Review session on normal labor

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NORMAL ABNORMAL LABOUR PART 1 normal labor
Dr Manal Behery Assistant Professor , Zagazig
University 2013
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Normal labour is the process by which
contractions of the gravid uterus expel the fetus
and the other products of conception

• A-between 37 and 42 weeks from the last menstrual
  period
• B- Before 37 weeks gestation
• C-After 42 weeks gestation
• D- After 24 weeks gestation
• ANSWER A

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Definition of normal labor

• Normal labour is the process by which
  contractions of the gravid uterus expel the fetus
  and the other products of conception between 37
  and 42 weeks from the last menstrual period (Term
  Delivery)

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Preterm labourPreterm labor is that occurring
before 37 weeks of gestational age. Postdate
pregnancyPostdate pregnancy occurs after 42
weeks .
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Fetal lie refers to

• longitudinal axis of the fetus in relation to
  the oblique axis of the maternal uterus
• longitudinal axis of the fetus in relation to the
  transverse axis of the maternal uterus
• longitudinal axis of the fetus in relation to the
  long axis of the maternal uterus
• longitudinal axis of the fetus in relation to the
  long axis of the maternal pelvis
• ANSWER C

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Fetal lie longitudinal axis of the fetus in
relation to the long axis of the maternal uterus.
assessed by abdominal examination prior to
delivery.

• Logitudinal transverse oblique

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Presentation is the part of the fetus that is

• Relates to right or left side of maternal pelvis
• presenting or is the closest in proximity to the
  birthing canal
• Ralated to long axis of mother
• First enter the pelvic cavity
• First felt by vaginal examination
• ANSWER B

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Presentation

• the part of the fetus that is presenting or is
  the closest in proximity to the birthing canal
• Vertex
  Breech

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Which is true about Position, attitude of the
fetus in labour

• position is either cephalic or breech
• attitude is either flexion ,OR deflexion
• position is the relationship of a landmark on
  the presenting part to the right or left side of
  the pelvis
• Position is either oblique lognitudinal or
  treasverse
• E .Attuide is landmark on presenting part that
  determine position
• ANSWER C

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Position, attitude of the fetus in labour

• The position of the baby is the relationship of a
  landmark on the presenting part to the right or
  left side of the pelvis i.e. LOA, LOP, LOT, OP,
  OA, ROA, ROP, ROT.
• The attitude describes the posture of the fetus
  i.e. flexion, deflexion, extension.

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Position, attitude of the fetus in labour
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True onset of labor is defined by which one of
the following

• Passage of bloody show
• Occurance of uterine contraction
• Excessive fetal movement
• Cervical dilation and effacement
• Gush of vaginal fluid
• ANSWER D

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How is true labor defined?

• cervical change
• Effacemant is shortening of the cervical canal
  (from a length of 3 cm to a circular aperture.

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True contractions characterized by all Except

• A-Occur at regular intervals
• B-Intervals get gradually smaller
• C-Intensity increases
• D-Pain felt in the back and abdomen
• E-Pain stop with sedation
• F-Cervix dilate
• ANSWER E

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False contractions characteristics
(Braxton-Hicks) all true Except

• A-Occur At Irregular Intervals
• B-Intensity doesn't change
• C-Pain primarily in lower abdomen
• D-Pain usually relieved with sedation
• E-Cervix dilate
• ANSWER E

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Which is true about retraction

• A-Relaxion after uterine contraction
• B-Intensity of uterine contraction in upper and
  lower segment
• C-The myometrium of the upper uterine become
  shorter after contraction
• D- the pacemaker in the right cornu of the uterus
  
• ANSWER C

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Symmetry and Polarity

• The intensity of the upper segment of the uterus
  is the most strong.
• Retraction
• The myometrium of the upper uterine
• segment does not relax to its original
• length after contractions rather,
• it becomes relative fixed at a shorter length.

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When do you have your patient call you?

