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Normal Labor

Normal Labor. Lectures 4 N.Petrenko, MD, PhD. 1 Birth Passage. 1 Birth Passage. 1 Birth Passage. 1 Birth Passage. 1 Birth Passage. Four different types of pelvises, but frequently mixed types. anthrapoid. android. gynaecoid. platypelloid. Pelvic inlets. Platypoid. Gynecoid.

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Normal Labor

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  1. Normal Labor Lectures 4 N.Petrenko, MD, PhD

  2. 1 Birth Passage

  3. 1 Birth Passage

  4. 1 Birth Passage

  5. 1 Birth Passage

  6. 1 Birth Passage • Four different types of pelvises, but frequently mixed types anthrapoid android gynaecoid platypelloid

  7. Pelvic inlets Platypoid Gynecoid Anthropoid Android

  8. 1 Birth Passage

  9. 1 Birth Passage

  10. 1 Birth Passage

  11. 1 Birth Passage

  12. 1 Birth Passage Asymmetrical pelvises • Abnormality of lower limb • Abnormality of pelvic girdle • Abnormality of vertebral column Osteomalacic pelvis Robert’s pelvis Scoliotic pelvis Coxalgic pelvis Split pelvis • Naegele’s pelvis

  13. 1 Birth Passage Measurement of AP conjugates •Diagonal conjugate ~12.0 cm •True conjugate ~11.0 cm •AP outlet ~12.5 cm

  14. 1 Birth Passage • Assess shape of sacrum

  15. 2 Fetus Lambdoidal suture • Sutures: • Frontal • Sagittal • Coronal • Lambdoidal Sagittal suture Coronal suture Frontal suture Note: sutures are actually membranous spaces that meet at fontanels

  16. Foetal skull 1. Bones: 2 parietals, 2 frontals, 2 temporals, occipital 2. Sutures: sagital, frontal, lamboidal, coronal, temporal 3. Fontanelles: anterior, posterior, 2 anterior temporals, 2 posterior temporals.

  17. Fetal skull 1 4 5 2 1. Suboccipitobregamatic: ~9.5 cc Vertex 2. Suboccipitofrontal: ~10.0 cm Sinciput 3. Occipitofrontal:~11.24 cm persistent OP 4. Mentovertical: ~13.8 cm brow 5. Submentobregmatic: ~9.5 cm Face 6. Submentovertical: ~11.25 cm incompletely extended face 7. Biparietal diameter: ~9.5 cm 6 3 7

  18. Fetus • ☺Fontanelles: intersection of sutures, allows for molding, helps identify position of head • Anterior (bregma) • Diamond shaped • Approx 2-3 cm • Ossifies in ~12-18 months • Posterior • Triangle shaped • Smaller • Closes in 8-12 weeks

  19. Fetus Fetal lie Longitudinal Transverse

  20. Fetus Fetal lie Cephalic • Breech Shoulder

  21. Fetus • Fetal presentation: Cephalic • ☺Vertex presentation • Most common • Head completely flexed on chest • Suboccipitobregmatic (Smallest diameter) • Occiput in presenting part

  22. Fetus • Fetal presentation: Cephalic • Military presentation • Fetal head neither flexed nor extended • Occipitofrontal diameter presents • Top of the head is presenting part

  23. Fetus • Fetal presentation: Cephalic • Brow presentation • Fetal head partially extended • Occipitomental diameter presents • Sinciput is presenting part

  24. Fetus • Fetal presentation: Cephalic • Face presentation • Head hyperextended • Submentobregmatic diameter presents • Face is presenting part

  25. Fetal presentations

  26. Fetus • Fetal presentation: Breech • Sacrum is the landmark • Complete breech • Knees and hips are flexed, thighs on abdomen (“fetal position”) • Buttocks and feet are presenting parts

  27. Fetus • Fetal presentation: Breech • Sacrum is the landmark • Frank breech • Hips flexed, knees extended • Buttocks is presenting part

  28. Fetus • Fetal presentation: Breech • Sacrum is the landmark • Footling breech • Hips and legs extended • Feet are presenting parts (single vs double)

  29. Fetus • Fetal presentation: Shoulder • Acromion process of shoulder is presenting part

  30. Station 􀂉In Gynaecoid & Android pelvis distance between ischial spine to brim is ~5 cm. 􀂉In Anthropoid pelvis distance is ~7 cm 􀂉In Platypelloid pelvis distance is ~3 cm Station of the head in relation to ischial spines

  31. Relationship of maternal pelvis and presenting part

  32. Normal uterine action

  33. Normal uterine action

  34. True vs False Labor☺

  35. Partogram Normal dilatation Alert line Abnormal dilatation Acton line

  36. Stages of Labor

  37. Stages of Labor

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