This document summarizes the normal labor process and its stages. It describes the first stage of labor as dilation of the cervix, usually taking 12 hours for first-time mothers and 6 hours for mothers who have given birth before. The second stage is described as beginning with full cervical dilation and ending with delivery of the fetus, typically taking 2 hours for first-time mothers and 30 minutes for others. The third stage involves delivery of the placenta, usually within 15 minutes. Key parameters like fetal position and presentation are also defined. The document provides details on managing each stage of labor.
2. NORMAL LABOUR
Series of events that
takes place in the
genital organs,is an
effort to expel the
viable products of
conception out of the
womb through the
vagina into the outer
world.
3. STAGES OF LABOUR
Ist STAGE:-
From onset of true
labour pains till the
full dilatation of
cervix.Its 12 hrs in
primigravida and 6
hrs in multiparae.
8. Contd…
PRESENTATION:-
The part of fetus which lies
at pelvis or lower pole of
uterus.
Vertex:- 98.6%
Breech:- 2.5%
Shoulder:- 0.4%
Face:- 0.2%
Brow:- 1%
9. Contd…
DENOMINATOR:- It is the leading point
of presentation.
In Vertex:- Occiput
In Breech:- Sacrum
In Face:- Chin
10. Contd…
POSITION:- The relationship of
denominator with pelvic brim.
L.O.A:- Left Occipito Anterior
R.O.A:- Right Occipito Ant.
L.O.P:- Lt. Occipito Posterior.
R.O.P:- Rt. Occipito Post.
L.S.A:- Lt. Sacro Ant.
R.S.A:- Rt. Sacro Ant.
L.S.P:- Lt. Sacro Post.
R.S.P:- Rt. Sacro Post.
11. PHYSIOLOGY OF Ist STAGE OF
LABOUR
Duration
Uterine action
Fundal dominance
Polarity
Contraction and Retraction
Formation of Retraction Ring A ridge on the inner
uterine surface at the boundary between the upper and
lower uterine segments that occurs in the course of
normal labor.
Dilatation of cervix
Effacement of cervix
Show
Rupture of Membranes/Formation of Bag
13. MANAGEMENT OF Ist STAGE
Non interference with watchful expectancy.
To monitor carefully:-
a) General management
b) Bowel And Bladder Care
c) Rest
d) Diet
e) Relief of pain
14. Contd…
Note Progress Of Labour:-
a) Abdominal Findings
b) Pelvic Grip
c) Vaginal Examination
d) Fetal And Maternal Condition
15. First maneuver: Fundal Grip
While facing the woman, palpate the woman's
upper abdomen with both hands. often determine
the size, consistency, shape, and mobility of the
form. The fetal head is hard, firm, round, and
moves independently of the trunk while the
buttocks feel softer, are symmetric, and the
shoulders and limbs have small bony processes;
16. Second maneuver: Umbilical
Grip
Still facing the woman, the health care
provider palpates the abdomen with gentle.
First the right hand remains steady on one
side of the abdomen while the left hand
explores the right side of the woman's
uterus. This is then repeated using the
opposite side and hands.
17. Third maneuver: Pawlick's
Grip
In the third maneuver the health care
provider attempts to determine what fetal
part is lying above the inlet, or lower
abdomen.[2] The individual performing the
maneuver first grasps the lower portion of
the abdomen just above the pubic
symphysis with the thumb and fingers of
the right hand.
18. Fourth maneuver: Pelvic Grip
The last maneuver requires that the health
care provider face the woman's feet, as he
or she will attempt to locate the fetus'
brow. The fingers of both hands are moved
gently down the sides of the uterus toward
the pubis.
19. PHYSIOLOGY OF IInd STAGE OF
LABOUR
Contractions become stronger & longer.
Continous contraction & retraction of upper
uterine segment & lower uterine segment thins.
Nature of contraction become more expulsive &
pressure is extended on the rectum & perineal
floor.
There is soft tissue displacement.
Bladder is pushed up.
Rectum becomes flattened into sacral curve &
pressure of advancing head expels any residue
20. SIGNS OF IInd STAGE OF LABOUR
Contractions become longer & stronger.
Full dilatation of cervix.
Presenting part is seen at vulva.
There is pouting & gapping of anus.
Buldging of perineum.
21. MECHANISM OF
LABOUR
The series of movements that
occur on the head in the
process of adaptation,during
its journey through the
pelvis.
