Normal labour and delivery involves 3 stages: 1) dilation of the cervix as contractions increase, 2) delivery of the baby as the cervix fully dilates, and 3) delivery of the placenta. During the first stage, contractions gradually become stronger and more frequent as the cervix effaces and dilates from 3-4 cm to fully dilated at 10 cm. In the second stage, with the cervix fully dilated, the baby's head descends and is born through rotations and flexions to match the pelvis. In the third stage, the placenta is delivered either physiologically or through active management with oxytocin and controlled cord traction.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Active Management of Third Stage of LaborAzael Haward
This short presentation gives a short overview of AMTSL, showing its evolution, advantages and illustrated steps.
AMTSL its a single important step you can do to reduce maternal death secondary to Post partum Hemorrhage.
For more information:
http://www.7activemedical.com/ info@7activemedical.com
http://www.7activestudio.com info@7activestudio.com
http://www.sciencetuts.com/
Contact: +91- 9700061777, 040-64501777 / 65864777
7 Active Technology Solutions Pvt.Ltd. is an educational 3D digital content provider for K-12 and Medical Education. We also customise the content as per your requirement for companies, platform providers, colleges etc . 7 Active driving force "The Joy of Happy Learning" -- is what makes difference from other digital content providers. We consider Student needs, Lecturer needs and College needs in designing the 3D & 2D Animated Video Lectures. We are carrying a huge 3D Digital Library ready to use.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Active Management of Third Stage of LaborAzael Haward
This short presentation gives a short overview of AMTSL, showing its evolution, advantages and illustrated steps.
AMTSL its a single important step you can do to reduce maternal death secondary to Post partum Hemorrhage.
For more information:
http://www.7activemedical.com/ info@7activemedical.com
http://www.7activestudio.com info@7activestudio.com
http://www.sciencetuts.com/
Contact: +91- 9700061777, 040-64501777 / 65864777
7 Active Technology Solutions Pvt.Ltd. is an educational 3D digital content provider for K-12 and Medical Education. We also customise the content as per your requirement for companies, platform providers, colleges etc . 7 Active driving force "The Joy of Happy Learning" -- is what makes difference from other digital content providers. We consider Student needs, Lecturer needs and College needs in designing the 3D & 2D Animated Video Lectures. We are carrying a huge 3D Digital Library ready to use.
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.
Explicación de mi página web Alquibla, dedicada al mundo de la cultura, con entrevistas a escritores de prestigio así como a profesionales de bibliotecas, archivos y centros de documentación.
Primeira reunião com os alunos do Programa de Ressignificação da Dependência e seus respectivos responsáveis para apresentação do programa e esclarecimentos de dúvidas.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
Stages of normal labor- easy explanation for Nursing Students(B.Sc & GNM)...
Introduction, definition of normal labor, definition of normal labor by WHO, Mechanism of labor, stages of labor, Intrapartum management of Labor, pain control.
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.
A biophysical profile is a prenatal test which is used to check on a baby's well-being. The test combines the fetal heart rate monitoring (NST- Non Stress Test) and fetal ultrasound to evaluate a Fetal heart rate, movements, breathing, muscle tone and amniotic fluid level.
