1. Normal Labor and Delivery 正常分娩
林建华

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 age
post-term delivery: 42 weeks
Abortion : <28 week
85% 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 duration
uterus can be felt to harden during contraction
lasting about seconds
interval between contractions to be 5 min’
Intensity (slight, middle, heavy)
the pain of labor is a character

7. 正常曲线 异常曲线

8. Birth canal;
Bony canal
Soft tissue canal (lower part of uterus, cervix, vagina

9. Bony pelvis The planes of pelvis inlet plane (promontory)
mid plane of pelvis (ischia spines)
outlet plane(two intersecting triangles)

11. fetus (lie, position ,presentation, weight)
Long axis of mother
LOA
Head down
Estimation of fetal weight :2500g - <4000g

12. 3. Mechanism of labor
The process of labor and delivery is marked by change in fetal position in relation to the maternal pelvis
Engagement
(BPD decent to a level below the pelvic inlet
An occiput below the ischial spines is engaged)
Flexion
Decent
Internal rotation
Extension
External rotation

13. 4. Symptoms and signs of the onset of the labor
Painful uterine contraction
a show
effacement and dilation of the cervix
rupture of membranes

14. The show
The mucus plug is expelled from the cervix
mixing with a little blood
the rupture of the membranes
at any time during labor
effacement and dilation of the cervix
to be short,taken up,dilated

15. The differentiation of labor
in labor:
spontaneous uterine contraction
with progressive dilation of the cervix
interval < 5 ’
lasting >30’’
intensity is middle or heavy
False 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, <2h
The 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 labor
station, 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 push
increase in intra-abdominal pressure
aiding in fetal descent through the birth cacal.

20. Head visible on vulval gapping
Crowning of head
Laceration or Episiotomy
Delivery of fetus
Deal 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 consistency
A gush of blood appears vaginally
The umbilical cord appears to lengthen
delivery of placenta (spontaneously, manually
inspection of the birth canal
Repair 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.