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NORMAL LABOR AND DELIVERY

MARY ANN R. ESTRADA-RATAG,MD MAY 13, 2011

troublesome effort or suffering PARTURIRE - to be ready to bear young

HISTORY PHYSICAL EXAM LAB TESTS

FUNDIC HEIGHT LEOPOLDS MANEUVER FHT UTERINE CONTRACTION

LEOPOLDS MANEUVER

95 % of all labors in occiput or vertex presentation LOT 40 % ROT 20 % OP 20 %

Fetal lie relation of the long axis of the fetus to that of the mother Longitudinal Transverse oblique

FETAL AXIS AND MATERNAL AXIS AT 45 DEGREE ANGLE

Presenting part is that portion of the body of the fetus that is either foremost in the birth canal or in closest proximity to it Cephalic presentation Breech presentation Shoulder presentation

Head flexed sharply Chin in contact with thorax Occipital fontanel is the presenting part

Neck sharply extended Occiput and back come in contact Face is presenting

Head partially flexed Bregma presenting

Head partially extended Brow presenting

Thighs are flexed and legs extended over anterior surface of the body

Thighs are flexed on the abdomen and the legs upon the thighs

If one or both feet, or one or both knees are lowermost

ACROMION

Fetus forms an ovoid mass that corresponds roughly to the shape of the uterine cavity

1 L2 L3

L4

CERVIX PRESENTING PART STATION BAG OF WATER CLINICAL PELVIMETRY

Sacral promontory Ischial spines Pelvic sidewalls Concavity of sacrum Subpubic arch Ischial tuberosity

Monitor Fetal well being progress of labor Oral intake IV fluids Sedation, Analgesia

Urinary bladder function Enema Maternal position amniotomy

FHT Monitoring Maternal Bearing Down Asepsis/ draping Episiotomy

ENGAGEMENT DESCENT FLEXION INTERNAL ROTATION EXTENSION EXTERNAL ROTATION EXPULSION

Biparietal diameter passes through the pelvic inlet

DESCENT

Pressure of amniotic fluid Direct pressure of the fundus Bearing down Extension and straightening of fetal body

FLEXION

Chin brought into more intimate contact with thorax

INTERNAL ROTATION

occiput gradually moves from original position anteriorly to s. pubis or posteriorly to hallow of the sacrum

EXTENSION

Brings the base of the occiput in direct contact with inferior margin of s. pubis

EXTERNAL ROTATION
The delivered head undergoes restitution Movement corresponds to rotation of fetal body

EXPULSION

anterior shoulders appear under s. pubis, perineum distended by posterior shoulders

After delivery of the shoulders, the rest of the body is quickly extruded

LATERAL DEFLECTION OF THE HEAD TO A MORE ANTERIOR OR POSTERIOR POSITION IN THE PELVIS Anterior asynclitism Posterior asynclitism Litzmann obliquity

ROUTINE vs SELECTIVE TIMING TYPES: MEDIAN MEDIOLATERAL

REPAIR HEALING POST-OP PAIN BLOOD LOSS DYSPAREUNIA EXTENTION ANATOMICAL RESULT

TIMING SUTURE TECHNIQUE what structures are cut? ANESTHESIA How to check if done CORRECTLY?

FIRST DEGREE 2ND DEGREE 3RD DEGREE 4TH DEGREE

Check Vital signs If uterus contracted or not Urinary bladder Vaginal bleeding

THANK YOU AND HAVE A GOOD DAY