Normal Labor and Delivery
正常分娩
林建华
? Labor,
the process by which contractions of uterus
expel the fetus,
? Delivery,
receive the neonate
1,definition
? Term pregnancy,37-42weeks from LMP
? pre-term delivery (labor),28- <37 weeks of
gestational age
? post-term delivery:? 42 weeks
? Abortion, <28 week
? 85% of women spontaneous labor and
delivery between 37-42 weeks
2,The four factors for labor
? Force ( uterine contraction)
? birth canal (bony canal)
? fetus (lie,position,presentation,weight)
? psychical-factors
Contractions
onset,frequency,duration,intensity
? increase in frequency and duration
? uterus can be felt to harden during
contraction
? lasting about 30-45 seconds
? interval between contractions to be 5 min’
? Intensity (slight,middle,heavy)
? the pain of labor is a character
正常曲线 异常曲线
? Birth canal;
Bony canal
Soft tissue canal (lower part of uterus,cervix,
vagina
Bony pelvis
? The planes of pelvis
? inlet plane (promontory)
? mid plane of pelvis (ischia spines)
? outlet plane(two intersecting triangles)
?
? fetus (lie,position,presentation,weight)
? Long axis of mother
? LOA
? Head down
? Estimation of fetal weight,2500g - <4000g
3,Mechanism of labor
? The process of labor and delivery is marked by change in
fetal position in relation to the maternal pelvis
? Engagement
(BPD decent to a level below the pelvic inlet
An occiput below the ischial spines is engaged)
? Flexion
? Decent
? Internal rotation
? Extension
? External rotation
4,Symptoms and signs of the
onset of the labor
? Painful uterine contraction
? a show
? effacement and dilation of the cervix
? rupture of membranes
The show
? The mucus plug is expelled from the
cervix
? mixing with a little blood
the rupture of the membranes
? at any time during labor
effacement and dilation of the cervix
? to be short,taken up,dilated
The differentiation of labor
? in labor,
spontaneous uterine contraction
with progressive dilation of the cervix
interval < 5 ’
lasting >30’’
intensity is middle or heavy
? False labor,
5,Three Stages of labor
The first stage,
? onset of labor to full cervical dilation(10cm)
? the latent phase ( onest to <3cm,<16h)
? the active phase(>3cm to 10cm,<8h)
The second stage,
? 10 cm to the delivery of the infant,<2h
The third stage,
? delivery of the infant to delivery of the
placenta,<30m’
6,Management of normal labor
The first stage,
? education,eating,walking,
? position(sitting,reclining,recumbent)
? monitoring of the fetal heart rate,
? Palpation of cervix ( effacement,dilation)
? uterus contractions (palpation or electronic
monitoring)
? Analgesia and anesthesia
The second stage
? fetal heart rate
? maternal conditions,
pulse,blood pressure,respiratory rate,
temperature,urine output,fluid intake…
? evaluation of progress of labor
station,position of the presenting part,
status of membranes,meconium,blood
? Pushing,
? with the onset of each contraction,the
mother is encouraged to inhale,hold her
breath,and push
? increase in intra-abdominal pressure
? aiding in fetal descent through the birth
cacal,
? Head visible on vulval gapping
? Crowning of head
? Laceration or Episiotomy
? Delivery of fetus
? Deal with umbilical cord
the third stage,
? waiting for up to 30 min
? Separation indication of placenta,
the fundus changes to a globular shape and firm
consistency
A gush of blood appears vaginally
The umbilical cord appears to lengthen
? delivery of placenta (spontaneously,manually
? inspection of the birth canal
? Repair of lacerations or episiotomy
Key word and questions
? Labor
? Delivery
? Engagement
? Effacement
? What are the four factors in labor and delivery?
? What is the mechanisms of labor?
? Explain the separation indications of placenta,