Normal Labor and Delivery - PowerPoint PPT Presentation

1 / 30
About This Presentation
Title:

Normal Labor and Delivery

Description:

... contractions that result in effacement and dilatation of the cervix. ... Check cervix. Negative pooling, nitrazine, ferning. 2/50/-1. UVA Labor and Delivery ... – PowerPoint PPT presentation

Number of Views:8877
Avg rating:3.0/5.0
Slides: 31
Provided by: Comp491
Category:

less

Transcript and Presenter's Notes

Title: Normal Labor and Delivery


1
Normal Labor and Delivery
  • Bridgett Casadaban
  • July 25, 2007

2
Definitions
  • Labor Uterine contractions that result in
    effacement and dilatation of the cervix.
  • Braxton-Hicks Uterine contractions NOT
    associated with cervical change.
  • Shorter in duration
  • Less intense
  • Over lower abdomen and groin
  • Resolve with ambulation
  • Lightening Descent of the fetal head into the
    pelvis

3
Definitions
  • Preterm labor Prior to 37 weeks
  • Term 37 to 42 weeks
  • Post term After 42 weeks
  • Post dates After 40 weeks

4
UVA Labor and Delivery
  • 22yo G2P1 at 39 wks comes into LD complaining of
    RUCs q5 minutes x 2 hours. Diana has hooked the
    patient up to the monitor and brings the
    patients chart to you to further evaluate the
    patient. What to do next?

5
UVA Labor and Delivery
  • Talk with the patient
  • Confirm ctx history
  • LOF?
  • Vaginal bleeding?
  • Feeling baby move?
  • Desires an epidural?
  • Distance from home to hospital?
  • GBS status?

q5 minutes x 2 hours
Yes
No
No
6
UVA Labor and Delivery
  • Examine patient
  • Rule out rupture
  • Check cervix

Negative pooling, nitrazine, ferning
2/50/-1
7
UVA Labor and Delivery
  • Formulate a plan
  • You decide to allow the patient to walk around
    the hospital for 2 hours then return for a
    cervical check. What steps must you take next
    before the patient can leave LD?

Ultrasound to confirm fetal presentation
Confirm a reactive/reassuring strip
8
UVA Labor and Delivery
  • Patient returns in 2 hours with continued,
    uncomfortable ctxs q5 minutes. Now what?
  • Recheck cervix

5/90/0
Now what?
9
UVA Labor and Delivery
  • Admit patient to Labor and Delivery
  • Complete HP
  • Obtain EFW by Leopolds
  • Consents signed for delivery and potential blood
    transfusion
  • Orders entered into MIS
  • Clear diet
  • IVFs
  • TS/CBC
  • GBS prophylaxis?
  • Continuous EFM vs. intermittent
  • Intermittent FHTs q 30 min to include a ctx and
    immediately after
  • Membranes intact or SROM and well-engaged
  • Continuous
  • NRFHTs, SROM and poorly engaged, augmented labor,
    epidural?

10
UVA Labor and Delivery
  • In order to maximize the patients chance at a
    vaginal delivery it is important to understand
    the basics of labor and delivery
  • Stages of labor
  • Mechanics of labor
  • Cardinal movements of labor
  • Delivery

11
Stages of Labor
  • 1st Stage
  • Interval between onset of labor and full cervical
    dilatation
  • 2 phases
  • Latent period between onset of labor and point
    at which a change in slope of rate of cervical
    dilatation is noted.
  • Active Greater rate of cervical dilatation and
    usually begins around 2-3cm

12
Stages of Labor
  • 2nd stage
  • Interval between full cervical dilatation and
    delivery
  • Duration
  • Nulliparous 3 hrs w/ epidural 2 hrs w/o
    epidural
  • Multiparous 2 hrs w/ epidural 1 hr w/o
    epidural
  • 3rd stage
  • Delivery of the placenta and membranes
  • Duration maximum of 30 minutes

13
Normal Labor and Delivery
  • In order to maximize the patients chance at a
    vaginal delivery it is important to understand
    the basics of labor and delivery
  • Stages of labor
  • Mechanics of labor
  • Cardinal movements of labor
  • Delivery

14
Mechanics of Labor
  • The Powers
  • Forces generated by uterine musculature
  • Frequency, amplitude, and duration of ctxs
  • Observation, manual palpation, tocodynamometry,
    intrauterine pressure catheter (IUPC)
  • Measured in Montevideo units
  • Average strength of ctxs (mmHG) x no. of ctxs
    in 10 minutes
  • Adequate 200-250 MVUs

15
Mechanics of Labor
  • Passenger
  • Fetal size
  • Abdominal palpation or Ultrasound
  • Macrosomia (gt4500g) associated w/ failure to
    progress
  • Lie
  • Longitudinal axis of fetus relative to
    longitudinal axis of uterus
  • Longitudinal, transverse or oblique
  • Presentation
  • Fetal part that directly overlies pelvic inlet
  • Cephalic, breech, or shoulder
  • Compound presence of gt1 fetal part overlying
    the pelvic inlet
  • Funic umbilical cord presenting at pelvic inlet
  • Malpresentation any presentation that is not
    cephalic with occiput leading

