Download Occiput, chin and sacrum

LABOUR
Labour can be defined as
involuntary coordinate uterine
constraction. Cause cervical
effacement and dilataion.
Follow up by expulsion of
products of conceptio.
DELIVERY
Delivery is the expulsion of
products of conception after viability of
the fetus(which is around 22 weeks of
gestation).
LIE OF THE FETUS
Is the relation between the long
axis of the fetus to the long axis of the
mother (longitudinal, transverse, oblique)
POSITION
Is the relation between arbitrary
chosen portion of the presenting part
and the right or left side of the pelvic,
it also can be anterior, transverse or
posterior.
(Occiput, chin and sacrum) in vertix,
face and breech respectively.
STATION OF THE HEAD
ONSET
OF LABOUR
it is part
of the pelvic assessment to
-Evaluate
Estrogenthe relation between the
Presenting part and the pelvis.
It can be determined by the amount
of the head felt above the pelvic brim
expressed as fifth or more accurate by
the vaginal examination of the
presenting part in relation to the ischial
spines and expressed as centimeters
above(-) or below + the ischial spines.
Is the portion of the fetus that is
Foremost within the birth canal or
closest toil.
It is head or breech in longitudinal
lie, shoulder in transverselie. Cephalic
presentation is classified according to
the degree of head flexion occiput,
Sinciput, below, face presentation.
usually sinciput and brow or transient
position changes with the progress of
labour.
Breech presentation is classified
according to the thigh and leg extension,
frank, complete footling.
-
CLINICAL EVALUATION OF LIE
PRESENTATION AND POSITION
OF THE FETUS
The examiner should first determined
The fundal height of the uterus.
First the Uterus Maneuver
gentle palpitaion of the fundus of the
uterus with the tip of the fingers of both
heads, to determine the fetal part that
occupy the fundus.]
Second Maneuver
the palm of the examiner’s hands are
placed on either side of the uterus and
press to exert deep pressure (hard
resistant structure is felt, the back,)
numerous nodulation is felt in the
side (the extremities).
Third Maneuver
By applying the thumb and fingers on
the presenting part of the lower portion
of the maternal abdomen, above the
symphysis pubis.
This maneuver is to determine the
presenting part, careful palpitation
may help to evaluate the degree of
head flexion and engagement of the
presenting part.
Fourth Maneuver
The examiner faces the mother’s feet
and with the lip of three fingers of both
hands palpate the presenting part of
vertex presentation. One hand will first
feel the prominent part while the other
will descent more vertex presentation,
or in the side of the back in face
presentation.
When the head is clearly enlarged the
shoulder is felt by this maneuver.
IN THE FIRST STAGE
OF LABOUR
Cervical changes is the result of two factors:
■ ■Passive stretching as an effect of the
pressure of the presenting part and
hydrostatic pressure of the amniotic
sac – early rupture of the membranes
does not prolonged labour as far as
the presenting part is will apply to
the cervix.
■ Contraction of the longitudinal muscle
THE STAGES OF LABOUR
First is the stage of effacement
and dilatation of the cervix.
Second stage is for the
expulsion of the fetus.
Third stage is for the expulsion
of the placenta and membranes.
Fourth stage is for the early
recovery.
IT IS DIVIDED INTO
TWO PHASES
1. Lateral phase – start with the regular
uterine contraction till the cervix
is 2-2.5 cm dilated and its mean
duration is around 7 hours
(Friedman’s sters).
2.Active phase – from the end of latent
phase until full cervical dilatation.
SECOND STAGE
Cervix is fully dilated and uterine
contraction every 2-3 minutes.
It has 2 component:
Phase I – head begins to descent and
patient feels abdominal lightening
(normal to encourage patient to push
at this phase).
Phase II – head reaches the pelvic floor
And patient starts to bear down.
IT IS THE THREE COMPONENTS
●Acceleration phase – it usually predict
the outcome of labour during which
cervix dilate most rapidly.
●Maximum slope – it reflects the efficacy
of uterine contraction.
●Deceleration phase – it reflect the
fetopelvis relationships the dilatation
rate normally is 1.2 cm/hr in
nulliparous women and 1.5 cm/hr in
multiparous women.(practically 1
cm/hr).
THIRD STAGE
Placenta separation happen
through spongiosa layer. The stage
rarely exceeds 5 minutes.
■Separation is the result of :
●Contraction and refraction of
uterine muscle
●Reduction of uterine volume and
area of placenta site
■Retroplacenta haematoma
If the leading part separate first
(Mathews Duncan mechanism) the raw
surface (maternal) will be exposed.
If the centre separate first Schultse
mechanism.
The fetal surface will be seen first.
Signs of placenta separation:
■Rising of the uterine fundus
■Blood show
■Lengthening of the umbilical cord
THE FOURTH STAGE
OF LABOUR
The immediate recovery phase
following the third stage where patient
needs close observation for any signs
of bleeding.
MECHANICAL OF NORMAL
LABOUR IN OCCIPUT
PRESENTATION
Flexion: Complete flexion of head take
place in vertex presentation and the
occiput used to indicate.
Position : LAO,LOP,LOT,ROA,ROP and
ROT
Engagement of the head – when the largest
diameter of the head (Biparietal) passes the
pelvic brim.
The sagittal sure is in the transverse
diameter of the pelvis so the occiput
is lateral.
Descent is Limited until the second
stage of labour.
Internal rotation – the largest diameter
of the pelvic outlet in anteroposterior.
So the occiput rotate anteriorly.
Restitution and external rotation – the
occiput rotate back to its lateral position.
Extension and delivery of the Head
When the vulva is distended over
the largest diameter of the head the
occiput remain below the public arch
and the sinciput sweeps forwards as
the neck extended (tearing of the
perineum should be avoided at the
stage).
ONSET OF LABOUR
- Estrogen
- Progesterone
- Prostaglandin appears in the myometrium.
- Prostaglandin resistance in the cervix.
Management Delivering Labor
- Admission
NPO
IV line
Fetal monitoring
Pinard stethoscope every 15-20min
Continous CTG
High risk Patient
Internal scalp electrode
Fetal blood scalp sampling
Monitoring of Labour
Comport of the patientExplain what is likely to happen in
labor presence of relative
Discuss with her pain killer
Material assessment/ 2 hours
abdominally/ 4 hours vaginally
Support of the perium at crowing
Episiotomy Midline
Mediolateral
Lateral
Delivery of the placenta by CCT
Third stage
Oxytocin
Ergometrin
Abdominal examination during labour
can be done between contractions.
It provides important information
(retraction ring in obstructed labour)