crsbar.GIF (2120 bytes)

Labor and Delivery (Normal Parturition)

Labor is defined as uterine contractions resulting in progressive effacement and dilation of the cervix.

On a physiologic basis, labor can be divided into several stages:

First stage: From the onset until complete dilation is reached.
Latent Phase: Cervical effacement
Variable
Active Phase:

Rapid dilation
Relatively fixed time

Second Stage:

From complete dilation until expulsion of the fetus.
Third Stage: Separation and expulsion of the placenta.

Signs of placental separation:

  1. Lengthening of cord
  2. Gush of blood
  3. hange in uterine shape

 

Norms:

PRIMIPARA MULTIPARA
First Stage 8 hours 4-6 hours
Active Phase 1.2 cm/hour 1.5 cm/hour

Second Stage

2 hours 1-1.5 hours

 

DESCRIPTION OF FETAL POSITION

Lie:  Longitudinal; oblique; transverse
Presentation:  Cephalic; breech; shoulder
Point of Direction:  Occiput; mentum, acromion
Asynclitism
Attitude
Station
Leopold’s Maneuvers

 

GOVERNING FORCES OF LABOR

Powers Passages

Passenger

Psyche

 

PELVIS

Bones: Sacrum; coccyx; innominate - ilium - ischium
Three planes exist through which the fetus must navigate:
Inlet - Midplane - Outlet
Types of Pelvis:
Gynecoid      Android
Anthropoid   Platypelloid

 

MECHANISM OF LABOR (CARDINAL MOVEMENTS)

Must have engagement and descent throughout

  1. Flexion
  2. Internal rotation
  3. Extension
  4. External rotation of "restitution"

ABNORMAL FRIEDMAN’S CURVES

Prolonged Latent Phase
Protacted Active Phase
Secondary Arrest of Labor

SHOULDER DYSTOCIA

POSTPARTUM HEMORRHAGE

  1. Massage and express clots
  2. Check of retained placenta
  3. Check for lacerations and hematomas
  4. Simultaneously give:
    • Pitocin, or
    • Methergine, or
    • Prostaglandin
  5. Hysterectomy

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  2001 Loyola University Chicago Stritch School of Medicine. All rights reserved.
Please send questions or comments to: Scott Graziano, M.D.
Updated: 12/12/05 ... Created: 05/02/00