Professional Documents
Culture Documents
Labor
Labor is the physiologic process by which a fetus is expelled form the uterus to the outside world. It involves the sequential integrated changes in the uterine decidua, and myometrium. Changes in the uterine cervix tend to precede uterine contractions
Labor - Mechanics
Uterine contractions have two major goals: To dilate cervix To push the fetus through the birth canal Success will depend on the three Ps: Powers Passenger Passage
Power
Uterine contractions
Power refers to the force generated by the contraction of the uterine myometrium Activity can be assessed by the simple observation by the mother, palpation of the fundus, or external tocodynamometry. Contraction force can also be measured by direct measurement of intrauterine pressure using internal manometry or pressure transducers.
Power
There is no specific criteria for adequate uterine activity Generally 3-5 contractions in a 10 minute period is considered adequate labor
Passenger
Passenger =fetus
Fetal variables that can affect labor: Fetal size Fetal Lie longitudinal, transverse or oblique Fetal presentation vertex, breech, shoulder, compound (vertex and hand), and funic (umbilical cord). Attitude degree of flexion or extension of the fetal head Position Station degree of descent of the presenting part of the fetus, measured in centimeters from the ischial spines Number of fetuses Presence of fetal anomalies hydrocephalus, sacrococcygeal teratoma
Passage
Passage = Pelvis
Consists of the bony pelvis and soft tissues of the birth canal (cervix, pelvic floor musculature) Small pelvic outlet can result in cephalopelvic disproportion Bony pelvis can be measured by pelvimetry but it not accurate and thus has been replaced by a clinical trial of labor
Passage
www.uptodate.com
Passage - Pelvimetry
www.uptodate.com
First stage - A: latent phase; B + C + D: active phase; B: acceleration; C: maximum slope of dilation; D: deceleration; E: second stage. Adapted from: Friedman. Labor: Clinical evaluation and management, 2nd ed, Appleton, New York 1978.
Labor
Labor NulliG
Active 6-18 h ~1 cm/h >2 h 0.5-3 h 0-30 min
MultiG
phase 2-10 h ~1.5 cm/h >2h 5-30 min 0-30 min
Freidmans curve is a good guideline for expected progression in labor and therefore helpful to note abnormal labor patterns.
Labor
Variables associated with longer labors:
Electronic fetal monitoring Narcotic use Maternal age >30 Ambulation
In Summary
Know the different stages of labor Know the labor curve Know the cardinal movements of labor Know the causes of postpartum hemorrhage The remaining talk regarding labor, induction, augmentation, surveillance and complications will be discussed in following lectures