like the liver, gallbladder, salivary glands, pancreas, and teeth. The stomach breaks down proteins and empties into the small intestine, where nutrients are absorbed. The large intestine absorbs water and contains bacteria that aid digestion before waste is eliminated. Accessory organs produce enzymes and chemicals that further break down food and aid digestion.
This document discusses the diagnosis and assessment of pregnancy. It outlines common symptoms of pregnancy like missed periods, morning sickness, and breast changes. Physical signs identified on examination include darkened nipples, skin pigmentation, and palpation of the uterus. Tests and calculations, like using the last menstrual period, are described to confirm pregnancy and estimate gestational age. Complications in each trimester are briefly mentioned. Important terms related to the stages and progression of pregnancy are also defined.
Antenatal care and high risk assessment1Pave Medicine
This document contains definitions, guidelines, and recommendations for various aspects of antenatal care. It discusses routine tests and screenings recommended during pregnancy including blood tests, ultrasounds, GBS screening, and tests for conditions like anemia, gestational diabetes, syphilis and HIV. The frequency of antenatal visits is outlined with tests typically done at each visit. Details are provided on assessing gestational age, fetal growth, position and heart rate at appointments.
Labor,labor abnormalities and the partogramPave Medicine
The document defines labor as the progressive dilation of the uterine cervix associated with cervical effacement and descent of the baby's head due to regular uterine contractions. It discusses the factors involved in initiating labor, including influences of the fetal brain and hormones. Abnormalities of labor can occur if there are issues with the power (uterine contractions), passage (maternal pelvis), passenger (fetus), or psychic (maternal mental) components of labor. A partogram is used to monitor the progress of labor by tracking cervical dilation, fetal descent, uterine contractions, and maternal vitals over time.
1. The document provides tips for effective study habits, including using memory aids, reviewing notes daily, planning study time for when most receptive, setting a schedule, setting study goals with a method and schedule, and tips for effective group study and reducing test anxiety.
2. It recommends limiting group study to 4-5 serious students, agreeing on a schedule, and finding an alternative if the group makes one anxious.
3. Tips are given for the night before an exam, including doing something pleasant, avoiding extremely anxious people, settling accounts in advance, and bringing past success to feel positive.
Mechanism of labour and use of partogramPave Medicine
This document discusses the mechanism of labour and use of the partogram. It defines labour as painful, regular uterine contractions that progressively efface and dilate the cervix, causing descent and rotation of the fetal head. The three stages of labour are also described: 1) cervical dilation from 0-10cm, 2) baby being born, 3) delivery of placenta. Key components that aid delivery are contractions of the uterus, the bony pelvis and soft tissues as passages, and the fetus. Progress of labour is tracked using a partogram to monitor cervical dilation and identify any issues requiring action.
Normal labor is defined as the spontaneous expulsion of a full-term, single, vertex-presenting fetus through the birth canal within 18-24 hours without complications for the mother or baby. Labor has three stages: first stage involves cervical dilation, second stage is fetal expulsion, and third stage is placental delivery. Onset is thought to involve hormonal changes like progesterone withdrawal. Contractions cause engagement, flexion, internal rotation, and extension of the fetal head to facilitate delivery. The placenta typically separates via the Schultz mechanism in the third stage.
MECHANISM OF LABOUR (NORMAL and ABNORMAL).pptkderib
This document describes the mechanism of normal labor, including definitions of key terms like labor, delivery, and presentation. It discusses the cardinal movements of labor for vertex presentations, including engagement, descent, flexion, internal rotation, extension, and external rotation. It also describes fetal lie, presentation, attitude, and position. Abnormal mechanisms are briefly mentioned, such as occiput posterior position which can result in failure to rotate and transverse arrest. Overall, the document provides an overview of the normal physiological process and stages of labor.
The document discusses the physiology of labor and pain pathways. It describes the theories behind the onset of labor, including progesterone withdrawal and estrogen stimulation. It outlines the stages of labor and differences between true and false labor. The passage of the fetus through the birth canal involves changes in position called cardinal movements. Factors that can affect labor include the passenger (fetus), passageway (maternal pelvis), and powers (uterine contractions and maternal efforts). Pain in labor is transmitted via neural pathways and can stimulate various physiological responses.
The document discusses normal labor, defining it as the spontaneous expulsion of a single, term fetus through the birth canal within 3-24 hours without complications. It describes the stages and physiology of labor, including the onset of labor, cervical dilation and fetal descent in the first stage, expulsion in the second stage, and placental delivery in the third stage. The summary also covers the diagnosis and management of normal labor.
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. Management of complications during labor requires additional measures (eg, induction of labor.
