Lecture 5 PHASES OF PARTURITION STAGES OF LABOR MECHANISM OF NORMAL LABOR IN OCCIPUT PRESENTATION
Management of Normal Labor
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Management of NormalManagement of Normal
Labor and DeliveryLabor and Delivery
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%dentification of Labor%dentification of Labor
&terine contraction that cause cervical&terine contraction that cause cervical
changechange
'aginal ()am:'aginal ()am:* note dilation+ effacement+ consistency+ stationnote dilation+ effacement+ consistency+ station
* ,uptured membranes,uptured membranes
+ nitra.ine test+ nitra.ine test
sterile speculumsterile speculum
infre/uent vaginal e)ams if #,0Minfre/uent vaginal e)ams if #,0M
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1tages of labor1tages of labor
irst 1tage-- stage of cervical effacementirst 1tage-- stage of cervical effacement
and dilationand dilation
* egins hen uterine contractions of sufficientegins hen uterine contractions of sufficient
fre/uency+ intensity+ and duration are attainedfre/uency+ intensity+ and duration are attained
to bring about effacement and progressiveto bring about effacement and progressive
dilation of the cervi)dilation of the cervi)
* (nds hen the cervi) s fully dilated 56 cm to(nds hen the cervi) s fully dilated 56 cm toallo passage of the fetal headallo passage of the fetal head
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Divisions of irst 1tage of LaborDivisions of irst 1tage of Labor
Divides 5st stage into latent and activeDivides 5st stage into latent and activephase:phase:* latent phase: onset of labor is definedlatent phase: onset of labor is defined
according to riedman as the point at hichaccording to riedman as the point at hichthe mother perceives regular contractionsthe mother perceives regular contractions
regular ct) ta!e place along ith cervical softeningregular ct) ta!e place along ith cervical softeningand effacementand effacement
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Latent #hase LaborLatent #hase Labor
"4 cm dilated"4 cm dilated
8ontractions may or may not be8ontractions may or may not bepainfulpainful
Dilate very slolyDilate very sloly
8an tal! or laugh through8an tal! or laugh throughcontractionscontractions
May last days or longerMay last days or longer
May be treated ith sedation+May be treated ith sedation+
hydration+ ambulation+ rest+ orhydration+ ambulation+ rest+ orpitocinpitocin
#rolonged latent phase: defined#rolonged latent phase: definedas greater than 26 hours in aas greater than 26 hours in anullipara and greater than 54nullipara and greater than 54hours in a parous omanhours in a parous oman
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9ctive #hase Labor9ctive #hase Labor
9t least 4 cm dilated9t least 4 cm dilated
,egular+ fre/uent+ usually,egular+ fre/uent+ usually
painful contractionspainful contractions
Dilate at least 52-5;Dilate at least 52-5;
cm
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irst 1tage of Laborirst 1tage of LaborContractionsContractions
%nterval%nterval
* 56 to 26 minutes beteen contractions: early labor56 to 26 minutes beteen contractions: early labor
* 3 to ; minutes beteen contractions: late labor3 to ; minutes beteen contractions: late labor
DurationDuration* 26 second long contraction: early labor26 second long contraction: early labor
* 46 to =6 second long contraction: late labor46 to =6 second long contraction: late labor
>uality>uality* &terus can be dented poor /uality: early labor&terus can be dented poor /uality: early labor
* &terus is hard good /uality: late labor&terus is hard good /uality: late labor
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irst 1tage of Laborirst 1tage of Labor
ManagementManagement
etal ?eart ,ate should be beteen 526 -etal ?eart ,ate should be beteen 526 -
5@6 #M5@6 #M
Mother should be coached to rela) andMother should be coached to rela) and
conserve energy beteen contractionsconserve energy beteen contractions
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Maternal Monitoring andMaternal Monitoring and
Management during LaborManagement during Labor
Maternal 'ital 1igns every 4 hoursMaternal 'ital 1igns every 4 hours
* if temperature: chorioamnionitis: need toif temperature: chorioamnionitis: need to
treat ith antibiotics that ill cover gramtreat ith antibiotics that ill cover gramnegative and anaerobes ampicillin andnegative and anaerobes ampicillin and
gentamicingentamicin
9nalgesia9nalgesia
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9ssessing #rogress of Labor9ssessing #rogress of Labor
'aginal ()am'aginal ()am
55 8ervi)8ervi)* 1oft or ?ard1oft or ?ard
* (ffaced or Ahic!(ffaced or Ahic!
