Normal Labor and Delivery

1. Normal Labor and Delivery Asja Ćosić Mentor: A. Žmegač Horvat

2. 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

3. 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

4. FIRST STAGE • from the beginning of labor to the full dilation of the cervixto about 4 inches (10 cm) • initial (latent) phase • active phase

5. 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

6. 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

7. 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

8. CARDINAL MOVEMENTS IN LABOR • Engagement • Descent • Flexion • Internal Rotation • Extension • External Rotation • Expulsion

9. 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

10. Fourth stage • can refer to the immediate puerperium, or the hours immediately after delivery of the placenta

11. 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 presentationof the fetus • vaginal examination is done to determine whether the membranes have ruptured and how dilated and effaced the cervix is • intravenous line– toprevent dehydration and for therapy, if needed • oxytocinor prostaglandin are used to induce labor • fetalmonitoring: electronic monitoring is used to continuously monitor fetal heartbeats and uterine contractions (CTG)

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