The first stage of labor involves the dilation of the cervix from 0-10cm as contractions become stronger and more frequent. It is divided into three phases: latent, active, and transitional. Several factors influence the progress of labor including uterine contractions, cervical effacement and dilation, fetal descent, and pressure from amniotic fluid. Monitoring includes regular assessment of maternal and fetal vital signs, uterine contractions, cervical dilation, and fetal heart rate. Natural pain management methods include breathing exercises, hydrotherapy, and doula support.
Normal labour is defined as delivery of a single baby by vertex presentation through the vagina at term, with spontaneous onset and completion within 24 hours, leaving a healthy mother and baby. Labour is caused by hormonal and mechanical factors that lead to cervical dilation and descent and rotation of the fetal head through the birth canal in four stages. The first stage involves cervical dilation. The second stage is the birth of the baby. The third stage is delivery of the placenta, and the fourth involves recovery of the mother. A series of movements including engagement, descent, flexion, internal rotation, and extension help the fetal head navigate the birth canal.
This document discusses the physiology of labor and pain pathways. It covers the stages of labor from early signs through delivery. The four stages are outlined as well as factors that can affect the labor process including the passenger (fetus), passageway (pelvis), and powers (uterine contractions and maternal efforts). Pain in labor is described as having both peripheral and central mechanisms. Visceral pain occurs in the first stage as the cervix dilates while somatic pain in the second stage results from pressure on the pelvic floor. The neural pathways and physiological responses to labor pain are also summarized.
6.Normal Labor,Delivery And The PuerperiumDeep Deep
The document summarizes normal labor, delivery, and the postpartum period. It describes the four main factors that determine labor (contractions, pelvis, fetus, psychology). It then explains the stages of labor and delivery in detail, including first, second and third stages. It discusses management of each stage. It also covers the postpartum period known as the puerperium, including typical uterine bleeding, lactation, and involution over 6 weeks.
The document summarizes key aspects of labor and delivery:
1. The myometrium consists of 4 layers of smooth muscle cells that contract during labor, driven by hormones like oxytocin and prostaglandins, to expel the fetus.
2. Labor progresses through three stages - early labor involving cervical changes, active labor of rapid cervical dilation, and third stage of delivering the placenta.
3. Multiple signs and assessments are used to monitor labor including cervical exams, fetal monitoring, and assessing contractions.
Pathophysiology of Normal Labour by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management and pathophysiology of Normal Labour . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
The document provides an overview of normal labour, including definitions, criteria, components, anatomy, onset, stages, monitoring and management. It defines labour and normal labour. The criteria for normal labour includes spontaneous expulsion of a single, full-term fetus presented by vertex within 3-18 hours without complications. The components are the passage (birth canal), passenger (fetus), and power (uterine contractions and abdominal muscles). It describes the anatomy of the female pelvis and fetal skull, as well as the onset, three stages and mechanism of labour. Intrapartum monitoring includes monitoring the mother's temperature, pulse, blood pressure and urine as well as fetal monitoring. Management includes pain relief, hydration, fetal monitoring and managing
The document provides information on the management of the second stage of labor by nurses. It discusses the normal physiology of the second stage, including cervical dilation, fetal descent and rotation, and maternal efforts. It describes the mechanism of labor, including engagement, descent, flexion, internal rotation, crowning, extension, and birth of the shoulders and trunk. Monitoring labor progress and managing the second stage with techniques like the partogram are also summarized.
The document discusses normal labor and defines its criteria. It describes the stages of labor and nursing care provided in each stage. Key points include defining normal labor as spontaneous delivery of a mature fetus through the birth canal within 24 hours without complications, describing the three stages of labor as dilation, birth of the baby, and delivery of the placenta. Nursing care focuses on comfort measures, monitoring labor progress, and providing pain management.
Normal labor typically occurs spontaneously at term and is completed within 18 hours without complications. The first stage of labor involves cervical effacement and dilation and lasts up to 20 hours for first-time mothers. The second stage involves fetal descent and birth of the baby, lasting 1-2 hours. The third stage involves placental delivery, lasting 5-30 minutes. Nursing care focuses on monitoring labor progress, providing comfort measures, and ensuring safety of the mother and baby.
Normal labor and delivery is defined as the spontaneous expulsion of a single, mature fetus through the birth canal within 3-18 hours without complications to the mother or fetus. Labor involves 3 stages - the first stage is cervical dilation, the second stage is baby's descent and birth, and the third stage involves delivery of the placenta. Uterine contractions increase in frequency and strength during the first stage to dilate the cervix by 1 cm per hour. The fetal head engages and descends through the birth canal during the second stage before birth. The third stage sees delivery of the placenta within 30 minutes.
