Normal Labor and Delivery(AFE) ????

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Normal Labor and Delivery(AFE)????

• Lin Jianhua M.D., Ph.D., Professor
• 
  Department Of Obstetrics Gynecology
• Renji
  Hospital Affiliated to SJTU School of Medicine

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definition

• Term delivery(labor) 37-42weeks
• pre-term delivery 28- lt37 weeks
• post-term delivery? 42 weeks
• Abortion lt28 weeks
• 85 of women spontaneous labor and delivery
  between 37-42 weeks
• LMP last menstrual period
• EDC expected date of confinememt

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The four factors for labor

• Force (contraction)
• birth canal (bony canal)
• fetus (lie,position ,presentation,weight)
• psychical-factors

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The contractions

• increase in frequency and duration
• uterus can be felt to harden during contraction
• lasting about 30-45 seconds
• interval between contractions to be 5 min
• the pain of labor is a character

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NST CST
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Bony pelvis

• The planes of pelvis
• inlet plane (promontory)
• mid plane of pelvis(ischial spines)
• outlet plane(two intersecting triangles)

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Mechanism of labor

• Engagement
• Flexion
• Decent
• Internal rotation
• Extension
• External rotation

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Symptoms and signs of the onset of the labor

• Painful uterine contraction
• a show
• effacement and dilation of the cervix
• rupture of membranes

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• The show
• The mucus plug is expelled from the cervix
• mixing with a little blood
• the rupture of the membranes
• at any time during labor
• effacement and dilation of the cervix
• to be short,taken up,dilated

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Stages of labor

• The first stage
• onset of labor to full cervical dilation(10cm)
• the latent phase ( onest to lt3cm, lt16h)
• the active phase(gt3cm to 10cm, lt8h)
• The second stage
• 10 cm to the delivery of the infant, lt2h
• The third stage
• delivery of the infant to delivery of the
  placenta, lt30m
• The fourth stage
• 2 hours after delivery of the placenta

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Management of normal labor

• The first stage
• education, eating, voiding,
• position(sitting, reclining, recumbent)
• monitoring of the fetal heart rate ,
• dilation of cervix and frequency
• severity of uterus contractions(auscultation or
  electronic monitoring)

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The second stage

• --- lt 2 hour
• fetal heart rate
• maternal conditions
• pulse, blood pressure, respiratory rate ,
  
• temperature, urine output, fluid intake
• evaluation of progress of labor
• cervical dilation, station,position of the
• presenting part, status of membranes,
• meconium, blood

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• Pushing
• with the onset of each contraction, the mother is
  encouraged to inhale,hold her breath, and push
• increase in intra-abdominal pressure
• aiding in fetal descent through the birth cacal.

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• Head visible on vulval gapping
• Crowning of head
• Laceration or Episiotomy
• Delivery of fetus
• Deal with umbilical cord

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the third stage

• waiting for up to 30 min
• the uterus decreases in size
• delivery of placenta(spontaneously, manually
• inspection of the birth canal
• evaluated for lacerations

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The fourth stage

• postpartum uterine hemorrhage ,1
• uterus palpation through the abdominal wall is
  repeats
• the amount of blood on pads are monitored
• pulse and BP are monitored
• use of drug oxytocin

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THANKS FOR YOUR ATTENTION
Lin Jianhua M.D., Ph.D., Professor Dep. of
Obstet. Gynecol. Renji Hospital Affiliated to
SJTU School of Medicine