Transcript Labor - unizg.hr

Normal Labor and Delivery
Asja Ćosić
Mentor: A. Žmegač Horvat
Labor
• labor
– series of rhythmic, progressive contractions of the
uterus
– gradually move the fetus through the cervix and birth
canal
• main stages of labor
– first stage: labor proper – contractions cause the
cervix to dilate and to thin and pull back (efface)
• cervix merges with the rest of the uterus
– second stage: delivery of the fetus
– third stage: delivery of the placenta
Labor
• within 2 weeks before or after the estimated date of delivery
• after 36 weeks a cervical examination is performed to estimate
when labor will start
• labor lasts - 12 to 18 hours in a woman's first pregnancy
- 6 to 8 hours in subsequent pregnancies
• main signs of the start of labor are:
– back pain
– contractions in the lower abdomen at regular intervals
• at first contractions may be weak, irregular, and far apart
• with time, they become longer, stronger, and closer together
– bloody show: a small discharge of blood mixed with mucus from the
vagina about 72 hours before contractions start
– rupture of membranes: the amniotic fluid flows out through the
vagina
FIRST STAGE
• from the beginning of labor to the full dilation
of the cervix to about 4 inches (10 cm)
• initial (latent) phase
• active phase
FIRST STAGE - Initial (Latent) Phase
• contractions become progressively stronger and
more rhythmic
• discomfort is minimal
• the cervix thins and opens to approx. 4 cm
• lasts an average of 8½ hours (up to 20 hours) in a
first pregnancy and 5 hours (up to 12 hours) in
subsequent pregnancies
FIRST STAGE - Active Phase
• cervix opens to the full 10 centimeters
• fetal presenting part begins to descend into the
mother's pelvis
• mother feels urge to push as the baby descends, but
she should resist it
• 5 to 7 hours in a first pregnancy and 2 to 4 hours in
subsequent pregnancies
SECOND STAGE
• from the complete opening of the cervix to
delivery of the fetus
• 45 to 60 minutes in first pregnancy
• 15 to 30 minutes in subsequent pregnancies
• during this stage, the woman pushes
CARDINAL MOVEMENTS IN LABOR
•
•
•
•
•
•
•
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
THIRD STAGE
• from delivery of the fetus to delivery of the
placenta
• usually lasts only a few minutes but may last up
to 30 minutes
• maternal blood loss is limited by contraction of
the uterus
• can be managed either expectantly or actively
Fourth stage
• can refer to the immediate puerperium, or the
hours immediately after delivery of the
placenta
Admission to a Hospital or Birthing
Center
• strength, duration, and frequency of contractions are noted
• weight, blood pressure, heart and breathing rates, and temperature
are measured
• urine and blood samples are taken for analysis
• abdomen is examined to estimate the size, position and
presentation of the fetus
• vaginal examination is done to determine whether the membranes
have ruptured and how dilated and effaced the cervix is
• intravenous line – to prevent dehydration and for therapy, if
needed
• oxytocin or prostaglandin are used to induce labor
• fetal monitoring: electronic monitoring is used to continuously
monitor fetal heartbeats and uterine contractions (CTG)
References:
http://www.merck.com/
http://en.wikipedia.org/wiki/Childbirth