Normal physiology of labour and delivery .pptxEndex Tam
Normal labour involves 3 stages - first stage of cervical dilation, second stage of baby's descent and birth, and third stage of placenta delivery. The first stage consists of latent and active phases, and progress is monitored using a partogram. Uterine contractions, cervical changes, and fetal positioning occur during the first stage to facilitate delivery, while maintaining the health and safety of the mother and baby is the primary aim in labour management.
This document defines labor and describes the key stages and processes involved, including:
1. Labor is characterized by uterine contractions, cervical effacement and dilation, rupture of membranes, descent and rotation of the baby through the birth canal, and delivery of the placenta.
2. The first stage of labor involves cervical changes and is divided into latent and active phases, with the active phase further separated into acceleration, linear, and deceleration periods.
3. Fetal monitoring, cervical exams, and other assessments are used to evaluate labor progress and the condition of the mother and baby, with actions like amniotomy and oxytocin administration taken if needed to address slow progress.
The female reproductive system releases an ovum from the Graafian follicle, and the leftover corpus luteum produces hormones like progesterone and estrogen. Key terms include puberty, menopause, and various conditions and procedures involving the ovaries, uterus, and pelvic area.
The document discusses the nervous system, including the cerebellum, protection of the central nervous system, meninges, cerebrospinal fluid, ventricles, blood brain barrier, traumatic brain injuries, strokes, Alzheimer's disease, spinal cord anatomy, peripheral nervous system structure, classification of peripheral nerves, and the 12 pairs of cranial nerves. Key structures and functions are described, along with their roles in coordinating movement, protecting the brain and spinal cord, circulating cerebrospinal fluid, and sensory and motor functions. Diagrams are referenced to illustrate anatomical features.
The document discusses the control and processes of the digestive system. It explains that digestion is controlled by reflexes triggered by the parasympathetic nervous system and chemical and mechanical receptors. The major organs of digestion - the stomach, small intestine, and pancreas - are described in terms of their roles in breaking down nutrients and absorbing them. The document also provides an overview of cellular metabolism, explaining the catabolic and anabolic processes that break down and build up biomolecules to produce energy and maintain life.
Focused antenatal and emergecy obstetric carePave Medicine
Focused antenatal care (FANC) aims to provide goal-oriented and timely care during pregnancy through a limited number of focused visits. The document outlines the elements and purposes of FANC, including early detection and management of diseases, individual birth planning, and 4 scheduled antenatal visits. It also discusses emergency obstetric care (EmOC) and the need to address barriers to access such as delays in seeking, reaching, and receiving appropriate care. A study in northern Tanzania found low availability of basic EmOC units, high availability of comprehensive EmOC units, and that 36% of expected deliveries occurred in EmOC facilities, above the minimum threshold of 15%.
This document provides guidance on taking an obstetric and gynecologic history and conducting a physical examination. It outlines the key components of the obstetric history including general information, current complaints, menstrual and gynecological history, past obstetric and medical history, medications, allergies and social history. The physical examination involves assessing vital signs, examining the head, neck, breasts, lungs, heart, abdomen and pelvis. The abdominal examination includes inspection, palpation, auscultation and percussion to evaluate the uterus, fetal position and wellbeing. The gynecologic history and examination similarly evaluate the presenting complaints, menstrual history, past medical history and perform a general, abdominal and pelvic
This document provides guidance on performing a thorough obstetric and gynecologic history and physical examination. The obstetric history includes details on the current pregnancy, past pregnancies, menstrual and medical history. The physical exam involves assessing vital signs, breasts, cardiovascular and respiratory systems, and performing an abdominal and pelvic exam. The gynecologic history focuses on the presenting complaint, menstrual history, past medical/surgical history, and social history. The gynecologic exam examines the external genitalia, speculum exam, and digital exam. Taking a complete history and performing a thorough physical exam provides important information to diagnose and manage the patient's obstetric or gynecologic concerns.
This document discusses the physiological changes that occur in a woman's body during pregnancy. It covers changes to the reproductive, cardiovascular, hematologic, renal, pulmonary, gastrointestinal, skin and metabolic systems. Some key points include:
- The uterus increases dramatically in size from 50g to 1100g and its blood flow increases from <2% to 15-20% of cardiac output.
- True labor contractions are regular, stronger, longer and closer together compared to false labor contractions which are irregular and can be stopped with sedation.
- The heart rate increases by 15% and cardiac output increases by 40% to accommodate the mother's increased blood volume and oxygen needs.
- Blood volume and plasma volume increase significantly (by
Physiological changes in pregnancy include increased blood volume, cardiac output, and kidney function to support the developing fetus. The uterus grows dramatically throughout pregnancy. Hormonal changes like increased estrogen, progesterone, and HCG levels from the placenta help prepare the body for pregnancy and childbirth. Diagnosis of pregnancy is suggested by missed periods and confirmed by tests detecting HCG in urine or blood within 4-5 weeks of conception.