22. The Principle Movements Are:-
Engagement
Descent
Flexion
Internal Rotation Of Head
Extension Of Head
Restitution
External Rotation Of Head & Internal
Rotation Of Shoulders
Expulsion Of Head & Trunk
23. ENGAGEMENT
Mechanism by which
fetal nestles into the
pelvis.also termed as
LIGHTENING or
DROPPING.In
primigravida it occurs
before the onset of
labour while in
multigravida occurs in
late Ist stage with
rupture of
membranes.
24. DESCENT
It is a continous
process.It is slow in
Ist stage & becomes
pronounced in Iind
stage.Descent is
completed with
expulsion of
fetus.Head is expected
to reach pelvic floor
by the time cervix is
fully dilated.
25. FACTORS FACILITATING
DESCENT
Uterine Contractions & Retractions.
Bearing Down Effort.
Straightening Of Fetus Especially After
Rupture Of Membranes.
26. FLEXION
Process of fetal head
nodding forward
towards the fetal
chest.As the head
meets the resistance
of birth canal during
descent,full flexion is
achieved either due to
resistance offered by
unfolding of cervix
walls of pelvic or by
pelvic floor
27. INTERNAL ROTATION OF
HEAD
In a well flexed vertex
presentation, the
occiput leads & meets
the pelvic floor Ist &
rotates ant. Through
1/8th of the circle.this
causes slight twist in
neck of fetus as head
is no longer in
alignment to
shoulder.The head
slips benesth sub-
pubic arch &crowning
occurs.
28.
29. CROWNING
After internal rotation
of head, further
descent occurs,untill
the sub- occiput lies
underneath the pubic
arch.At this stage the
max. diameter of head
stretches the vulval
outlet without any
recession of head
even after contraction
is over-It is called
CROWNING.
Biparietal diameter:-
9.5cm.
30. EXTENSION OF HEAD
Once crowning has
occurred the fetal
head can extend.The
driving force pushes
the head in downward
direction.The
successive parts of
fetal head to be born
through stretched
vulval outlet are
VERTEX,BROW
&FACE
31.
32. RESTITUTION
Visible passive movement of head
due to untwisting of neck sustained
during internal rotation.Movements
of restitution occurs rotating the
head through 1/8th of circle in
direction opposite to internal
rotation & comes in lateral flexion
& faces towards thighs.
33.
34. EXT. ROTATION OF
HEAD &INT. ROTATION
OF SHOULDER
Movement of rotation of head
visible externally due to internal
rotation of shoulders.As the
ant.shoulder rotates towards the
symphysis pubis,it carries the head
in a movement of ext. rotation
through 1/8th of circle in same
direction of restitution.
35. EXPULSION OF
SHOULDER & TRUNK
After the shoulders are positioned in
ant.-post. Diameter of outlet,further
descent takes place until the ant.
Shoulder is born.By a movement of
lat.flexion of spine,the post. shoulder
sweeps over the perineum.Rest of the
trunk is expelled out by lateral
flexion.
36. PRINCIPLES OF
MANAGEMENT OF IInd STAGE
OF LABOUR
To assist in natural expulsion of fetus
slowly & steadily.
To prevent perineal injuries.
37. MANAGEMENT OF IInd STAGE
OF LABOUR
General Measures:-
a)Patient should lie down in bed.
b)Constant supervision for F.H.S.
c)To note maternal vital signs every ½ hrly
d)To administer analgesics.
e) To advice & instruct the patient to keep
up morale.
38. Vaginal examination
It is done at early or beginning of
2nd stage of labour to rule out any
accidental cord prolapse.Position &
station of head should be once
more noted to progressive descent
of head.
Nothing should be given to mother
except sips of water.
39. PREPARATION OF DELIVERY
Shifting of patient to delivery table.
Positioning of patient.
Aseptic techniques.
Toileting of genitalia.
Emptying of bladder.
Supporting perineum while delivery.
Providing EPISIOTOMY to prevent tears.
Inj. METHERGIN 0.2 mg I/M after
delivery of anterior shoulder of baby.
40. CONDUCTION OF DELIVERY
Delivery should be spontaneous & is
divided into 3 phases:-
a) Delivery of head.
b) Delivery of shoulders.
c) Delivery of trunk.
41. SIGNS OF IIIrd STAGE OF
LABOUR
Lengthening of cord.
Gush of bleeding.
Uterus becomes full
OR boggy uterus.