Clinical course all stages OF LABOUR

UNIT 4, LABOUR, OBG

1. Clinical course

2. NORMAL LABOUR Series of events that takes place in the genital organs, in an effort to expel the viable products of conception out of the womb through the vagina into the outer world.

3. CLINICAL COURSE PAIN: Initially the pains come at intervals of 15-30 mins . With duration of about 30 secs . But gradually the interval becomes shorts with increasing intensity and the duration comes at the interval of 3-5 mins and at last for about 45 secs . Dilatation and effacement of cervix: Cervical dilatation is expressed either in term of fingers 1,2,3, or fully dilated or in term of centimeter. Effacement of cerrix is expressed in terms of percentage i.e. 25,50,100%.

4. Status of membranes: Usually the membrane remain intact with the full dilatation of cervix or some times even beyond in second stage and intact membrane is best felt with the help of fingers during uterine contraction when it becomes tense and bulges out through cervical opening. Maternal health: feeling of transient fatigue appear after strong contraction . Pulse rate is increased by 10-15 beats/min. Systolic B.P. by about 10 mmHg. Temp remains unaffected. Fetal wellbeing: During contractions, there may be slowing of fetal heart rate by 10-20 beats min.

5. Clinical course 2 nd stage of labour Pains – Come at interval of 2-3 minutes , last for 1-1 ½ min Bearing down efforts Membrane status Membranes may rupture with a gush of liqour per vaginum Vaginal signs Crowning of the head

6. Maternal signs Features of exaustion , respiration slowed down with increased perspiration. During the bearing down efforts face become congested with neck veins prominent. Immediately following the expulsion of the fetus, mother having a sigh of relief Fetal effects Slowing of FHR during contraction is observed

7. CLINICAL COURSE: 3 rd stage A)Pains: For a short time the patient experience no pain. However intermittent discomfort in the lower abdomen appears due to uterine contractions. B)Before separation Per abdomen: Uterus become discoid in shape, firm in feel and non- ballotable . The fundal height will reaches slightly below the umbilicus. Per vaginum : There may be slight trickling of blood. Length of the cord remains static as visible from outside. After separation Per abdomen: Uterus become globular, firm and ballotable . Fundal height is slightly raised as the separated placenta comes down in the lower segment and contracted uterus rest on top of it. Per vaginum : There may be slight gush of bleeding. Permanent lengthening of cord is established.

8. C)Expulsion of Placenta and Membranes: This is achieved either by voluntary bearing down efforts or more commonly aided by manipulative procedure. The after birth delivery is followed by slight to moderate bleeding i.e. 100- 250ml. D)Maternal signs: May be: Chills Occasional shivering Slight transient hypotension is not unusual.