The document summarizes obstetric anatomy, including the fetal skull, pelvis, and diameters important for labor and delivery. It describes:
1) The fetal skull diameters and how they change with flexion/deflexion of the head during birth. Moulding can reduce diameters by up to 1cm. Complications like caput succedaneum and cephalhematoma are also outlined.
2) The female pelvis is described through its planes, diameters, and four types (gynecoid, android, anthropoid, platypelloid). Key diameters include the true conjugate (11cm), obstetric conjugate (10.5cm), and diagonal conjugate (12cm).
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This document provides an overview of the anatomy and physiology of the female reproductive system. It describes the external structures including the vulva, labia majora, labia minora, clitoris, and vestibule. Internally, it outlines the vagina, uterus, fallopian tubes, and ovaries. The uterus is further divided into the body, isthmus, and cervix. The document also briefly discusses the functions of these structures and the layers of the uterus. Finally, it notes the role of the bony pelvis in supporting the reproductive organs.
This document outlines principles and components for taking a thorough paediatric history. It emphasizes using good communication skills to encourage an open account from the informant. Specific questions should then clarify and amplify the description. Components include identification, chief complaints, history of present illness, review of systems, previous history, family history, and social history. Guidance is provided on questioning techniques for common symptoms like vomiting, abdominal pain, cough, and convulsions. Thorough history taking allows for a comprehensive understanding of the child's health issues.
Paediatrics is the branch of medicine that deals with the care and treatment of children from birth through adolescence. The document discusses several aspects of paediatrics including the role of doctors in caring for children's physical, mental, and emotional health. It also outlines differences in common diseases between developing and developed countries, with developing countries facing greater issues with malnutrition, malaria, diarrhea and pneumonia. Overall health and nutrition of children are influenced by factors such as poverty, lack of resources, and cultural practices in developing areas.
The document provides guidance on examining the respiratory system in pediatric patients. Key points include:
1) Examination of the respiratory system in children is generally similar to adults but requires special techniques due to the child's size, such as having the child sit on the parent's lap.
2) Inspection focuses on chest shape and size, signs of respiratory distress, and chest expansion.
3) Auscultation uses the diaphragm of the stethoscope and evaluates breath sounds from the apices to the bases, noting any adventitious sounds. Breath sounds in young infants are often harsher than in adults.
The pediatric history and physical examinationPave Medicine
This document provides guidance on performing a paediatric history and physical examination. It discusses obtaining a complete history from the parent or caretaker, including chief complaint, present illness, past medical history, developmental history, and family/social history. The physical examination should begin by establishing rapport with the child and proceed systematically while respecting modesty. It involves measuring vital signs, anthropometrics, and a full systemic examination from head to toe. Priority is given to assessing emergency signs relating to airway, breathing, circulation, consciousness and dehydration to identify patients needing immediate treatment.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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2. objectives
Define labour.
Understand the components of labour (passage,
passenger, power).
Be able to take a focused history, examination and
anlyse the symptoms and signs to diagnose labour.
Describe the stage sand phases of labour.
Discuss the mechanism of labour.
Discuss the management of labour.
3. Labour (parturition)
It Is the process where by with time regular uterine contractions, brings about
progressive affacment and dilatation of the cervix, resulting in delivery of the
fetus from the uterus and expulsion of the placenta at or beyond 24 (or 28)
completed weeks of pregnancy.
It is a social, psycological and economical event for the couple, family and
community.
4. Cervical dilatation: The cervix
begins dilating and stretching beyond the normal
dimensions and is measured in centimeters. (0-10cm).
Cervical effacement: softening,
thinning and shortening of the cervix. It is expressed in
percentage (0 – 100%)
5. A 20 year old primigravida comes to maternity unit at 39 weeks gestation
complaining of regular uterine contractions, 3-4/10min. For the past 6 hours. The
contractions are becoming more frequent lasting 45-50 sec. she denies any vaginal
fluid leakage. The blood pressure, pulse and temperature are normal.
Vaginal examination cephalic, head at s-1,90% affaced, 5 cm dilated, soft and
anterior. FH=133bpm .
What is your diagnoses?
6. Labour can occur at:
PTL
Term
Labour
pprroolloonnggeedd
1 LNMP 24 W 28 W 37 W 40W 42W
7. Normal labour:
Spontaneous expulsion, through the natural passages
(birth canal) of a single, mature (37-42 completed
weeks of pregnancy) Alive fetus, presenting by vertex,
within a reasonable time, without fetal or maternal
complications.
