NORMAL LABOUR Dr.(Mrs.

) Eranthi Samarakoon NORMAL LABOUR Spontaneous painful uterine contractions associated with the effacement and dilatation of the cervix and descent of the presenting part. he end result is the !irth of a health" !a!" followed !" expulsion of the placenta. Stages of La!our

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1st stage - Latent phase - Active phase 2nd stage 3rd stage

The oncept o! Active Management o! La"o#r # Antenatal preparations # Rigorous criteria for diagnosis of la!our # $nitial assessment on admission to the la!our ward # careful monitoring and use of a partogram # earl" amniotom" # earl" recourse to s"ntocinon # pain relief # emotional support # ade%uate h"dration # earl" intervention if la!our !ecomes a!normal Antenatal &reparation

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$e%a&ation c%asses E&p%anation o! the process o! %a"o#r and the proced#res invo%ved Antenata% visit to the %a"o#r 'ard Active participation o! the h#s"and

'iagnosis of La!our o%ick( pain sho' pain!#% #terine contractions e!!acement ) di%atation o! the cervi&

( Accurate diagnosis is difficult, specially in the latent phase) $nitial Assessment arried o#t at the time o! admission to the %a"o#r 'ard.

To con!irm diagnosis o! %a"o#r

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To identi!( high risk %a"o#r To commence recordings on the partogram

&artogram (raphical recording of the maternal ) foetal condition and the progress of la!our Monitoring of the foetal condition

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*ntermittent a#sc#%tation at 1+ min. interva%s. ontin#o#s !oeta% heart rate monitoring. ,( inspection o! the co%o#r o! %i-#or

,( determining the !oeta% "%ood p. va%#es. Monitoring of the maternal condition # The !re-#enc( and the d#ration o! the #terine contraction -1/2 hr%(. # 0rogress o! %a"o#r- 1 hr%( a) di%atation o! the cervi& ") descent o! the !oeta% head # Materna% 'e%%"eingp#%se ,0 temperat#re #rine !or ketone "odies *motional Support

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Sho#%d commence "( onset o! %a"o#r $eass#rance E&p%anation o! the process and proced#res invo%ved Mid'i!e in attendance .#s"and to "e 'ith the patient

+"dration

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2eep !asting *3 !%#ids not necessar( in norma% %a"o#r Sips o! iced 'ater or ice c#"es co#%d "e given

&osture Am"#%ation in ear%( %a"o#r assist descent o! the head avoid cava% compression

*ncrease pe%vic diameters 2nd stage

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rec#m"ent- dorsa% / %atera% #pright

%atera% *arl" Amniotom" Done once the active phase has started Advantages o! ear%( amniotom(

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augmentation of la!our ,alone or with ox"tocinto exclude presence of meconeum to facilitate the application of intrauterine pressure catheters . scalp electrodes

Disadvantages o! ear%( amniotom( cord prolapse infection

ARM should be delayed ; if the head is high

in case of breech presentation Use of Ox"tocin Should !e commenced after ARM/ if the fre%uenc" of contraction is 01 per 23 mins. (ravit" fed drips are unrelia!le. An infusion pump should !e used. Starting dose is 145 micro units. min.

should !e increased ever" 63 mins till 6 contractions per 23 min is noted. A!normalities in the 2st stage 4oeta% distress Lack o! progress o! %a"o#r

Materna% distress Lac7 of &rogress of La!our

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&rolonged latent phase &rimar" d"sfunctional la!our

Secondar" arrest 8auses of &rolonged La!our $nade%uate uterine contractions An increased resistance of the !irth canal to the passage of the foetus reatment of &rolonged La!our

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Augmentation 8aesarean section he second stage

D#ration - 1 ho#r in the primipara 1+ min#tes in the m#%tipara passive phase - progressive descent o! the !oeta% head thro#gh the materna% pe%vis.

Active phase - materna% #rge to "ear do'n 'iagnosis of the second stage 5rge to "ear do'n 4#%% di%atation o! the cervi& Di%atation o! the an#s

.ead "ecomes visi"%e Episiotom( ,ene!its prevention o! perinea% tears preservation o! pe%vic !%oor !#nction protection to the !oet#s omp%ications vagina% haematomas increase "%ood %oss in!ection chronic perinea% pain

se&#a% d(s!#nction hird stage 4rom de%iver( o! the "a"( to e&p#%sion o! p%acenta T.A62 785