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    4840 - Conduct of Normal Labor and Delivery

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    andini
    Normal labor and delivery is defined as spontaneous initiation between 37-42 weeks of pregnancy, with the fetus in a longitudinal lie and occiput anterior position. It has four stages: cervical dilation, expulsion of the fetus, expulsion of the placenta, and a 2 hour recovery period. Normal delivery is vaginal, with less than 500ml of blood loss, over the course of 4-18 hours, resulting in a good pregnancy outcome. The document then proceeds to describe the stages and processes of normal labor and delivery in detail.

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    4840 - Conduct of Normal Labor and Delivery

    Uploaded by

    andini
    9K views31 pages
    Normal labor and delivery is defined as spontaneous initiation between 37-42 weeks of pregnancy, with the fetus in a longitudinal lie and occiput anterior position. It has four stages: cervical dilation, expulsion of the fetus, expulsion of the placenta, and a 2 hour recovery period. Normal delivery is vaginal, with less than 500ml of blood loss, over the course of 4-18 hours, resulting in a good pregnancy outcome. The document then proceeds to describe the stages and processes of normal labor and delivery in detail.

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    Normal labor and delivery is defined as spontaneous initiation between 37-42 weeks of pregnancy, with the fetus in a longitudinal lie and occiput anterior position. It has four stages: cervical dilation, expulsion of the fetus, expulsion of the placenta, and a 2 hour recovery period. Normal delivery is vaginal, with less than 500ml of blood loss, over the course of 4-18 hours, resulting in a good pregnancy outcome. The document then proceeds to describe the stages and processes of normal labor and delivery in detail.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    9K views31 pages

    4840 - Conduct of Normal Labor and Delivery

    Uploaded by

    andini
    Normal labor and delivery is defined as spontaneous initiation between 37-42 weeks of pregnancy, with the fetus in a longitudinal lie and occiput anterior position. It has four stages: cervical dilation, expulsion of the fetus, expulsion of the placenta, and a 2 hour recovery period. Normal delivery is vaginal, with less than 500ml of blood loss, over the course of 4-18 hours, resulting in a good pregnancy outcome. The document then proceeds to describe the stages and processes of normal labor and delivery in detail.

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    Normal Labor and

    Delivery

    dr. Damayanti Eka, SpOG

    Dept of Obstetric and Gynaecology


    Raden Mattaher Hospital/Faculty of Medicine,
    Jambi University
    Labor, definition
     Labor: All processes from the onset of
    contraction to the end of the forth stage (2
    hours after delivery of he placenta

     Four stages of labor:


    • First: Dilation of the cervix (1-10 cm)
    • Second: Expulsion of the fetus, or delivery
    • Third: Expulsion of the placenta
    • Fourth: Hemostasis period, 2 hours after
    expulsion of the placenta
    Delivery
     Definition:
    Expulsion of the fetus (second stage)

     Delivery is included in labor.

     Types:
    • Spontaneous delivery vs. Assisted delivery
    • Operative
    • Vaginal vs. abdominal
    Normal labor and delivery
    (definition)

     Spontaneous initiation
     Pregnancy age: 37-42 weeks
     Longitudinal lie, occiput presentation
     Duration of labor: 4-18 hours
     Vaginal delivery
     Amount of bleeding: < 500 ml
     Pregnancy outcome: good
    Terminologies
     Normal delivery
     Physiological delivery
     Pathological delivery
     Spontaneous delivery
     Assisted delivery
     Operative delivery
    First stage
     Uterine contraction: frequency, duration, intensity
     Fetal heart rate: every 30 ‘ (uncomplicated) and 15 ‘
    for high risk fetus or electronic fetal monitoring
     Maternal vital signs: BP, T, PR every 4 hours
     First vaginal ex: dilatation, thickness, and consistency
    of the cervix, presentation, position, station,
    membrane, and cephalopelvic balance (clinical
    pelvimetry)
     Next vaginal ex: 2-4 hours
     Oral intake: avoid dehydration especially for
    prolonged labor
     Intravenous fluid: indicated for potential bleeders
     Analgesia: indicated in certain condition
    First stage
    Dilatation and descent of fetal
    head
    Partograph
    Station
    Delivery room
    Handheld Doppler fetal heart rate
    monitor
    Cardiotocography
    Reactive Non-Stress Test (CTG)
    Normal Contraction Stress
    Test (CTG)
    Abnormal Contraction Stress Test
    (CTG)
    Late deceleration
    Second stage
     Signs and symptoms:
    • Bearing down sensation
    • Dilated anus
    • Vomiting
    • Ruptured membrane
     Bimanual (Vaginal) examination
    • Check for dilatation
    • Determine: station, position of denominator
    • Check for cord prolapsed
     Preparation
    • Dorsal lithotomy with leg holder
    • Supine with flexed, semi-abducted hip and
    flexed knee
    • Catheterization, if bladder is disturbing
    Delivery the head (1)
     Engagement: Sagital suture fits the
    transverse diameter of the inlet (occiput in 3
    or 9 o’clock)
     Flexion
     Descent
     Internal rotation (occiput moves to 12 o’clock,
    to fits the mid pelvis)
     More descent
     Crowning (distension of the head on the
    vaginal opening as wide as 3-4 cm diameter)
    Delivery the head (2)
     Episiotomy (if necessary)
     Extension of the head
     External rotation
     Delivery of the anterior followed by
    posterior shoulders
     Delivery of the rest of the body
     Clamp the cord on two points, cut
     Deliver the newborn to baby nurse
    Third stage
     Delivery of the placenta, active management
     Oxytocin 10 IU soon after delivery of the fetus
     Or, 3 tablets of 200 mg misoprostol orally or
    rectally
     Catheterization in case of full bladder
     Examine signs of separation of the placenta
     Pressure on the fundus and traction on the
    cord
     Examine maternal surface to detect missing
    cotyledon
     Methylergonovin maleat 0.3 mg i. m.
     Massage on the fundus
    Forth stage

     Monitor vital sign


     Monitor uterine contraction
     Repair episiotomy
     Monitor bleeding especially for
    potential bleeders
    Synclitism and asynclitism
    Engagement, descent to delivery of the
    head
    Delivery of the placenta
    Repair of episiotomy or perineal rupture
    Deflection of the head
    Deflection of the head
    (malpresentation)

    vertex sinciput brow face


    Breech presentation & transverse lie
    Transverse lie with subseptate
    uterus & low lying placenta
    Thank you.....

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