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Labor, Delivery, and Changes at Birth PowerPoint Presentation
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Labor, Delivery, and Changes at Birth

Labor, Delivery, and Changes at Birth

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Labor, Delivery, and Changes at Birth

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  1. Labor, Delivery, and Changes at Birth Fred Hill, MA, RRT

  2. Fetus in Uterus

  3. Fetus in Uterus

  4. Events of Birth (Maternal) • Rupture of membranes • Dilation of cervix • Contraction of uterus • Separation of the placenta • Shrinking of the uterus

  5. Stages of Labor & Delivery • Stage I: Onset of regular contractions to full dilation and effacement of the cervix • Primigravida: 16 – 18 hours • Multigravida: 7 – 12 hours • Stage II: Full dilation (10 cm) and effacement of the cervix to delivery of the baby • Primigravida: 1 – 2 hours • Multigravida: 20 mins • Stage III: Delivery of the baby to delivery of the placenta • Primigravida: 3 – 4 mins • Multigravida: 4 – 5 mins

  6. Tocolysis • Beta-2 sympathomimetics • Terbutaline sulfate • Ritodrine hydrocholoride • Magnesium sulfate • Indomethacin • Calcium channel blockers

  7. Dystocia • Uterine dysfunction • Abnormal fetal presentation • Cephalopelvic dysproportion • Hydrocephalus • Excessive fetal size (maternal diabetes) • Small pelvic dimensions • Abnormality in shape of birth canal

  8. Abnormal Fetal Presentation • Normal presentation: Vertex ( head first), 95% • Abnormal presentation • Cephalic • Breech (buttocks down) • Face • Brow • Shoulder • Transverse lie

  9. Vertex Presentation

  10. Cephalic Presentation

  11. Face Presentation

  12. Complete Breech

  13. Footling Breech

  14. Frank Breech

  15. Transverse Lie

  16. Other Problems • Prolapse of umbilical cord • Cord wrapping around fetus • Placental abnormalities • Placenta previa: Implantation in lower uterus • Abruptio placentae

  17. Placenta Previa

  18. Abruptio Placentae

  19. Other Risky Deliveries • Cesarean deliveries • Multiple gestations

  20. Changes at Birth • Vaginal squeeze when head presents • Presentation of chest and recoil of chest • First breath: high initial pressures (-100 cm H2O) • Succeeding breaths require less negative pressure • Remaining liquid in lungs • Expelled by coughing and sneezing • Absorption into lung interstitium into lynphatics

  21. Fetal Circulation

  22. Fetal to Adult Circulation • Major changes • First and subsequent breaths • Reduces pulmonary vascular resistance • Air replaces liquid surrounding vasculature • ↑ PaO2 → pulmonary vasodilation • Increase in systemic vascular resistance • Clamping of umbilical cord • R → L Shunting changes to L → R • Foramen ovale closes: mechanical • Ductusarteriosus begins to close due to chemical changes • Cessation of blood flow leads to constriction of: • Ductusvenosus • Umbilical arteries and veins