Normal labor and delivery

Normal Labor and Delivery

Resident Lecturer: A. Polintan, MD

Moderator: V. Espallardo, MD, FPOGS

Outline:• Definition of Labor• Mechanism of Labor• Stages of Labor• Management of Normal Labor

Definition of Labor:• The process that leads to childbirth• Begins with the onset of regular

uterine contractions• Ends with delivery of the newborn

and expulsion of the placenta

Chapter 22: Normal Labor. William’s Obstetrics 24th Edition.


Mechanism of Labor

• Important relationship to be considered:• Fetal lie• Fetal presentation• Fetal attitude or posture• Fetal position


Mechanism of Labor:

Fetal Lie• Definition: The relation of the fetal

long axis to that of the mother.• Longitudinal• Transverse• Oblique


Mechanism of Labor:

Fetal Presentation• Definition: The presenting part is that

portion of the fetal body that is either foremost within the birth canal or in closest proximity to it.


Mechanism of Labor:

Fetal Presentation• Longitudinal Lie

• Cephalic• Breech

• Transverse Lie


Mechanism of Labor:

Fetal Presentation

Chapter 22: Normal Labor. William’s Obstetrics 24th Edition.https://www.pinterest.com/pin/20969954489829027/

Mechanism of Labor:

Fetal Presentation


Mechanism of Labor:

Fetal Attitude or Posture• Definition: A characteristic posture

that the fetus assumes in the later months of pregnancy

• Usually convex• May rarely be concave


Mechanism of Labor:

Fetal Position• Definition: Refers to the relationship

of an arbitrary chosen portion of the fetal presenting part to the right or left side of the birth canal.

• May be directed anteriorly, transversely or posteriorly


Mechanism of Labor:

Fetal Position


Mechanism of Labor:Abdominal Palpation – Leopolds Maneuver• LM 1: Identifies which fetal

pole occupies the fundus• LM 2: Performed to

determine the fetal lie• LM3: Determined if the

presenting part is engaged• LM4: Readily differentiates

the anterior shoulder


Mechanism of Labor:Cardinal Movements of Labor• Engagement – the

mechanism by which the biparietal diameter passes through the pelvic inlet


Mechanism of Labor:Cardinal Movements of Labor• Descent - The first

requisite for birth• 4 Forces:

– Pressure of AF– Direct pressure of the

fundus upon the breech with contractions

– Bearing-down efforts of maternal abdominal muscles

– Extension and straightening of the fetal body


Mechanism of Labor:Cardinal Movements of Labor• Flexion – as soon as

the descending head meets resistance


Mechanism of Labor:Cardinal Movements of Labor• Internal Rotation -

consist of a turning of the head in such a manner that the occiput gradually moves toward the symphysis pubis anteriorly, or less commonly posteriorly towards the hollow of the sacrum.


Mechanism of Labor:Cardinal Movements of Labor• Extension – takes

place when the head reaches the vulva


Mechanism of Labor:Cardinal Movements of Labor• External Rotation

(Restitution) – Corresponds to the rotation of the fetal body and serves to bring its bisacromial diameter into the relation with the AP diameter of the pelvic outlet


Mechanism of Labor:Cardinal Movements of Labor• Expulsion



Stages of Labor• Strict definition of labor – uterine

contractions that bring about demonstrable effacement and dilatation of the cervix


Stages of Labor

First Stage


Stages of Labor

First Stage


Stages of Labor

Second Stage


• Begins with complete cervical dilatation• Ends with fetal delivery


Management of Normal Labor:

• 1. Birthing should be recognized as a normal physiological process that most women experience without complications

• 2. Intrapartum complications, often arising quickly and unexpectedly, should be anticipated.



Admission Procedures• Urge to report early in labor rather

than until delivery is imminent



Identification of Labor• Uterine contractions 5 minutes apart

for 1 hour• Cervical dilatation ≥4cm



Electronic Fetal Monitoring• Routine for high risk pregnancies

from admission• May be used for low-risk pregnancies

as admission test, then followed by intermittent assessment for the remainder of labor



Initial Evaluation• Baseline:

• BP• Temperature• Pulse• RR• Membranes• Cervical assessment



Initial EvaluationCervical Factors

Score Dilatation (cm) Effacement (%) Station (-3 to +2) Consistency Position

0 Closed 0-30 -3 Firm Posterior

1 1-2 40-50 -2 Meduim Midposition

2 3-4 60-70 -1 Soft Anterior

3 ≥5 ≥80 +1,+2 -

Chapter 26: Induction and Augmentation of Labor. William’s Obstetrics 24 th Edition.


Initial Evaluation• Laboratory Studies

– CBC– UA– Blood Typing– HbsAg, VDRL– HIV screening



First Stage of Labor• Intrapartum Fetal Monitoring

– OB Normal• FHT monitoring at least every 30 minutes during

the 1st stage• FHT monitoing at least every 15 minutes during

the 2nd stage

– FHT• Immediately after a contraction at least every 30

minutes and then every 15 minutes during the 2nd stage



First Stage of Labor• Intrapartum Fetal Monitoring

– High Risk Pregnancy• FHT monitoring every 15 minutes and every 5

minutes during the 2nd stage of labor



First Stage of Labor• Cervical Examination

– 2-3 hours intervals during the 1st stage of labor

• Oral Intake– Food should be witheld during active labor

and delivery



First Stage of Labor• Intravenous Fluid

– No actual need unless analgesia has been given

– 60 -120mL/hour

• Maternal Position– Let the woman assume the position most

comfortable to her



Second Stage of Labor• Bearing-down efforts• Active Management of Labor

– Amniotomy– Oxytocin


Degrees of Perineal Laceration


Degrees of Perineal Laceration


Active Management of Labor


Admission:Cervix 4cm

Amniotomy

Internal contraction monitoring

Oxytocin

Delivery

4-8 hours depending on

parity


parity

2 hours

3 hours


parity

THANK YOU!

Health & Medicine

Normal labor and delivery