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STAGES OF LABOR

STAGES OF LABOR. DR. RAZAQ O. MASHA,FRCOG Asst. Prof. & Consultant. FIRST STAGE: Labour is the onset of regular uterine contractions with progressice effacement and dilatation of the cervix and descent of the presenting part. PRE-LABOUR OR LATENT PHASE:

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STAGES OF LABOR

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  1. STAGES OF LABOR DR. RAZAQ O. MASHA,FRCOG Asst. Prof. & Consultant

  2. FIRST STAGE: Labour is the onset of regular uterine contractions with progressice effacement and dilatation of the cervix and descent of the presenting part. PRE-LABOUR OR LATENT PHASE: Period of increased uterine activity that occurs for a few weeks before active labour.  facilitates softening of the cervix  some cervical effacement  some dilatation  expansion of lower uterine segment

  3. “Show” OR BLOODY SHOW • Discharge from the vagina of blood tinged mucus (extension of mucus plug from cervical canal). Movements of Labour • Engagement • Descent • Flexion • Internal rotation • Extension • External rotation • Expulsion

  4. ACTIVE MANAGEMENT • ARM • Use of oxytocin • 1.5 cm / hr multipara • 1.2 cm / hr nullipara • I.O.L. • Bishop’s Score: • - Cx effacement • - Position • - Dilatation • - Station of the presenting post • PGE2 • ARM + oxytocin

  5. 2nd Stage • From full dilatation to expulsion of the fetus ♦ Duration ♦ Intervention ♣ Forceps ♣ Ventouse ♣ Shoulder dystocia in macrosomic babies

  6. PAIN RELIEF: 1. Non Pharmacological Methods a. Psychological management – fear potentiates pain. b. Childbirth preparation classes 2. Analgesia - Pethidine and metoclopramidepathilorfan 3. Entonox 50% Nitrous oxide + 50% oxygen – self administered

  7. 3rd Stage • Separation of the placenta • Retained placenta – duration • Manual removal Primary dysfunction labour Secondary arrest

  8. INDUCTION OF LABOUR • Induction • Augmentation INDICATIONS • Fetal • Fetal compromise • Rhesus disease • Diabetes Melitus

  9. Maternal / Fetal • P I H • Pre labour rupture of membranes • Post maturity • Maternal disease – valvular heart disease, renal disease, PIH

  10. METHODS OF INDUCTION 1. Prostaglandins 3mg dinoprostone PGE2 tabs or intra cervical gel. 2. Amniotomy 3. Oxytocin – has ADH action 4. Membrane Sweep 5. Mechanical dilators Latent Phase Active Phase

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