NORMAL LABOR
DR. BAUTISTA
• Resultant vector → head extends toward NORMAL LABOR CHARACTERISTICS
vulvar opening. • Definition: uterine contractions that cause demonstrable cervical
• Head born sequentially: occiput → anterior effacement and dilation.
fontanel → brow → nose → mouth → chin. • Onset of labor is challenging to time:
Extension allows passage under pubic symphysis
o Clock time when painful contractions become regular.
without perineal rupture. -
▪ False labor – nakakatulog pa si mommy
EXTERNAL ROTATION (RESTITUTION) (bringing the presenting parts into its original position
= ▪ True labor – di na makatulog si mudra + back
pain
• After delivery of head, it rotates back to
If the occiput was originally directed If it was originally directed toward the
- o Admission time to a labor unit.
align with shoulders. toward the left ! it rotates toward the left
ischial tuberosity.
right !"the occiput rotates to the right.
• Head reaches transverse position; FIRST STAGE OF LABOR
shoulders align with AP diameter of outlet.
• Pattern: Friedman described a sigmoid cervical dilation-time curve.
• One shoulder anteriorIbehind symphysis;
the other posterior. bring the biacromial
• Divisions of the first stage:
diameter into relation with the AP
diameter of pelvic outlet 1. Preparatory division – minimal dilation; connective tissue
changes.
Maneuver for shoulder delivery:
2. Dilatational division – rapid dilation at the maximum slope.
• Pull downward on the head/neck → 3. Pelvic division – deceleration phase of dilation with cardinal
delivers the anterior shoulder under movements. (8-9 cm)
the symphysis pubis. Phases 41m
at
• Then lift upward → delivers the
posterior shoulder over the perineum.
D-ends
LATENT PHASE at
Gem
• Ends once cervical dilation = 4 cm. active
• Active labor redefined to begin atAr
= 6 cm.
EXPULSION
• Prolonged latent phase: >20 h in nulliparas, >14 h in multiparas.
• After external rotation:
• Contributors: excessive sedation or epidural analgesia.
o Anterior shoulder appears Duration is highly variable; many with heavy sedation later progress to active
under symphysis pubis.
labor or contractions abate as false labor.
o Perineum distended by
posterior shoulder. O
ACTIVE PHASE
o Shoulders delivered → rest of • &
Threshold when cervical dilation = 3–6 cm with effective contractions.
body follows quickly. • Mean duration: ~4.9 h in nulliparas. (Friedmans) 15 hours)
• Shoulder dystocia if anterior shoulder tightly wedged behind symphysis. • Typical progress (Zhang):
o 4 → 5 cm: ~1.3 h median.
OCCIPUT POSTERIOR POSITION o 5 → 6 cm: ~0.8 h median.
• Face up
o Normal labor may take
▪ >6 h from 4 → 5 cm and
• Occurs in ~20% of labors.
▪ >3 h from 5 → 6 cm.
• Often associated with narrow forepelvis.& placentation anterior
-
•
* With effective contractions,
-
good head flexion, and average fetal size,
~
SECOND STAGE OF LABOR
Begins: complete dilation--
most posteriorly positioned occiputs rotate anteriorly toward the
symphysis.
• & (10 cm). → FULLY DILATED
• Transverse arrest – results if rotation is incomplete.
• -
Ends: fetal delivery.
• Persistent occiput posterior – occurs if no anterior rotation takes place.
• Median duration: ~50 min in nulliparas; ~20 min in multiparas.
In 5–10% of cases, rotation may fail or be incomplete, predisposing to • Prolonging factors: contracted pelvis, large fetus, impaired expulsive
dystocia and need for cesarean delivery. efforts from sedation or neuraxial analgesia, high fetal station at
complete dilation.
FETAL HEAD SHAPE CHANGES
LABOR DURATION
• Mean combined length of first + second stages:
o Nulliparas: ~9 h.
o Multiparas: ~6 h. – MASMABILIS NA
IDENTIFICATION OF LABOR
• In the absence of ruptured membranes or bleeding:
o Contractions every 5 minutes for 1 hour.
o At least 12 contractions in 1 hour.
-
>
Caput succedaneum sonamed pressuresduringdeliver
by
:
Rigid vaginal wall t Cra
INITIAL EVALUATION
• “Edema of the scalp” daw
m
Maternal Status
• Develops in prolonged labors.
• Blood pressure • Pulse
• Attains a thickness of a few millimeters but may be more extensive.
• Temperature • Respiratory rate
• Formed when head is in the lower portion of the birth canal.
Fetal Status
Molding • FHR (fetal heart rate) using portable
doppler/conography/fetscoea
-on
Pregnancy Record (prenatal record ( Ted
• Changes in bony fetal head shape due to external compressive forces.
• Should be promptly reviewed.
• Clinical significance:
o A shortened suboccipitobregmatic diameter helps progress • Check for comorbidities
in contracted pelves or asynclitism. Vaginal Examination X
o Degree of molding may determine whether vaginal delivery • Placenta previa or vasa previa → an IE = vaginal digital examination
-
is possible. must not be performed, since it may provoke hemorrhage.
Cervical Examination
• Usually resolves within the first week postpartum.
• Initial cervical exam provides a baseline for progress during labor.
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