Normal labour and delivery ppt

Basic Anatomy, basic physiology, stages of labour and management of each stage. How to use a partogram and the relations of this to Friedman's curve.

1. Normal Labour And Delivery Rhea Marcano 413003930

2. Contents 1. Definition of normal Labour 2. Factors influencing progress of Labour 3. Diagnosis of Labour 4. Stages of Labour 5. Management of Labour

3. Labour Definition Labour is defined as the onset of regular painful contractions with progressive effacement and dilatation of the cervix accompanied by decent of the presenting part leading to expulsion of the fetus or fetuses and placenta from the mother.

4. Factors to help determine if labour is normal Mature Fetus 37-42 weeks Spontaneous expulsion Vertex is the presenting part Vaginal Delivery Time ( not < 3hour but not >18 hours) Complications??

5. Influential Factors of the Progress of Labour 3P’s Power Passenger Passage

6. Female Pelvis Basic framework for the birth canal True Pelvis- Inlet, cavity and Outlet ( The fetus must pass through all three in order for labour to be sucessful) Types of Pelvis- Gynaecoid , Anthropoid, Android and Platypelloid

7. The Fetal Skull

8. Moulding The bones of the fetal head can move closer together or overlap to help the head fit through the pelvis. Parietal bones overlap occipital and frontal bones. Moulding can be staged from +1 to +4, +1-+3 being normal and +4 being cause for some concern.

9. Diameters of the Skull

10. InitIATion OF LABOUR

11. Causes of the Onset of Normal Labour It is unknown but the following theories are proposed: Hormonal Factors Oestrogen Theory Progesterone withdrawal theory Prostaglandin Theory Oxytocin Theory Fetal Cortisol Theory Mechanical Factors Uterine Distension Theory Stretch of the lower uterine segment

12. Friedman’s Curve

13. Diagnosis of LAbour Signs that can clue you into the onset of Labour Show- evidence by mucus mixed with blood or mucus plug Rupture of membranes- look for leaking liquor panful, regular uterine contractions, atleast (1:10)

14. A D M I S S I O N M A N A G E M E N T

15. ON ADMISSION: Review antenatal record Complete history if record isn't available GENERAL EXAMINATION OF MOTHER General condition- pallor, oedema, abdominal scars, maternal height Vital signs- Blood pressure, Pulse, respiration, temperature (measured and recorded) Heart and Lungs Urinalysis- protein, sugar, ketones

16. Abdominal Examination: Detail examination, determine fetal presentation, position and engagement Auscultate fetal heart sound Evaluate uterine contractions Attach Carditocography (CTG) for 20 min trace

17. VAGINAL EXAMINATION Confirm degree of dilatation and effacement Identify the presenting part Fetal head engagement if any doubt Confirm or artificially rupture if necessary (ROM) Exclude cord prolapse BLADDER/BOWEL CARE Administer an Enema allow to empty bladder ever 1 1/2 - 2 hours

18. NUTRITION IN EARLY LABOUR No food after labour is established to prevent regurgitation and aspiration Place IV to start administration of fluids POSITIONING OF LABOURING MOTHER Once everything is well with mom and baby, patient may ambulate or lay in bed as the feel comfortable MONITORING, PROGRESS OF LABOUR PAIN RELIEF Opiate drugs- Pethidine given IM q4hrly Epidural analgesia

19. Partogram A cartogram is a composite graphical record of key data (maternal & fetal) during labour entered against time on a single sheet of paper. Relevant measurements such as cervical dilatation, fetal heart rate, duration of labour and vital signs Monitors progress of Labour

20. Components of a partogram Patient Identification Time (recorded in 1hr intervals) Fetal Heart Rate State of Membranes Cervical Dilatation Uterine Contractions Drugs & Fluids BP (2hr intervals) Pulse Rate (30min intervals) Oxytocin Urinalysis Temperature

21. StaGes of Labour

22. First Stage Second Stage Third Stage Begins with the onset of true labour contractions and ends when the cervix is fully dilated (10cm). Cervical effacement and dilatation occurs in this stage 2 Phase: Latent & Active Latent: From diagnosis of labour to 3cm dilatation Active: From 3cm to ful dilatation (10cm) The second stage of labour begins with complete dilatation and ends with the birth of the baby.

Approximately 2 hours in a nulliparous and 1 hour in a multiparae woman Begins after birth and ends with the expulsion of the placenta and membranes

Shortest stage: After birth, up to 30 minutes

23. First Stage What happens and how to Manage!

24. 1. Contractions Regular Increasing Frequency Stronger 2. Cervical Dilatation and Effacement 3. Engagement of the presenting part

25. MAnagement Continuity of care Observation of progress of Labour Monitoring fetal & maternal well-being Adequate pain relief (according to mothers wishes) Adequate hydration to prevent Ketosis Lactate ringer solution

26. Second Stage What happens and how to manage?

27. Second stage First sign of the second stage is the urge to push Full Dilatation to Delivery of the fetus Signs to look for:- (1) Distention of the perineum (2) Dilatation of the anus Satisfactory progress:- steady descent of the fetus through the birth canal & onset of the expulsive phase