10. passengers
The following will pass during labour (fetus, cord,
placenta and membranes). The most important to pass
is the head and shoulder
11. Moulding of the skull:
means obliteration of the suture line between
the bones and overlapping of the un-united
bones of the fetal skull, and is measured by
degree.
Degree Clinical finding
+
++
+++
Suture line closed, no overlap
Overlap of suture line reducible
Overlap of suture line irreducible
As the degree of moulding increase- means there is CPD
12. Fetal attitude: is the relation of the fetal parts to each
other
1- flexion attitude (common)
2- extension attitude (rare).
13. Clinical course of labour
Onset of labour: not definitely known – however there
are several theories, but none of them is completely
proven.
Mechanical theories: - uterine distension
Hormonal theories:
1. Maternal :
o progesterone withdrawal
o oxytocin stimulation
o prostaglandins
o serotonin
2. fetal:
o fetal cortisol
o fetal membranes
3. Neuronal factors:
o sympathetic- alpha receptor stimulation
15. 2. Show – blood stained mucous.
3. SROM
B. Signs:
o palpable or recorded uterine contraction
o effacement and dilation of the cervix
o formation of forewater
16. THE ACTIVE STAGE OF LABOUR –– WWHHEENN TTHHEE CCEERRVVIIXX
IISS MMOORREE TTHHAANN 33 CCMM DDIILLAATTEEDD AANNDD FFUULLLLYY EEFFFFAACCEEDD
STAGES OF LABOUR:
I-The First stage: stage of cervical effacement and dilatation
Definition: the first stage of labour refers to the period from the onset of true
uterine contractions to the fully dilation of the cervix, when the diameter of
the cervical os measures 10cm.
17. Duration:
o primigravida = 8-12 h
o multigravida = 6-8 h
Phases of the first stage:
Latent phase: started when the cervix dilatated
slowly and reached to about 3cm.
A. in primigravida = 8h
B. in multigravida = 4h
- Active phase: rapid dilatation of the cervix to
reach 10cm
A. in primigravda = 4h
B. in multigravida =2h
18. The active phase is divided into:
1. Accelerative phase
2. Slopping phase
3. Decelerative:
A. prolonged active phase
B. primary dysfunction: dilation in active
phase of<1cm/hr
C. secondary arrest: active phase dilation
stops or slow significantly.
N.B – in primigravida the cervix dilates from
above downwards, in multigravida
dilatation of the internal os, taking up of
the cervix and dilatation of the external
os occurs simultaneously.
19. Factors affecting cervical dilatation:
1. Contraction and retraction of the uterus.
2. The bag of fore-water.
3. Absence of membranes.
4. Fitting of the presenting part to the lower segment and the
cervix.
5. Pre-labour changes in the cervix (eg, softening)
20. II-The Second stage of labour: stage of
delivery of the fetus.
Definition: the second stage of labour refers
to the period from complete cervical
dilatation to the birth of the fetus.29-30
Duration:
A.in primigravida =1 h
B.in multigravida = ½ h
however the timing of the second stage is
very different to determine and
controversial and can be extended as much
as there is progress in descent and no harm
to the mother or fetus
21. The second stage of labour had two phases:
1. Passive phase – stage of descent of the presenting part and
dilatation of the vagina – due to contraction and retraction of
the uterine muscle.
2. Expulsive phase – stage of bearing down – due to contraction and
retraction of the uterine muscle and voluntary efforts by
diaphragm and abdominal muscles.
22. Mechanism of labour in vertex presentation:
Definition: The spontaneous adjustments of the
fetal position and attitude to affect efficient passage of
the fetus through the pelvis, marked by progressive
descent until delivery of the fetus.
Delivery of the fetal head:
A- Descent: is a continuous movement throughout
the process of delivery, however it becomes more
rapid in the second stage of labour, it is caused by:
o-Uterine contraction and retraction.
o-bearing down effort – mainly in the second stage of
labour
23. In normal pelvis, the fetal head enters with
the sagittal suture in the transverse
diameter (or occasionally oblique
diameter of the brim). If the sagittal
suture in between the symphysis pubis and
sacral promontory – both parietal bones
are felt vaginally at the same level – the
head is said to be (synclitic). In such case
the biparietal diameter (9.5cm) is the
diameter of engagement. However some
degree of lateral inclination of the head
over the shoulder – (Asynclitism) is present
normally as the head enters the pelvic
inlet.
24. *If the sagittal suture lies close to the sacrum and the anterior
patietal bone lies over the inlet (Anterior parietal bone
presentation) - Anterior asynclitism.
*If the sagittal suture lies close to the symphysis pubis and the
posterior parietal bone lies over the inlet (posterior parietal bone
presentation) – posterior asynclitism.
