2 Labor :the process by which contractions of uterus expel the fetus.Delivery :receive the neonate
3 1. definition Term pregnancy: 37-42weeks from LMP pre-term delivery (labor): 28- <37 weeks of gestational agepost-term delivery: 42 weeksAbortion : <28 week85% of women spontaneous labor and delivery between weeks
4 2. The four factors for labor Force ( uterine contraction)birth canal (bony canal)fetus (lie,position ,presentation,weight)psychical-factors
5 Contractions onset, frequency, duration, intensity increase in frequency and durationuterus can be felt to harden during contractionlasting about secondsinterval between contractions to be 5 min’Intensity (slight, middle, heavy)the pain of labor is a character
11 fetus (lie, position ,presentation, weight) Long axis of motherLOAHead downEstimation of fetal weight :2500g - <4000g
12 3. Mechanism of laborThe process of labor and delivery is marked by change in fetal position in relation to the maternal pelvisEngagement(BPD decent to a level below the pelvic inletAn occiput below the ischial spines is engaged)FlexionDecentInternal rotationExtensionExternal rotation
13 4. Symptoms and signs of the onset of the labor Painful uterine contractiona showeffacement and dilation of the cervixrupture of membranes
14 The showThe mucus plug is expelled from the cervixmixing with a little bloodthe rupture of the membranesat any time during laboreffacement and dilation of the cervixto be short,taken up,dilated
15 The differentiation of labor in labor:spontaneous uterine contractionwith progressive dilation of the cervixinterval < 5 ’lasting >30’’intensity is middle or heavyFalse labor:
16 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, <2hThe third stage:delivery of the infant to delivery of the placenta, <30m’
17 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
18 The second stage fetal heart rate maternal conditions: pulse, blood pressure, respiratory rate ,temperature, urine output, fluid intake…evaluation of progress of laborstation, position of the presenting part, status of membranes, meconium, blood
19 Pushing:with the onset of each contraction, the mother is encouraged to inhale,hold her breath, and pushincrease in intra-abdominal pressureaiding in fetal descent through the birth cacal.
20 Head visible on vulval gapping Crowning of headLaceration or EpisiotomyDelivery of fetusDeal with umbilical cord
23 the third stage: waiting for up to 30 min Separation indication of placenta: the fundus changes to a globular shape and firm consistencyA gush of blood appears vaginallyThe umbilical cord appears to lengthendelivery of placenta (spontaneously, manuallyinspection of the birth canalRepair of lacerations or episiotomy
24 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.