28. Management Continuous monitoring during this phase Maternal Position, usually semi-recumbent or supported sitting position with thighs abducted but any comfortable position expect supine for an uncomplicated pregnancy Encourage to bear down with the contractions

29. Management (Cont’d) Maternal condition - BP and PR measured every 15-30mins and after contractions Fetal Condition- Fetal heart rate, measured continuously or after contractions Uterine Contractions- strength, length and frequency continuously assessed Progress of descent- recorded every 30 mins

30. Conducting the delivery position patient antiseptic solution to clean skin of lower abdomen, vulva, anus and upper thigh, then drape DELIVERY OF THE HEAD Control delivery of the head Perform episiotomy if required Perform Ritgen’s Maneuver Clear the airways after delivery of the head

31. Conducting the delivery (Cont’d) DELIVERY OF THE SHOULDERS Anterior shoulder assisted by gentle downward traction of the head Posterior shoulder is delivered by elevating the head.

32. Conducting the delivery DELIVERY OF THE TRUNK Grasp baby around the chest after shoulders delivered to help with birth of trunk Baby swept unto mother’s abdomen Note time of delivery CUTTING THE UMBILICAL CORD wait 15-20 seconds then clamp plastic crushing clip placed 1-2cm above umbilicus and cut 1cm beyond the clamp

33. Immediate Care of the newborn Assess baby Health baby with spontaneous respiration place on mother’s abdomen, dry& cover baby No spontaneous respiration or respiratory problems then resuscitate baby APGAR scores

34. Events occurring during labour Flexion and Descent Internal Rotation of the fetal head Crowning Extension Restitution Internal rotation of the shoulders External rotation of the fetal body Lateral flexion of the body

35. Third Stage What happens and how to manage?

36. Third Stage Begins with fetus delivery and ends with delivery of the placenta/membranes Two phases: Separation and Expulsion 30 mins or less Average blood loss 150-250 mld

37. Management BIRTH OF THE PLACENTA Two (2) stages:- Separation of the placenta from the wall of the uterus and into the lower uterine segment or vagina Actual expulsion of the placenta out of the birth canal

38. Two mechanisms of separation Mathews-Duncan mechanism (raw surface exposed when delivered) Schultz Mechanism (placenta inserted at fundus, placenta inverts and covers the raw surface)

39. Signs of separation Globular and hard uterus Sudden gush of blood Cord Lengthening (Most reliable clinical sign)

40. Birth of the placenta Two methods: Passive Management (wait for spontaneous expulsion of the placenta) Active Management

41. Active Management of the third stage Help prevent postpartum hemorrhage Includes:- Use of oxytocin (given around the time of the anterior shoulder delivery, 10 units) Controlled cord traction Uterine massage

42. active Placenta delivery Brandt’s Andrew method Placenta separation Controlled cord traction Delivery of the membranes Examination of the Placenta:- placenta, membranes & umbilical cord for completeness and anomalies

43. EXAMINATION OF THE PERINEUM look for lacerations, also vulva outlet, vaginal canal & cervix should be inspected Repair lacerations or episiotomies immediately

44. Immediate management after the delivery EARLY POSTPARTUM MANAGEMENT Monitor for postpartum hemorrhage, keep for atlas 1 hour in delivery suite (bleeding- ask to report any sudden gushes of blood, bp and pulse) Before discharging from delivery suite Check uterus frequently to ensure it is firm Remove intrauterine clots Look at introitus for NO hemorrhage Keep bladder empty Ensure baby is breathing well, pink and well flexed

45. References Obstetrics ten teacher Various online resources

46. Learning Resource http://intranet.tdmu.edu.ua/data/kafedra/internal/ginecology2/classes_stud/en/nurse/adn/ptn/2/Nursing%20Care%20of%20Childbearing%20Family_Practicum/04.%20Labor%20and%20birth%20process..htm

47. QUESTIONS?? Let’s Deliver Babies…………………… THANK YOU!!!

48. • Engagement : The fetus is engaged if the widest leading part (typically the widest circumference of the head) is negotiating the inlet. • Station : Relationship of the bony presenting part of the fetus to the maternal ischial spines . If at the level of the spines it is at “0 (zero)” station, if it passed it by 2cm it is at “+2” station. • Attitude : Relationship of fetal head to spine: flexed, neutral (“military”), or extended attitudes are possible. • Position : Relationship of presenting part to maternal pelvis, i.e. ROP=right occiput posterior, or LOA=left occiput anterior. • Presentation : Relationship between the leading fetal part and the pelvic inlet: cephalic, breech (complete, incomplete, frank or footling), face, brow, mentum or shoulder presentation. • Lie : Relationship between the longitudinal axis of fetus and long axis of the uterus: longitudinal, oblique, and transverse. • Caput or Caput succedaneum: oedema typically formed by the tissue overlying the fetal skull during the vaginal birthing process. GLOSSARY

49. Pelvic types Traditional obstetrics characterizes four types of pelvises: • Gynecoid : Ideal shape, with round to slightly oval (obstetrical inlet slightly less transverse) inlet: best chances for normal vaginal delivery. • Android : triangular inlet, and prominent ischial spines, more angulated pubic arch. • Anthropoid : the widest transverse diameter is less than the anteroposterior (obstetrical) diameter. • Platypelloid : Flat inlet with shortened obstetrical diameter.