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:
- Lengthening of cord
- Gush of blood
- 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
- Flexion
- Internal rotation
- Extension
- External rotation of "restitution"
ABNORMAL FRIEDMAN’S CURVES
Prolonged Latent Phase
Protacted Active Phase
Secondary Arrest of Labor
SHOULDER DYSTOCIA
POSTPARTUM HEMORRHAGE
- Massage and express clots
- Check of retained placenta
- Check for lacerations and hematomas
- Simultaneously give:
- Pitocin, or
- Methergine, or
- Prostaglandin
- Hysterectomy
Previous
|
