Post on 25-Feb-2016
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NORMAL LABOUR: NORMAL ANATOMY
NORMAL LABOUR: NORMAL PHYSIOLOGY
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NORMAL LABOUR
FIRST STAGE
SECOND STAGE
THIRD STAGE
LATENT PHASE: 0-4cmACTIVE PHASE: 4-10cm
FULL DILATION TO EXPULSION OF FETUS
BIRTH TO EXPULSION OF PLACENTAExpectant (physiological) vs Active (CCT +OT)
Cervical effacement vs
cervical dilation
Cervix closed, 3 cm long
Cervix effaced, 1 cm dilated
Cervix 5 cm dilated
Cervix fully dilated
FIRST STAGE OF LABOUR: LATENT vs ACTIVE PHASE
MODIFIED WHO
PARTOGRAM
1. Engagement of the fetal head in the transverse position. 2. Descent and flexion of the fetal head.
3. Internal rotation. The fetal head rotates 90 degrees to the occipito-anterior position
4. Delivery by extension. The fetal head passes out of the birth canal head is tilted backwards
5. Restitution. The fetal head turns through 45 degrees to restore its normal relationship with the shoulders, which are still at an angle.
6. External rotation. The shoulders repeat the corkscrew movements of the head, which can be seen in the final movements of the fetal head.
TERMINOLOGY OF VAGINAL DELIVERY
WHAT IS NORMALITY
Term / Preterm / Post dates
Spontaneous rupture of membranes / Prolonged rupture of membranes/Preterm prolonged rupture of membranes
Fetal monitoring during labour: Intermittent fetal auscultation / continous cardiotocograph
Analgesia during normal labour: nothing/birth partner/ TENS/ 1-1 midwifery care/ drugs/ epidural
the Ferguson reflex
Bishop score
WHAT IS NORMAL?Term: 37 completed weeks to 42 weeks gestation Preterm: 24-37 completed weeksPost-dates: after 42 weeks (postmature, prolonged pregnancy, post-term)
SROM = spontaneous rupture of membranes at term
PROM = prelabor or premature rupture of membranes at term (labour doesn't ensue within 24 hours of ROM)PPROM = preterm, premature rupture of membranes
ARM = artificial rupture of membranes (used for labor induction)
Fetal monitoring during normal labour:
Intermittent fetal auscultation
Continous cardiotocograph (CTG)
NothingWaterTENSbirth partner1-1 midwifery careDrugsEpidural
Analgesia during labour
the Ferguson reflex: as pressure on the cervix increases, the Ferguson reflex increases uterine contractions so that the second stage can go ahead.
Bishop score
Thank You