25. Causes of non-engagement:
Erroneous dates (primigravida)
Extra-uterine:
A. full bladder or loaded rectum
B. Pelvic tumours
C. Pendulous abdomen and marked lumbar lordosis.
D. High angle of inclination of the pelvis.
E. Contracted pelvis.
-Uterine:
A. Poor uterine tone.
B. Congenital deformities.
C. Fibromyomata.
D. Placenta previa.
26. -Fetal:
A. polyhydramnios.
B. Short umbilical cord(acutal or relative,
due to entanglement)
C. Large baby.
D. Deflexion attitude, and malposition.
E. Multiple pregnancy.
F. Hydrocephalus.
Engagement – can be assessed by abdominal
station in fifths during antenatal period,
and by abdominal and vaginal stations
during labour.
27. C.Increased flexion: as the head descends, it meets resistance
from the pelvic walls and floor and this leads to increased flexion of
the head. As the head flexed it brings the shortest longitudinal
diameter of the head (sub-occipito-bregmatic – 9.5cm) to pass
through the birth canal. Flexion is explained by the (two armed
lever theory).
28. D-Internal rotation: the internal rotation
occurs as the head descends through the
pelvic cavity. As the head enters the pelvic
inlet in transverse diameter will rotate 3/8
of the cycle to pass through the pelvic outlet
in antero-posterior diameter.
The rotation is favoured by the slopping
shape of the pelvic floor, angling the leading
point of the head (occiput) in downward and
forward direction, by the effect of the
contraction and retraction of the uterus.
29. E-Crowning, extension and delivery of the fetal
head:
The combined effect of descent and internal
rotation bring the presenting diameter to the plane
of the pelvic outlet, with the occiput lying under
the pubic arch and the sinciput at the lower border
of the sacrum or coccyx.
When the widest diameter of the fetal head is
embraced by the distended vulva, it is said to be
crowned.
The occiput remains under the pubic arch but the
sinciput sweeps forwards as the neck extends.
30. The head is acted upon by:
1. The downward and forward force of the
uterine contraction and retraction.
2. The upward and forward force offered by
pelvic floor resistance so the head passes
forwards i.e. extends vertex, forehead,
and face come out successively.
Frequently, especially in primigravida, the
soft tissues are not able to distend
equally so that tearing of the perineum
and adjacent tissues may occur unless
steps are taken to avoid it by making a
formal incision (episiotomy).
31. F-Restitution and external rotation:
Following delivery of the head the occiput
rotates to the lateral position, in the
opposite direction of internal rotation to
correct the twist of the head on the
shoulders produced by internal rotation. The
internal rotation of the shoulders inside the
pelvis transmitted to the delivered head
which in turn move one eight of a circle
outside the pelvis, in the same direction as
that of the restitution, so at the end the
occiput is towards one thigh and the face is
towards the other thigh.
32. Delivery of the shoulder and body:
The widest diameter of the shoulders,( the
bi-acromial diameter), pass the pelvic brim
at the time when the anterior rotation of
the head is occurring. Thus the anterior
rotation of the occiput is favourable for both
the head and the shoulders. Similarly
external rotation of the head is associated
with rotation of the shoulders to bring them
into the antero-posterior diameter of the
outlet. With further descent, the anterior
shoulder delivered first from under the
pubic arch, followed by posterior shoulder,
during which time lateral flexion of the
trunk is occurring. The trunk and buttocks
follow with the same or the next
contraction.
33. Even in the course of normal delivery, there are many variations
of the mechanisms, dependent on the variation in the size and
shape of the pelvis and of the fetal head.
III-The Third stage of labour: the stage of expulsion of the
placenta and membranes.
34. Duration: up to 30 minutes, however the
average length of the third stage of labour
is 10 minutes.
Mechanism: the third stage is made of two
phases:
1. The first phase: phase of placental
separation occurs through the spongiosa
layer of the decidua at the time of expulsion
of the baby or very soon afterwards. The
shearing force responsible for the
separation is the contraction and retraction
of the uterus, reducing the uterine volume
and the area of the placental site, as the
fetus is expelled.
35. 2. The second phase: phase of placental
expulsion – The separated placenta
descends from the upper (active) segment
into lower (passive) uterine segment,
cervix, and vagina by two mechanisms:
A. -Schultze mechanism:(80%)
The placenta delivered as an inverted
umbrella with it’s fetal surface presenting
first followed by the membranes with retro-placental
haematoma.
B.Mattews – Duncan mechanism: (20%)
The placenta delivered side way and it
presents with it’s inferior surface first.
36. Stage of
labour
Definition Duration
Stage I latent
phase
(affacment)
•Begins from the onset of regular
contractions.
