Normal Labor

Tomsk 2019
 Normal Labor
 Labor is the process that leads to childbirth. It
begins with the onset of regular uterine
contractions and ends with delivery of the newborn
and expulsion of the placenta.
 Normal Labor
 At the onset of labor, the position of the fetus with
respect to the birth canal is critical to the route of
delivery and thus should be determined in early labor.
 Important relationships include:
• fetal lie,
• presentation,
• view,
• position.
 Fetal Attitude or Posture

 The fetus becomes folded or bent

upon itself in such a manner that
the back becomes markedly
convex; the head is sharply flexed
so that the chin is almost in contact
with the chest; the thighs are
flexed over the abdomen; and the
legs are bent at the knees.
 In all cephalic presentations, the
arms are usually crossed over the
thorax or become parallel to the
sides.
 Fetal Lie / положение плода/situs

 The relation of the fetal long axis

to that of the mother is termed
fetal lie
 It is either
 Longitudinal /продольное
 or transverse /поперечное
 or oblique / косое
 Fetal Presentation / предлежание /
Praesentatio
 The presenting part is that portion of the fetal body
that is either foremost within the birth canal or in
closest proximity to it.
 Accordingly, in longitudinal lies, the presenting part
is either the fetal head or breech, creating cephalic
/головное / сapitis and breech presentations/
тазовое/ pelvis respectively.
 When the fetus lies with the long axis transversely,
the shoulder is the presenting part
 Presentacio capitis

Occipitalis / сephaloanterior/ frontis/ facies/

затылочое переднеголовное лобное лицевое
Breech Presentation / тазовое / pelvis

 When the fetus

presents as a breech,
the three general
configurations
 There are frank,
complete, and footling
presentations
 Fetal Position

 Position refers to the relationship of an arbitrarily

chosen portion of the fetal presenting part to the
right or left side of the birth canal.
 Accordingly, with each presentation there may be
two positions—left / первая / prima or right
/вторая/secunda
 View / вид / visus
 the ratio of the fetal back to the anterior or
posterior wall of the uterus.
 If the back is facing forward, they say about the
front view / visus anterior, if the back - about the
back / visus posterior .
 Normal Labor

 It is a spontaneous birth with a gestational age of

37-42 weeks in the head presentation.
 After birth, mother and baby are in good condition.
 Normal Labor
 For mother - this period ends with a successful
separation of the placenta and a good condition
after childbirth
 Normal Labor
 For the child - this period ends with primary
treatment and its transfer under the supervision of
a neonatologist or pediatric nurse. A rating on the
Apgar scale at the 1st and 5th minutes should
correspond to 8 points or more
 The term of labor is determined by the
formula:
 - term of labor = first day of the last menstruation +7 days - 3
months
 pregnancy as a result of IVF:
- the calculation of the gestational age and date of birth is carried
out from the date of the follicle puncture, but the duration of
pregnancy is 266 days
 Determining the date of birth by ultrasound:
- the size of the fetal egg and / or coccygeal-parietal size - in the
period of 6-14 weeks:
- ultrasound results in the first trimester (optimally at 11-14 weeks)
- a more accurate method of determining the gestational age than
by the date of the last menstruation
Objective signs of labor onset
 Regular contractions after 10 minutes or less
 Opening the cervix 2-3 cm (more than 1 finger)
 Shortening and smoothing the cervix (more than
80% of the original length)
 Normal Labor
 I stage of labor- the period of the opening of the
cervix:
• Latent phase
• Active phase
• Deceleration phase

 II stage of childbirth - the period of fetal delivery

 III period of childbirth - the subsequent period
 I stage of labor-
 The latent phase ends once dilatation of cervix оf 4
cm is achieved.
 Active phase - dilatation of cervix 4 cm – 8 cm
 Deceleration phase – 8 cm - complete cervical
dilatation
 First stage of labor
- nulliparas 10 -12 hours
- multiparas 7-9 hours
 Second Stage of Labor
 This stage begins with complete cervical dilatation
and ends with fetal delivery.
 The median duration is approximately 50 minutes
for nulliparas and about 20 minutes for multiparas,
but it is highly variable
Labor: Praesentatio occipitalis visus
anterior
 1 moment - flexio capitis.
The head is installed with sutura saggitalis in the transverse /
oblique size of Pelvic Inlet .
The leading point is fontanella minor.
The leading line is sutura saggitalis .
Labor: Praesentatio occipitalis visus
anterior
 2 moment - rotatio capitis interna normalis –
 It begins with the transition from the wide part to
the narrow part of the pelvic cavity and ends with
the establishment of the saggital suture in the
direct size of Pelvic Outlet
Labor: Praesentatio occipitalis visus
anterior
 3 moment - deflexio capitis.
 The extension of the head occurs around the
fixation point - suboccipital fossa.
 As a result of the extension of the head, its birth
occurs.
 Cutting diameter - small oblique size - diameter
suboccipitobregmatica - 9.5 cm,
circumferentia suboccipitobregmatica - 32 cm.
3 moment - deflexio capitis
Labor: Praesentatio occipitalis visus
anterior
 4 moment - rotatio trunci interna et capitis
externa
 face to the thigh of the mother, opposite the position of
the fetus.
 The front shoulder is cut through to the upper third, a
fixation point is formed around which the fetal torso is
bent in the cervicothoracic region. In this case, the
hind shoulder is born above the perineum, and then
the front shoulder is completely released.
 Dolichocephalic
head configuration
Labor: Praesentatio occipitalis visus
posterior
 1 moment - flexio capitis.
The head is installed with sutura
saggitalis in the transverse /
oblique size of Pelvic Inlet .
 The leading point is middle of
sutura saggitalis
 The leading line is sutura
saggitalis .
 2 moment - rotatio capitis interna
anormalis

It begins with the transition from

the wide part to the narrow part
of the pelvic cavity and ends with
the establishment of the saggital
suture in the direct size of Pelvic
Outlet
3 moment - flexio capitis accessorius
 - additional bending of the head, it occurs around
the first fixation point (the border of the scalp). As
a result of the third moment of the bio-mechanism
of labor, the occipital part of the skull erupts
4 moment - deflexio (extensio) capitis
 extension of the head, which
occurs around the second
fixation point - the
suboccipital fossa. Cutting
diameter — diameter
suboccipitofrontalis — 10
cm, circumferentia
suboccipitofrontalis — 33
cm.
Labor: Praesentatio occipitalis visus
posterior
 5 moment - rotatio trunci interna et capitis
externa
 face to the thigh of the mother, opposite the position of
the fetus.
 The front shoulder is cut through to the upper third, a
fixation point is formed around which the fetal torso is
bent in the cervicothoracic region. In this case, the
hind shoulder is born above the perineum, and then
the front shoulder is completely released.
 Dolichocephalic
head configuration
Thanks for attention!