2. 1
NORMAL LABOUR
• A series of uterine contractions
• Progressive dilation and effacement of the cervix
• Divided into three recognised stages
3. 2
STAGES OF LABOUR
• First Stage
– Latent Phase
– Irregular contractions with gradual effacement and dilation up to 4cm
– Active Phase
– More frequent contractions, foetal descent, faster dilation to a full 10cm
• Second Stage
– Passive Stage
– Full dilation of cervix but without expulsive contractions
– Active Stage
– Onset of expulsive contractions through to delivery of the neonate
4. 3
STAGES OF LABOUR
• Third Stage
– Physiological
– No drugs, cord clamping or assistance with placental delivery
– May be tried for up to 60 minutes before active management is commenced
– Active
– 10iu IM Oxytocin, either when anterior shoulder is delivered or upon
commencement of active management
– Cord clamping or cutting, delivery of the cord by placental traction
5. 4
POSSIBLE SIGNS OF LABOUR
• Lightening
• Movement of foetal head deeper into pelvis causing observable drop in abdomen
and relieving DiB
• Weeks to Hours from onset
• Bloody Show
• Bloody or brown discharge – the mucus plug of the cervix being released
• Days to Hours from onset
• Ruptured Membranes
• “Waters Breaking” – PV fluid indicating rupture of the amniotic sac
• Labour within 24 hours or induced
• Contractions
• Labour begins when the cervix is effaced and 3-4cm dilated
• This usually coincides with regular contractions
6. 5
FIRST STAGE – DILATION
• Cervix effaced and dilated 3-4cm
• Uterine muscles contract pushing the foetus downwards
• The cervix begins to dilate to accommodate the foetal head
• Typically the cervix will dilate to 10cm, to allow the passage of the
foetal head
• Contractions increase in regularity and discomfort
• Initially <45 second contractions >5 minutes apart
• By late Active Phase, ~60sec contractions 2-3 minutes apart
7. 6
FIRST STAGE CARE
• One to one midwifery led care in a private, relaxed setting
• Facility to eat and drink as desired
• Full discussion of birth plans and options
• Regular obs and intermittent FHR
• Abdominal exams for descent and position 4hrly
• Vaginal exam only where clinically necessary to see cervical
effacement and dilation
• Assessment of PV discharge including “bloody show”, blood and
amniotic fluid
• 0.5cm/hr dilation rate is lower limit of normal in para 0
• 1cm/hr in para >0
8. 7
SECOND STAGE – FOETAL DELIVERY
• Begins when cervix is fully dilated to 10cm
• Foetal head is fully descended into the pelvic brim
• Pressure on the cervix gradually increases
• Expulsive contractions push the foetus from the uterus
• Assisted by maternal pushing, which should be spontaneous rather
than directed
• Upright postures are associated with higher quality of contractions
and faster labour
9. 8
FOETAL MOVEMENTS DURING DELIVERY
• Descent takes places throughout
labour
• Leading aspect of the foetus descends
through the pelvic canal, twisting to
take advantage of the widest parts
• Rotates forwards under the symphysis
pubis, guided by the pelvic floor
• Normal foetal progress is a vertex
presentation
10. 9
FOETAL MOVEMENTS DURING LABOUR
• Flexion increases throughout labour
• As pressure along the longitudinal axis of the foetus increases the
head is flexed forwards
• This position presents the smallest diameter to the pelvic canal
• Rotation of the head
• As the head and then the shoulders pass through the pelvic canal
they twist to pass match the widest axes
• Typically the foetus crowns with a 45° rotation of the head relative
to the shoulders which resolves as they follow
• Shoulders
• Shoulders are born sequentially, anterior first, twisting and passing
out under the pubic symphysis
11. 10
SECOND STAGE CARE
• 4 hourly obs, FHR after each contraction for 1 minute
• Abdo and or PV exams as required to assess descent and position
• Descent should begin within 1 hour of commencement of pushing
for para 0 or 30 mins for para >0
• Descent of foetal head and quality of contractions are the most
reliable progress indicators
• Episiotomy is not routinely indicated unless there are signs of foetal
distress or clear evidence of perineum obstructing progress
12. 11
THIRD STAGE – PLACENTAL DELIVERY
• Begins after the delivery of the neonate and lasts until the placenta
has been delivered
• Active management of third stage is recommended (NICE)
– Routine use of uterotonic drugs (oxytocin)
– Early clamping and cutting of the cord
– Controlled cord traction with uterine counterpressure
• Physiological management may be supported in low risk women if
requested
– Convert if haemorrhage, >1 hr duration, requested by mother
– Consult obstetrics if not resolved with 30 mins active
management or 1 hr physiological management
13. 12
KCND
• Keeping Childbirth Natural & Dynamic (KCND)
• Scottish Govt Program led by consultant midwives
• Aims to provide women with as natural a birth as possible by:
– Providing evidence based care
– Reducing unnecessary intervention
– Ensuring informed choice
– Developing “multiprofessional” care pathways
14. 13
PRINCIPLES OF CARE
• Ascertain the patient’s needs and expectations of labour and care
• Avoid interventions where labour is progressing normally
• Ensure 1-to-1 care is delivered wherever practicable
• Avoid leaving the woman alone
• Where necessary provide a means to summon help and a time when
staff will return
• Allow and encourage the involvement of birth partners
• Allow and encourage women to ask for analgesia at any stage
• Allow women to drink and eat lightly except where specific risks
preclude it
15. 14
BIBLIOGRAPHY
Slide Principle Source(s)
1 UofAbereen – KCDN
http://www.abdn.ac.uk/dugaldbairdcentre/projects/kcnd.shtml
2 NICE Pathway, Normal Labour & Birth
http://pathways.nice.org.uk/pathways/intrapartum-care/normal-labour-and-birth
3