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Mechanisms of labor

Mechanisms of labor. Dr.F Mostajeran. Mechanisms of labor. Lie presentation Attitude and position Fetal lie: Longitudinal Oblique. F . Presentation. Cephalic Breech Shoulder (preria-septum). Relationship head and body classified

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Mechanisms of labor

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  1. Mechanisms of labor Dr.F Mostajeran

  2. Mechanisms of labor • Lie presentation • Attitude and position Fetal lie: • Longitudinal • Oblique

  3. F . Presentation • Cephalic • Breech • Shoulder (preria-septum)

  4. Relationship head and body classified • Chin contact thorax vertex, occiput presentation occiput and back contact , face presentation F. head position between these partially flexed , fontanel (bregma) , sinciput presentation partially extended , brow

  5. Breech presentation • Frank • Complete • Footling

  6. Fetal attitude or posture • Fetus forms an avoid • Back • Head • Legs • Arms

  7. Position : • Presenting part • Vertex → occiput • Face →mentum • Breech →sacrum • Lo Ro oA oP

  8. Diagnosis presentation – position Abdominal palpation: • Leopold maneuvers • First maneuver • Second maneuver fetal fole • Third maneuver thumb – fingers ,movable • Fourth maneuver • First three fingers • Direction of axis pelvic inlet

  9. V. E xamination • Sutures • Fontanels

  10. Auscultation reinforce • V.S • Radiography

  11. Labor with occiput presentation • vertex presentation • 40% LOT • 20% ROT • 20% OP OP (placenta anterior –narrow fore pelvis)

  12. Cardinal morement of labor • Engagement • Descent • Flexion • Internal rotation • Extension • External rotation • Expulsion

  13. Changes in shape of the head • Caput succedaneum Vertex → head change shape → labor forces • Fetal scalp → forming swelling • prevent differentiation sutures fontanels

  14. Molding • Head shape change → external compressive forces possibly → Braxton hicks cont

  15. Admission procedures • Urged to report early in labor • Early admittance to labar , delivery unit • especially high risk pregnancy • accurat diagnosis of labar • Falsely diagnosed , inappropriate in terrention • Not diagnosed (remot from medical personnel medical facilities)

  16. Definition of labor • Uterine contractions that bring effacement and dilatation of cervix. • Painful contractions become regular • onset of labor as beginning at the time of admission to the labor unit • Admission for labor based on dilatations accompanied by painful contractions .

  17. D. Diagnasis between false and true labor is difficult • Contractions of true labor • Regular intervals • Intervals gradually shorten • Intensity gradually increases • Discomfort back , abdomen • Cervix dilates • Discomfort is not stopped by sedation

  18. Contractions of false labor • Irregular intervals • Intervals long • Intensity unchanged • Discomfort lawer abdomen • Cervix not dilate • Relieved by sedation

  19. Pregnant woman who is having Cantractions • Emergency condition • Labor is defined as process of childbirth beginning • Latent phase delivery placenta

  20. Electronic admission testing • Recommend NST or CST on all patient • (labar – delivery unit) • Fetal admission test • identify unsuspected cases

  21. Vaginal examination • Amnionic fluid effacement • Cervix dilatation position • Presenting part • Station • Pelvic architecture

  22. Detection of ruptured membranes • Leakage of fluid • Prolapse cord • Labor occur • Serious intra uterine infection • Nitrazine paper (PH= 7.0 – 7.5) • Arborization or ferning • Alpha – fetoprotein • Injection various dyes

  23. Vital signs and review of pregnancy record • Physical examination • Preparation of vulva and perineum • Inspection and cleaning of the vulva , perineum , mini – shave - enema

  24. Friedman • Three functional divisions of labor • Preparatory division: Little cervical dilatation Considerable change • Dilatational division : Most rapid rate • pelvic division: Deceleration phase of cervix - dilatation Cardinal fetal movements

  25. Cervical dilatation • Latent phase (14-20h) • Active phase: acceleration ,phase of maximum slope , deceleration phase

  26. Management first stage of labor • Remainder of general physical exam is completed • HCT HB protein - glocose • average duration first stage of labor • 7 hours in nulliparous w • 4 hours in parous w

  27. Fetal monitoring during labar • Contractions and response FH • Suitable stethoscopc , doppler ultrasonic devices • FH should be checked after contractions • every 30 minutes (15) • Second stage every 15 minutes (5) • Cantinous electronic monitoring

  28. MATERNAL MONITORING • Vital signs • T , pulse , BP every 4/h • PROM temprature every 1/h • 18 h of PROM antimicrobial

  29. Subsequent vaginal examinations • When membrans rupture if head was not Defenetly engaged • fetal H immediately and during the next uterine contraction • (occult umbilical cord compression) • periodic examinations at 2-3 hours interval

  30. Oral intake • Gastric emptying time prolanged (food – medication remain in the stomach – not absorbed may be vomited) • Food should be withheld • Intravenous fluids • Infusion system routine early labar (IV line) • Longer labors glucose sodium water 60-120 ml/hr

  31. Maternal position during labor • normal laboring woman • Not be confined to bed • Comfortable chair • In bed position most comfortabl (lateral recumbend)

  32. Analgesia • Is initiated on the basis of maternal discomfort • vaginal examination befor administration of analgesia (delivering a depressed infant) • Timing , method and size of initial and subsequent dose , interval of time until delivery

  33. Amniotomy • There is a great temptation • Benefits: rapid labor detection of meconium staining • Internal fetal M • Aseptic technique • Head must be well applied to the cerxin

  34. Urinary bladder function • Bladder distention avoid • Abstracted labor • Subsequent bladdes hypotonia, infection • Suprapubic region shauld be visualized , palpated detect filling bladder • If could not void on a bedpan • Intermittent catheterization

  35. Management of second stage labor • Full dilatation of the cervix • Begins to bear dawn • 50 minutos in nulliparous • 20 minutos in multiparous

  36. Higher parity 2-3 expulsive efforts may suffice Complete the delivery of the infant • FHR • Low – risk 15 H.risk 5

  37. Fetal H.R • Contraction – maternal expulsive efforts • FHR are not consequence of head compression • Descent fetus and reduction in uterine volume • some degree of premature separation placenta

  38. tighten a loop or loops of umbilical cord • Around the fetus umbilical blood flow • Prolonged uninterrupted maternal expulsive efforts dangerous to the fetus

  39. Preparation for delivery • Variety of positions • Dorsal lithotomy position • For beter exposure legholders stirrups • Cramps in the legs (brief massage – changing position) • Preparation for delivery entails vulvar and perineal cleansing

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