DescribeLabor
as:Labor
Rhythmic contraction
and relaxtion of uterine
muscle with progressive
effacement [thining] and
dilation [opening] of the
cervix leading to expulsion
of products of conception .
con
Definition of labor
the process by which the
fetus,placenta,and
membranes are expelled
through the birth canal.
It may occur at any time
during pregnancy[after 24
weeks] but most frequently
occur at term of (completely
of37ws conception
Normal
labor
Occurs at terms,
spontaneous, with
vertex presenting,
vaginal single,
.
life……,completed
within{18h]
, with no complication
SIGNS AND SYMPTOMS OF IMPENDING
LABOR ;
Lighteing
cervical
Bloody
change show
s prematur
e rupture
false energy
of
labor spurt membran
Lighteing
2-3 weeks before onset of labor the
lower uterine segment expand s and
allow the fetal head to sink lower, usually
is fixed or engaged afterwards the
symphysis pubis widens and pelvic floor
become more relaxed and soft leading
to descend of uterus further
in to the pelvis
some discomfort decreased
con
But other discomfort occur;
feeling of pelvic pressure, vaginal
secretion ,increase venous stasis
producing edema.
Cervical
changes
cervix becomes (ripe)
softer, ,some degree of
effacement and perhaps slight
dilatation[grand multipara
cervix normal 2cm and pg
cervix is closed]ripeness
indicate readiness of cervix for
labor
energy spurt
;
sudden burst of energy 1-
2days before labor the
cause[un known] they become
full with energy doing many
home task
4/vaginal
discharge[sho
w
plug, created by cervical
secretions from proliferation of
glands of cervical mucosa early in
pregnancy which is act as
protective barrier and close the
cervical canal through out
pregnancy
bloody show mucus with blood it
should be differenced from frank
bleeding then labor may occur
premature
rupture of
membranes
normally membranes rupture
at the end of first stage when
it occur before onset of labor
it term as prom occur in 12%;
women 80% of prom labor
begin spontaneously with
24hs
Stages of labor
1st Stage =
Cx dilatation
2nd Stage =
Head descend
3rd Stage =
Placental delivery
4th Stage =
first 2 hours following delivery
(I) First stage:
- It is the stage of cervical
dilatation.
- Start with the onset of true labor
pain and end with full dilatation of
the cervix i.e.
10 cm in diameter.
- It takes about 10-18 hours in
primigravida and about 6-8 hours in
multipara.
-
Phases of cervical dilatation:
latent phase (early):
Dilates from 0 to 3 cm.
Contractions are usually every 5 to
20 minutes, duration 20 to 40
seconds, and of mild intensity.
The contractions progress to about
every 5-7 minutes and establish a
regular.
Active phase:
Dilates from 4 to 7 cm.
Contractions are usually every 3 to 5
minutes ;duration 30 to 60 seconds
and of
mild to moderate intensity.
After reaching the active phase,
averages length 6hs in the
primgravida and 4hs in multipara.
Dilation 1.2 to 1.5 cm/hour
Transitional phase:
Dilates from 8 to 10 cm.
Contractions are every 2 to 3
minutes, duration50 to 60 seconds
and of moderate to strong intensity.
Some contractions may last up to
(but not exceed) 90 seconds
(II) Second stage:
- It is the stage of
- expulsion of the foetus.
- Begins with full cervical dilatation
and ends with the delivery of the
foetus.
- - Its duration is about 1 hour in
primigravida and ½ hour in
multipara.
(III) Third stage:
- It is the stage of
expulsion of the placenta and
membranes.
- Begins after delivery of the foetus
and ends with expulsion of the
placenta and
membranes.
- Its duration is about 10-20 minutes
in both primi and multipara.
After delivery of the foetus, the uterus
continues to contract and retract. As
the placenta
Is inelastic, it start to separate by one
of the following mechanisms:
(1) Schultze’mechanism(80%):
The central area of the placenta
separates first and placenta is
delivered like an
inverted umbrella so the foetal surface
appears first followed by the
containing small retroplacental clot.
There is less blood loss and less
liability for retained of fragments.
(2) Duncan mechanism (20%):
The lower edge of the placenta
separates first and placenta is
delivered side ways.
There is more liability of bleeding
and retained fragments.
The 3rd stage is composed of 3 phases:
a) Placental separation
b) Placental descent.
c) Placental expulsion.
Sings of
separation
1/sudden gush of blood.
2/lengthening umbilical cord visible
at vaginal introits.
3/change in shape of uterus from
discoid[cirlular] to globular.
4/change in position of uterus rises
in the abdomenحف ظ
IV) Fourth stage:
- It is the stage of early recovery.
- Begins immediately after expulsion of the
placenta and membranes and lasts for one
hour.
Nursing management during 4th stage:
Nursing management during 4th stage:
1/assessment
physical assessment
•Bp ,pulse
•funds height
•lochia [it scant to
moderate]
• bladder not palpable
• perineum is intact.