* DilatationDilatation
22 #resentation#resentation
* #art cephalic+ breech+ shoulder#art cephalic+ breech+ shoulder* le)ion+ ()tensionle)ion+ ()tension
* 1tation1tation
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PartografPartograf
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1tages of labor1tages of labor
1econd stage of labor-- stage of e)pulsion of the1econd stage of labor-- stage of e)pulsion of the
fetusfetus
* begins hen dilatation of the cervi) is complete andbegins hen dilatation of the cervi) is complete and
ends ith delivery of the fetusends ith delivery of the fetusDuration of 1econd 1tageDuration of 1econd 1tage
* #rimigravida: ;6 minutes+ ma) 2 hours#rimigravida: ;6 minutes+ ma) 2 hours
* Multiparous: 26 minutes or less+ ma) 5 hoursMultiparous: 26 minutes or less+ ma) 5 hours
8ontractions8ontractions
* %nterval: 2 to 3 minutes%nterval: 2 to 3 minutes
* Duration: ;6 to 566 secondsDuration: ;6 to 566 seconds
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1econd 1tage of Labor1econd 1tage of Labor
ManagementManagement
* Mother may feel urge to push+ coach to pushMother may feel urge to push+ coach to push
only during a contraction once the cervi) hasonly during a contraction once the cervi) has
been determined to be fully dilatedbeen determined to be fully dilated
(pisiotomy(pisiotomy
* #erform to avoid unnecessary tearing hen#erform to avoid unnecessary tearing hen
head is croninghead is croning* 8ontrolled delivery avoids need for episiotomy8ontrolled delivery avoids need for episiotomy
in most casesin most cases
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Ritgen Maneuver
Erbs palsey
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1econd 1tage of Labor1econd 1tage of Labor
Delivery of head -Delivery of head -80NA,0L head to80NA,0L head toprevent e)plosive deliveryprevent e)plosive deliveryand subse/uent tearingand subse/uent tearing
8hec! for presence of8hec! for presence ofcord around nec!cord around nec!
9spirate oral and nasal9spirate oral and nasalcavities ith bulb syringecavities ith bulb syringe
Deliver anterior shoulderDeliver anterior shoulderith donard pressureith donard pressure
8omplete delivery and8omplete delivery and?9NB 0N A0 9C?9NB 0N A0 9C
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1econd 1tage of Labor1econd 1tage of Labor
(pisiotomy(pisiotomy
*9nestheti.e ith pudendal bloc! or infiltration9nestheti.e ith pudendal bloc! or infiltration
* #ut to fingers into the vagina along the#ut to fingers into the vagina along the
posterior allposterior all
* #lace one blade of scissors beteen fingers#lace one blade of scissors beteen fingers
inside vagina+ other blade outside vaginainside vagina+ other blade outside vagina
toard anustoard anus* 8ut to appro)imately 5 inch aay from anus8ut to appro)imately 5 inch aay from anus
during a contractionduring a contraction
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Robekan Perineum- Tatalaksana grade IIRobekan Perineum- Tatalaksana grade II
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Robekan Perineum- Tatalaksana grade IIIRobekan Perineum- Tatalaksana grade III
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Aehni! penyambungan ototAehni! penyambungan otot
sfingter anisfingter ani
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Robekan Perineum- Tatalaksana grade IVRobekan Perineum- Tatalaksana grade IV
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#ain ,elief#ain ,elief
NarcoticsNarcotics
8ontinuous Lumbar (pidural8ontinuous Lumbar (pidural
#aracervical loc!#aracervical loc!;6
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9nesthesia During Delivery9nesthesia During Delivery
LocalLocal
#udendal loc!#udendal loc!
(pidural(pidural8audal8audal
1pinal1pinal
;6
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1tages of labor1tages of labor
Ahird stage of labor-- stage of separation ofAhird stage of labor-- stage of separation of
separation and e)pulsion of placentaseparation and e)pulsion of placenta
* begins immediately after delivery of the fetusbegins immediately after delivery of the fetus
and ends ith delivery of the placenta andand ends ith delivery of the placenta andfetal membranesfetal membranes
*9citive management9citive management controlled cordcontrolled cord
traction+ o)ytocin+ uterine massagetraction+ o)ytocin+ uterine massage
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8hec! the #lacenta8hec! the #lacenta