16
Mechanics of Labor
  • Passenger (cont)
  • Attitude
  • Position of head with regard to fetal spine (ie
    degree of flexion or extension)
  • Flexion allows smallest diameter of fetal head to
    present at pelvic inlet
  • Position
  • Relationship of a nominated site of presenting
    part to denominating location on internal pelvis
  • Example cephalic presentation

17
Mechanics of Labor
18
Mechanics of Labor
  • Passenger (cont.)
  • Station
  • Measure of descent of presenting part of the
    fetus through the birth canal.
  • Multifetal Pregnancy
  • Increase probability of abnormal lie and
    malpresentation in labor

19
Mechanics of Labor
  • Passenger (cont.)
  • Leopolds maneuvers
  • 1 Correct dextrorotation of the uterus with
    the back of one hand and delineate the fundus
    with the other to determine gestational age
    and/or appropriate size.
  • 2 Run hands down maternal abdomen on either
    side of fetus to determine fetal lie, identifying
    small parts and fetal spine
  • 3 Firmly grasp upper and lower poles of fetus
    by placing fingers at uterine fundus and above
    symphysis to determine presentation and fetal
    size.
  • 4 Move hands in bilaterally from anterior
    superior iliac crests to determine whether or not
    the presenting part of the fetus is engaged in
    maternal pelvis.
  • Head regarded as unengaged if examiners hands
    are see to converge below fetal head.

20
Mechanics of Labor
  • Passenger (cont.)

21
Mechanics of Labor
  • Passage
  • Bony pelvis soft tissues
  • X-ray pelvimetry now rarely used, having been
    replaced by a trial of labor
  • 4 types of the female bony pelvis

22
Normal Labor and Delivery
  • In order to maximize the patients chance at a
    vaginal delivery it is important to understand
    the basics of labor and delivery
  • Stages of labor
  • Mechanics of labor
  • Cardinal movements of labor
  • Delivery

23
Cardinal Movements of Labor
  • Engagement
  • Passage of widest diameter of presenting part to
    level below the plane of the pelvic inlet
  • 0 station
  • Occurs earlier in nulliparous women (36 wks)
  • Descent
  • Downward passage of presenting part through the
    pelvis.
  • Flexion
  • Occurs passively as the head descends due to the
    shape of the bony pelvis and resistance of pelvic
    floor soft tissues
  • Allows smallest diameter of fetal head to pass
    through the pelvis.

24
Cardinal Movements of Labor
  • Internal Rotation
  • Rotation of presenting part from original
    position (transverse) to anteroposterior position
  • Extension
  • Occurs once fetus has descended to the level of
    the introitus
  • Base of occiput in contact with inferior margin
    of symphysis pubis
  • External Rotation
  • Return of fetal head to correct anatomic position
    in relation to the fetal torso
  • Expulsion
  • Delivery of rest of fetus
  • Anterior shoulder delivered first with rotation
    under the symphysis pubis

25
Cardinal Movements of Labor
26
Normal Labor and Delivery
  • In order to maximize the patients chance at a
    vaginal delivery it is important to understand
    the basics of labor and delivery
  • Stages of labor
  • Mechanics of labor
  • Cardinal movements of labor
  • Delivery

27
How to effectively deliver a baby
  • Prepare for the delivery taking into account
    parity, progression of labor, presentation of
    fetus, complications of labor
  • When head crowns and delivery is eminent, protect
    the perineum downward pressure to keep head
    flexed
  • Ritgens maneuver my help if delay in delivery of
    the fetal head
  • Sterile towel used to palpate fetal chin through
    the rectum to apply upward pressure to facilitate
    extension of fetal head
  • After delivery of head
  • Allow for external rotation (restitution).
  • Reduce nuchal cord
  • Suction fetal mouth and nares
  • After clearing fetal airway
  • Place a hand on each parietal eminence to apply
    downward traction to deliver anterior shoulder
  • Followed by upward traction to deliver posterior
    shoulder

28
How to effectively deliver a baby
  • After complete delivery of infant
  • Cradle in a single arm below the perineum to
    allow maximal blood transfer to infant
  • Delivery of the placenta
  • 3 classic signs of placental separation
  • Lengthening of the umbilical cord
  • Gush of blood from vagina
  • Change in shape of the uterine fundus to a more
    globular appearance
  • Active management of 3rd stage has been shown to
    reduce total blood loss
  • Brandt-Andrews Maneuver abdominal hand secures
    the uterine fundus to prevent uterine inversion
    while the other hand exerts sustained downward
    traction on umbilical cord
  • Crede maneuver cord is fixed with lower hand
    while the uterine fundus is secured and sustained
    upward traction is applied using abdominal hand

29
How to effectively deliver a baby
  • Inspect the placenta
  • Abnormalities of lobulation
  • Site of insertion of umbilical cord into the
    placenta
  • Marginal insertion inserts into edge of placenta
  • Membranous insertion vessels course through the
    membranes prior to attaching to placental disk
  • Length (50-60cm)
  • 2 arteries and 1 vein
  • Single umbilical artery associated with 20 risk
    of other structural anomalies.

30
(No Transcript)
Write a Comment
User Comments (0)
About PowerShow.com