Normal Labor and Delivery

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Normal Labor and Delivery

• Asja Cosic
• Mentor A. Žmegac Horvat

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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

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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

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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

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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

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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

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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

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CARDINAL MOVEMENTS IN LABOR

• Engagement
• Descent
• Flexion
• Internal Rotation
• Extension
• External Rotation
• Expulsion

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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

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Fourth stage

• can refer to the immediate puerperium, or the
  hours immediately after delivery of the placenta

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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)

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References
http//www.merck.com/ http//en.wikipedia.org/wiki
/Childbirth