•Ends with acceleration of cervical dilatation
•Prepares cervix for dilatation.
<20 hours in PG
<14 hours MG
Stage 1 active
phase
(dilatation)
•Begins with acceleration of cervical
dilatation.
•Ends at 10 cm dilatation
•Rapid cervical dilatation
<2/hours in PG
<1.5/ hrs in MG
Stage 2
(descent)
•Begins from 10cm dilatation
•Ends with delivery of the baby
•Descent of the fetus
<2 hours in PG
<1 hours in MG
Add 1 hour in epi
Stage 3
(expulsion)
•Begins with delivery of the baby.
•Ends with delivery of the placenta
•Delivery of the placenta
<30 min.
37. Management of labour
The management of labour should be
commenced during the antenatal period, and
the women should be classified as high or
low risk pregnancy. The medical or surgical
problems should be corrected as in case of
(anaemia, hypertension, urinary tract
infection), vaccination should be given if
necessary, and all investigations should be
performed and prepared such as (HIV, HCV,
Hbs Ag, blood grouping…….etc).
38. Also the patient should be advised to attend
the antenatal class (parenterful class) and
visit the hospital including the labour ward to
be familiar to the place and staff.
Once labour is commenced and the patient
arrived to the admission room the following to
be done:
39. A. -Taking history or reviewing the antenatal
file.
1-Last menstrual period – expected date of
confinement.
2-Time of onset of labour.
3-Frequency and duration of contraction (3-
4cm/10min).
4-Presence or absence of amniotic fluid
leakage.
5-Presence or absence of show or vaginal
bleeding.
6-Past obstetric history especially mode of
previous delivery, presentation, mode of
delivery, and weight of previous children.
7-Past medical or surgical history that may
affect labour or delivery, especially
diabetes, heart disease, respiratory
disease allergies, and any medication.
40. B-Examination:
1. .General:
a-pallor, oedema, varicosities, height, and built.
b-Vital signs (BP, P, T)
c-Examination of heart, lungs, breast and other
organs if necessary
2. .Abdominal Examination:
a-To determine fundal height in cm using tape
measure (to determine gestational age
clinically), fetal lie, presentation, engagement in
fifths, size of the fetus, amount of liquor, fetal
heart rate.
b-The frequency and duration of the contraction.
41. 3. .Vaginal Examination: to assess the following.
a-Cervical dilatation in cm and effacement in %.
b-Length of the cervix.
c-Consistency of the cervix
d-Position of the cervix
e-State of the membranes, amount and colour of
liquor.
f-fetal presentation, position and station.
g-pelvic architecture.
42. DO NOT DO VAGINAL EXAMINATION IN
CASES OF VAGINAL BLEEDING BEFORE
THE PLACENTA PREVIA IS EXCLUDED.
DO STERIL SPECULUM EXAMINATION IF
SUSPECTED PLROM, IF THE WOMAN IS
NOT IN LABOUR.
If the woman diagnosed as having active labour – to
be admitted to labour ward.
N.B- active labour means –regular strong and
frequent uterine contraction 3-4/10min lasting 45-50
sec, and the cervix is fully effaced and 2.5-3cm
dilated.
43. Arrival to the labour ward:
I-first stage of labour:
1-Ensure patient’s privacy by covering her with
sheaths or blankets.
2-Reassure and show great sympathy and interest.
3-Record maternal vital signs every hour (BP, P, T).
4-Take blood for grouping and cross match for high
risk patients.
5-Monitor:
a-high risk patients should have a continuous
electronic fetal heart monitoring.
44. b-low risk patients should have brief electronic fetal
heart monitoring if NORMAL, to be followed by
intermittent auscultation:
-first stage every 15min
-second stage every 5min
6-Limit oral intake to small amount of clear fluid or
frozen pineapple.
7-Give all patients in active labour Ranitidine
(Zentac) 150mg orally / 6hourly.
8-Nurse the patient in:
a-left lateral position for mediated patients.
b-sitting or semi-reclining for unmediated patients.
45. 9-Encourage spontaneous voiding, catheterization
may be necessary.
10-Test all urine specimen for proteins, sugar, and
acetone.
11-Give IV fluids during labour to avoid
dehydration
a-0.9% Nacl or hartmann’s solution at 80-
125ml/hr
b-Supplementation with 5% dextrose to prevent
ketosis and hypoglycemia.
12-Give analgesia/anesthesia as required.
a-Pethidine (50-150mg)IM.
b-Diamorphin (5-10mg)IM. Every 3-4 hours.
*avoid giving it too early in labour < 3-4cm cervical
dilation or too late when the delivery is expected
within 1-2hours.