• 5-1-1 contractions approximately every 5 minutes
  lasting for 1 min for 1 hour
• Sudden gush of fluid from the vagina or a
  constant leakage/wetness
• Vaginal bleeding(bloody show)
• D.Decrease in fetal movement
• (kick counts should be 10 kicks
• in 2 hours)
• E All of the above
• ANSWER E

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The three components of the cervical exam are

• Dilation ,presention and effacment
• Effacement ,station and position
• Dilation ,effacment ,and station
• Station ,dilation and descent
• Presentation ,station ,and dilation
• ANSWER C

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Three components of the cervical exam

• 1. Dilation estimation of the diameter of the
  cervical opening at the level of the internal os
• 2. Effacement thinning of the cervix expressed
  as a percentage of thinning from the perceived
  uneffaced state
• 3. Station the level of the fetal presenting
  part in the birth canal in relation to the
  ischial spines

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Cervical dilatation by vaginal examination
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Effacement thinning of the cervix
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How is station measured and recorded?

• -3 3 cm above the ischial spines0 at the
  ischial spines, engaged3 3 cm below the
  ischial spines

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Engagement and station of the fetus in labour
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Regarding stasges of labor

• First stage of labor ends with delivery of fetus
• Second stage of labor is divded into latent and
  active phase
• Third stage of labor lasts one hours
• D.Third stage of labor begins immediately
• after delivery of the infant and ends with
  placental delivery
• ANSWER D

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First stage of labor

• -interval between the onset of labor and full
  cervical dilation
• latent cervical effacement and early dilation,
  usually the woman spends most of the latent phase
  of labor at homeactive more rapid cervical
  dilation occurs, usually begins around 4 cm
  dilated

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Second and third stage of labor

• 2ND -complete cervical dilation to delivery of
  the infant
• 3rd -begins immediately
• after delivery of the infant
• and ends with delivery of
• the placenta

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Intrapartum CTG a finding of late deccleration
is

• Relfied by maternal position on left side
• Compression of fetal head mediated by vagus
• Caused by umbilical cord compression
• Is not worrisome if non recurrent
• Is mostly due to placental insufficancy
• ANSWER E

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Intrapartum fetal monitoring (CTG)external and
internal
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Early ,Variable ,late deccleration
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HR variability, accelerations

• Variability is the result of push pull of
  sympathetic and para sympathetic
• Acceleration is gt 2 elevation of baslind FHR
  above 25 pbm in 30 min period
• Acceleration with absent variability is
  reassuring trace
• Moderate variability and lasck of accleration is
  worrisome
• ANSWER A

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Contraction stress test is considered positive if
late deccleration occur in

• 50 or more of contraction
• All of contraction
• 25 or more of contraction
• One out of tree contraction
• ANSWER A

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2. Fetal monitoring
2.2 Baseline rate, HR variability, accelerations,
decelerations
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Fetal blood SAMPLING
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The cardinal movements of labor?all except

• A-engagementB-flexionC-descentD-internal
  rotationE-extensionF-Backword rotation
• ANSWER F

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Signs of placental separation include

• A-Gush of blood
• B-Lengthening of umbilical cord
• C-Rebound of the uterus
• D-All of the above
• ANSWER D

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How to deliver placenta

• -Expectant Management-gentle traction while
  applying suprapubic pressure to avoid uterine
  inversion

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Active management of third stage include all
Except

• A-IV oxytocin after
• delivery of ant shoulder.
• B-Controlled cord traction
• C- Suprapubic massage
• D-Uterine massage
• ANSWER C

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Progress in labor is determined by which of the
following

• A- Dilation and intensity of contraction
• B-Dilation and effecmant
• C-Dilation and descent
• D,Frequancy of contraction and descent
• E- All of the above
• ANSWER C

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PARTOGRAM - Friedman
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How long does each stage of labor take?

• Nulliparous first stage latent-6.5 hours, first
  stage active-4.5 hours, second stage-1 hour
• Multiparous first stage latent-5 hours, first
  stage active-2.5 hours, second stage-0.5 hour

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THANK YOU