OBSTETRICS OSCE REVIEWER egpt2010. Internal Examination Dilatation Effacement.
LABOUR Labour can be defined as involuntary coordinate uterine constraction. Cause cervical...
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Transcript of LABOUR Labour can be defined as involuntary coordinate uterine constraction. Cause cervical...
LABOUR
Labour can be defined as
involuntary coordinate uterineconstraction. Cause cervical
effacement and dilataion. Follow up by expulsion of
products of conceptio.
DELIVERY
Delivery is the expulsion of products of conception after viability ofthe fetus(which is around 22 weeks of
gestation.(
LIE OF THE FETUS
Is the relation between the longaxis of the fetus to the long axis of the
mother (longitudinal, transverse, oblique)
POSITION
Is the relation between arbitrarychosen portion of the presenting partand the right or left side of the pelvic,
it also can be anterior, transverse orposterior.
) Occiput, chin and sacrum (in vertix,face and breech respectively.
ONSET OF LABOUR- Estrogen
- STATION OF THE HEAD
it is part of the pelvic assessment toEvaluate the relation between the Presenting part and the pelvis.
It can be determined by the amountof the head felt above the pelvic brim expressed as fifth or more accurate by
the vaginal examination of thepresenting part in relation to the ischialspines and expressed as centimetersabove(-) or below + the ischial spines.
PRESENTATION
Is the portion of the fetus that is Foremost within the birth canal orclosest toil.
It is head or breech in longitudinallie, shoulder in transverselie. Cephalicpresentation is classified according tothe degree of head flexion occiput,Sinciput, below, face presentation.
usually sinciput and brow or transientposition changes with the progress oflabour.
Breech presentation is classifiedaccording to the thigh and leg extension,frank, complete footling.
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CLINICAL EVALUATION OF LIEPRESENTATION AND POSITION
OF THE FETUS
The examiner should first determinedThe fundal height of the uterus.
First the Uterus Maneuvergentle palpitaion of the fundus of theuterus with the tip of the fingers of bothheads, to determine the fetal part that
occupy the fundus].
Second Maneuverthe palm of the examiner’s hands areplaced on either side of the uterus andpress to exert deep pressure (hard
resistant structure is felt, the back(,numerous nodulation is felt in theside (the extremities).
Third Maneuver
By applying the thumb and fingers onthe presenting part of the lower portionof the maternal abdomen, above thesymphysis pubis.
This maneuver is to determine thepresenting part, careful palpitationmay help to evaluate the degree of head flexion and engagement of thepresenting part.
Fourth Maneuver
The examiner faces the mother’s feet
and with the lip of three fingers of both
hands palpate the presenting part of
vertex presentation. One hand will first
feel the prominent part while the other
will descent more vertex presentation,
or in the side of the back in face
presentation.
When the head is clearly enlarged the
shoulder is felt by this maneuver.
■
IN THE FIRST STAGE
OF LABOUR
Cervical changes is the result of two factors:
■Passive stretching as an effect of the
pressure of the presenting part and
hydrostatic pressure of the amniotic
sac – early rupture of the membranes
does not prolonged labour as far as
the presenting part is will apply to
the cervix.
■Contraction of the longitudinal muscle
fires of the uterus.
THE STAGES OF LABOUR
First is the stage of effacement and dilatation of the cervix.
Second stage is for the expulsion of the fetus.
Third stage is for the expulsion of the placenta and membranes.
Fourth stage is for the early recovery.
IT IS DIVIDED INTO
TWO PHASES
1. Lateral phase – start with the regular uterine contraction till the cervix is 2-2.5 cm dilated and its mean duration is around 7 hours (Friedman’s sters).
2.Active phase – from the end of latent phase until full cervical dilatation.
SECOND STAGE
Cervix is fully dilated and uterine
contraction every 2-3 minutes.
It has 2 component:
Phase I – head begins to descent and
patient feels abdominal lightening
)normal to encourage patient to push
at this phase.(
Phase II – head reaches the pelvic floor
And patient starts to bear down.
IT IS THE THREE COMPONENTS
●Acceleration phase – it usually predict the outcome of labour during which cervix dilate most rapidly.
●Maximum slope – it reflects the efficacy of uterine contraction.
●Deceleration phase – it reflect the fetopelvis relationships the dilatation rate normally is 1.2 cm/hr in nulliparous women and 1.5 cm/hr in multiparous women.(practically 1 cm/hr).
THIRD STAGE
Placenta separation happen
through spongiosa layer. The stage
rarely exceeds 5 minutes.
■Separation is the result of:
● Contraction and refraction of
uterine muscle
● Reduction of uterine volume and
area of placenta site
■Retroplacenta haematoma
If the leading part separate first
)Mathews Duncan mechanism( the raw
surface (maternal) will be exposed.
If the centre separate first Schultse
mechanism.
The fetal surface will be seen first.
Signs of placenta separation:
■ Rising of the uterine fundus
■ Blood show
■ Lengthening of the umbilical cord
THE FOURTH STAGE
OF LABOUR
The immediate recovery phase
following the third stage where patient
needs close observation for any signs
of bleeding.
MECHANICAL OF NORMAL
LABOUR IN OCCIPUT
PRESENTATION
Flexion: Complete flexion of head take
place in vertex presentation and the
occiput used to indicate.
Position : LAO,LOP,LOT,ROA,ROP and
ROT
Engagement of the head – when the largest diameter of the head (Biparietal) passes the pelvic brim.
The sagittal sure is in the transverse
diameter of the pelvis so the occiput
is lateral .
Descent is Limited until the second stage of labour.
Internal rotation – the largest diameterof the pelvic outlet in anteroposterior.So the occiput rotate anteriorly.
Restitution and external rotation – theocciput rotate back to its lateral position.
Extension and delivery of the Head
When the vulva is distended over
the largest diameter of the head the
occiput remain below the public arch
and the sinciput sweeps forwards as
the neck extended (tearing of the perineum should be avoided at the stage).
ONSET OF LABOUR- Estrogen- Progesterone- Prostaglandin appears in the myometrium.- Prostaglandin resistance in the cervix.
Management Delivering Labor - Admission NPO IV line Fetal monitoring Pinard stethoscope every 15-20min Continous CTG High risk Patient Internal scalp electrode Fetal blood scalp sampling
Monitoring of Labour
-Comport of the patient Explain what is likely to happen in labor presence of relative Discuss with her pain killer
Material assessment/ 2 hours abdominally/ 4 hours vaginally Support of the perium at crowing Episiotomy Midline Mediolateral Lateral Delivery of the placenta by CCT
Third stage Oxytocin Ergometrin
Abdominal examination during labour
can be done between contractions.
It provides important information
)retraction ring in obstructed labour(