46. *if given too late:
-inform the pediatrician
-give Naloxon (Narcon) 0.02mg IM to the neonate.
c-Use Entonox (NO2 50%+O2 50%) by mask if
available.
d-Use epidural analgesia in selected cases if
available such as Breech, Twins, preterm delivery.
e-Give anti-emetics such as Metoclopromide (5-
10mg)IM if necessary, but should not be routine.
13-Do vaginal examination to:
a-assess progress of labour every 2-4hr
b-or immediately after rupture of membranes
c-FHR abnormalities.
47. 14-Recall all the observations in labour in
Partogram.
15-Consider augmentation with syntocinon if
progress of labour is slow (partogram).
-1000 ml Hartmann’s solution or normal saline + 10
units syntocinon (pitocin)
-Begin the infusion using a pump at 4 milliunits per
minute and double the dose every 20 minutes to a
maximum of 32 milliunits/min.
-Or begin with 15 drops / min and increase the rate
by 10 drops every 30 minutes untill adequate
contractions.
48. II-second stage of labour:
Once the patient reach the second stage of labour and have
the desire to push down then:
1-Put the patient in lithotomy position or other positions clean
the vulva, and perineum with antiseptic solution.
2-Encourage organized pushing down which she is feeling to
do so
3. -Monitor the uterine contraction and fetal heart more
frequent.
4. -Use syntocinon if progress is slow and no contractions.
5. -When the head appears at the vulva, the perineum is
supported during uterine contraction by sterile pad to
promote flexion and prevent premature extension of the
head by pressing up on the sinciput until crowning occur.
49. 6. -After crowning the head is allowed to be
delivered by extension slowly in between the
contractions by sliding the perineum over the
face.
7. -DO episiotomy if necessary under local
anaesthetic ( 10-20 ml) of 1% lignocain, but
should not be routine.
8. -Wait for the next contraction to deliver the
shoulder and trunks.
9. -Clamp and deliver the cord and baby to be
handled to pediatrician.
50. III-Third stage of labour:
The management of third stage is aimed at:
1-Complete delivery of the after birth
(placenta and membranes).
2-Prevention of acute inversion of the uterus.
3-prevention of postpartum haemorrhage
51. A-Delivery of the placenta and membranes:
a-Conservative method: the left hand is
placed over the abdomen to detect any
change in the level of the fundus or sign of
placental separation and decent are
detected, the patient is asked to bear down
to deliver the placenta spontaneously.
Ergometrine 0.5mg or Syntometrine(5 units
syntocinon + 0.5mg Ergometrine) to be
given intravenouslly.
52. Signs of separation and decent of the
placenta:
1. -The body of the uterus becomes smaller,
harder, and globular.
2. -The fundal level rises in the abdomen because
the lower segment becomes distended by the
placenta.
3. -Suprapubic bulge may appear due to presence
of the placenta in the lower segment.
4. -Elongation of the cord out side the vulva.
5. -Sudden gush of blood from the vagina.
53. b-Active methods(prophylaxis against postpartum
haemorrhage)
1-Give Methargine 0.5 mg IM or Syntometrine
(5units oxytocin+0.5mg Methargine), at the time
of the anterior shoulder is free from symphysis
pubis or as soon as possible thereafter.
2-Deliver the placenta and membranes by control
cord traction by right hand, and the left hand is
placed on the suprapubic region, pushing the
uterus upwards.
N.B. USE SYNTOCINON RATHER THAN
METHARGINE IN CARDIAC AND
HYPERTENSIVE CASES.
54. IV-Post Delivery:
1-examine the placenta for their completeness,
anomalies, length, and number of vessels in the
cord and record the placental weight.
2-Suture the episiotomy or any laceration.
3-Estimate blood loss, count swabs, and take cord
blood for Hb, blood group, Rh, bilirubin, and
coomb’s test for Rh negative mother.
4-Check BP, P, T, Lochia and firmness of the
uterus before transferring the patient.
5-Continue an infusion of syntocinon through the
first hour if necessary.
6-Allow no food during the first hour, sips of water
may be taken, encourage nursing.
55. V-Care of the new born infant:
1. -Clearance of the new passages.
2. -Determine the Apgar score one and five minutes
- heart rate
- respiratory rate
- muscle tone
- colour
- reflex irritability
3-Care of the umbilical cord stump
4-General assessment of the infant to exclude any
congenital anomalies.
5-Identification of weight, estimate the gestational
age, dress it and put a mask to identify it.
6-Protect the baby against cold.
56. A-Delivery of the fetal head:
Enter the pelvis by flexion
Engagement
Increased flexion
Internal rotation
DESCENT Crowning
Extension
Restitution
External rotation
Delivery of the fetal head
B-Delivery of the shoulder and body: