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Normal Labour

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Labour is the act of expulsion of the foetus, placenta, and membranes from the uterus. Types of Labor: Normal Labour: Labor is considered normal When: There is a ... – PowerPoint PPT presentation

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Title: Normal Labour


1
Normal Labour
No pain,No gain
2
Labour
  • Labour is the act of expulsion of the foetus,
    placenta, and membranes from the uterus.
  • Types of Labor

3
  • Normal Labour Labor is considered normal When
  • There is a single mature foetus, presenting
    by vertex, the process of labour terminates
    spontaneously, through the birth canal, without
    foetal and maternal complications, and within 24
    hours.
  • Post Mature labour
  • When the duration of pregnancy is 42
    weeks or more.
  • Prolonged labour
  • The course of labour lasting more than 24
    hours.
  • The causes of prolonged labour are
  • Inefficient uterine contractions (inertia) is the
    commonest cause.
  • Occipto posterior position.
  • Rigid perineum especially in elderly women.
  • Full bladder and rectum of the pregnant woman.

4
  • Precipitate labour
  • When the duration of labour lasting less than 3
    hours, due to
  • Strong uterine contraction, No obstruction in the
    birth canal, lack of resistance of the soft
    tissues and usually the patient does not feel
    expect the last contraction during the expulsion
    of the foetus.
  • It is more frequent in multiparas.

5
THE ONSET OF LABOUR
  • SYMPTOMS OF ONSET OF LABOUR
  • 1) Show
  • Discharge of mucous mixed with blood may
    occur. This is due to dilatation of the cervix.
  • 2) True Lbour pain
  • The true labour pains are characterized by
    the follwing
  • They are regular and increase gradually in
    amplitude, frequency
  • and duration.
  • They are accompanied by hardening of the
    uterus.
  • The discomfort is in both the back and the
    abdomen.
  • They are accompanied by progressive
    dilatation of the cervix.
  • The contractions are not affected by
    sedation.
  • They are usually enhanced by an enema.

6
  • 3. Rupture of membranes
  • Rupture of membranes associated by gush of
    amniotic fluid (liquor aminii, about one liter)
  • The women should be admitted to the hospital
    immediately because of danger of cord prolapsed.
  • The functions of liquor amnii are
  • Protection of the fetus.
  • Medium for free movement of the fetus.
  • Keep the fetus temperature constant.
  • Medium of fetal exertion. After rupture of
    membranes the liquor amnii act as antiseptic
    fluid for birth canal.
  • False labor pain
  • Many women may complain of painful uterine
    contraction, despite, the contractions,
    progressive of the cervix falls to occur.

7
  • The false pains are characterized by
  • The contraction occur at irregular intervals.
  • The intensity of the contraction remain the same.
  • The discomfort is chiefly in the lower abdomen.
  • The contractions are usually relived and after
    stopped by sedation.
  • The pains do not cause progressive dilatation of
    the cervix.

8
Forces of labour
  • 1) Uterine force
  • It is the most important force of labor, It
    consists of contractions and retraction of the
    uterus. (Retraction means incomplete relaxation
    or sustained partial contraction)
  • The values of retraction are
  • Assist in dilatation of the cervix.
  • Assist in expulsion of the fetus .
  • Assist of separation of the placenta.
  • To control post-partum bleeding.
  • 2) Auxiliary forces of labor
  • By strong contraction of the diaphragm and
    abdominal muscles. When the head stretches the
    pelvic floor, bearing down occurs involuntary by
    a reflex mechanism, which is needed for expulsion
    of the fetus and placenta (in 2nd stage and 3rd
    stages of labor.)

9
Stages of labour
10
Stages of labour
11
  • 1st stage
  • Begins with the onset of labour and ends when
    dilatation of the cervix is complete(10 cm
    diameter or 5 fingers).
  • It is the longest stage(8?12 hours in
    primi-gravida, 6?8 hours in multi-gravida.
  • It is
    divided into
  • 1st Quiet phase
    2nd Active phase
  • when contractions are
    when contractions are
  • infrequent, short duration.
    frequent,?and strong.
  • Contraction that occur every 2-3 min. and last
    30-45 sec. indicates
  • Significant dilatation or effacement of
    cervix and decent of presenting part.
  • 1st stage of labour may be less than one hour or
    more than 24 hours depending on
  • The parity of the woman
  • The frequency, intensity and duration of the
    uterine contractions.
  • The ability of the cervix to dilate.
  • The presentation and position of the fetus.

12
  • During the 1st stage of labor the uterine muscle
    fibers contract and retract, they do not return
    to their original length after contraction but
    remain shorter.
  • Thickening also occur in the upper uterine
    segment while lower uterine segment becomes
    thinner and stretched.

13
  • 2nd stage
  • From full dilatation of the cervix to complete
    birth of the infant, it varies from a few minutes
    to several hours. depending on the following
  • Fetal presentation and position.
  • Feto pelvic relationship.
  • Resistance of maternal pelvic tissue.
  • Frequency, intensity, duration, and regularity of
    uterine contraction.
  • Efficiency of maternal voluntary expulsive
    effort.

14
  • 3rd stage
  • From the birth of the infant to delivery of the
    placenta and membranes. (by uterine contraction),
    it takes about 5min.
  • If the placenta falls to be expelled within half
    hour after delivery of the
  • foetus ,the condition called retained
    placenta.
  • The 3rd stage is composed of 3 phases
  • Placental separation.
  • Placental decent.
  • Placental expulsion.
  • Sings of placental separation
  • Gush of blood.
  • Lengthening of the cord of the fetus passes
    though the cervix.
  • A rise of height of the funds as the placenta
    reaches the vagina.

15
  • 4th stage
  • Postpartum hemorrhage due to uterine atony. It
    may be primary (when bleeding occur during the
    3rd stage
  • or within24 hours) or secondary (when it occurs
    after the 1st 24 hours.
  • The progress of labour can be observed by
  • The rate of cervical dilatation.
  • Descent of the presenting part.
  • The strength and frequency and duration of
    uterine contraction

16
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18
Management of the frist stage of labour
Management of the frist stage of labour
  • When labour is established the uterine
    contractions will come at intervals (from one
    hour or more to ten minutes).
  • The mother should choose a position she prefer
    and relax completely each time contraction
    begins.
  • Breath deeply (the key of relaxation.)
  • No strain during 1st stage (will cause prolapse
    and unnecessary exhausts the mother).
  • The mother may walk in the intervals between
    pains if the membranes are intact.
  • Once the membranes rupture
  • The mother is asked to lie down to avoid leakage
    of liquor amnii.
  • If the mother complains from backache
  • Apply firm massage on lumber region to alleviate
    pain from modified side lying position.
  • The rectum should be empty by enema and the
    mother should be asked to empty the bladder at 2
    hours interval.

19
  • Vaginal examination is performed when indicated
  • Pulse, temp, and blood pressure are recorded
    every 2 hours in normal cases and more frequently
    if any abnormality.
  • The foetal heart rate should be listened every 15
    minutes in the 1st stage of labour and every 5
    minutes in the 2nd stage especially towards the
    end of uterine contraction to detect any
    abnormality.
  • The normal variation of foetal heart ratio
    (F.H.R.) is between 120-140 beats per minute. If
    the F.H.R. delayed to return after the end of
    uterine contraction is an early sign of foetal
    disress.
  • Normally there is slowing of F.H.R. during
    uterine contraction, and may return to normal
    after contraction.
  • F.H.R. above 160 or below 100 is more dangerous.

20
Womans positions during normal labour
21
Management of the second stage of labour
  • When the cervix is fully dilated
  • The mother lies lithotomy position and ask her to
    bear down during uterine contraction (there a
    reflex desire to bear down during the
    contractions) and relax in between.
  • Relaxation between contraction is important in
    the 2nd stage of labour to enable the mother to
    regain her strength and to recover from the
    effect of the last effort.
  • Instruct the mother to take deep breath and bear
    down to increase the power of expulsion of the
    foetus
  • The attendant supports the perineum and press on
    it during uterine contraction to prevent perineal
    laceration.
  • At crowning the mother will be asked to stop
    bearing down and pant in and out softly and
    easily with mouth open.
  • If the perineum is much stretched and about to
    tear episiotomy will be done.

22
Management of the 3rd stage of labour
  • As soon as the signs of separation and descent of
    the placenta are detected
  • Massage the uterus to help it to contract to stop
    any bleeding.
  • After delivery of the placenta
  • Inspect the external genitalia and perineum (any
    laceration 1cm. Or more should be repaired.
  • Observe the mother carefully for one hour for
    fear of postpartum hemorrhage.

23
Post Partum Exercises
  • Post partum exercises should start with shorter
    duration which consists of
  • Warm up period.
  • Gentle stretching exercises.
  • Postural correction exercises.
  • Specific strengthening exercises.
  • Relaxation techniques.
  • Avoid strenuous exercises (cause significant ? of
    lactic acid concentration in breast milk which
    affect the taste and acceptance of milk by the
    infant.
  • Exercises program at 60-70 of the maximum heart
    rate for 45 minutes a day., Five times a week for
    12 weeks, will significantly improve the
    cardiovascular fitness of post natal woman.

24
Values of Post Partum Exercises
  • Prophylactic
  • Diminish respiratory complications
  • Diminish vascular complications as thrombosis and
    embolism.
  • Guard against prolapse and stress incontinence.
  • Curative
  • Restore the muscle tone (abdominal and pelvic
    floor.
  • Re-education of posture sense.
  • Help excretion (micturition and defecation).
  • Help involution of uterus.
  • Lactation
  • To aid lactation by improving the blood supply of
    the breast and allowing free flow of milk.
  • Pervent sagging of the breast.

25
Contra-indications for postnatal exercises
  • Post partum heamorrhage.
  • Nephritis.
  • Puerperal fever.

26
Post partum exercises
  • 1st day
  • Breathing exercises.
  • Circulatory exercises.
  • Relaxation exercises.
  • Static abdominal exercises.
  • 2nd day
  • Repeat the previous exercises and add the
    following exercises.
  • Leg exercises.
  • Pelvic floor exercises.
  • Arm exercises.
  • 3rd day
  • Repeat exercises of the second day and add the
    following
  • Pelvic rocking exercises.
  • 4th day
  • Repeat exercises of the third day and add the
    following
  • Hip shrugging.
  • Pelvic rotation.
  • Posture correction training.

27
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