i oc feces OSC stall e oennunnoUeee SNORMAL LABOUR.” Monday a * Normal tobow- fat gfe PRE-LABOUR ee ae Taye LABOUR r Tere are 4 Pains. observed bon! ees, ‘following by | inJoe) gods) ae tvers| wend] Roe Primi = 12 Reg Seat Un tour). eM alti Par’ she Dizference bho falge. g TRVE LABOUR PRIN ee True labour » Site: Lower abdomen SIRE != Bower abdomen, ~— TREKS ; a lomen, — Back region. e Pots and — S/he ronadacky + Pains ove — Regular ~Or frregular = Rhythnve * No Cx dilatation - fic — Howe of? & on character. Cue al (+ Pitociaded with Cy dilatation, Pfearance oP SHoW~ | + Btowd with mucoid discharge |? Ne bag of water. q which is called of SHow o* - i * Og of water + when cdilake, Pain subsicleg after giving. Ben He Qianton é enema, chavion mamb: bulge cain or Amniotic flutd, + Pain neverdtubsider after ving | enema or Le hey after 4 enema: pLaborer ran St Ros tuo P- ‘se Ev sies LATENT PHASE | ere * True tobour Passes and up-biu cervix tg 3em dilated. # Actual vole :— Cervix becomes Short called 08 Cx ePfacment. cx Lalu TE betome Sport and then ditate, +3n a Prins Patient -) 6-82 Latent Phare, +90 a mubtifarous => 4-6 hy! According te WHO , Latent Prose 114 sald to be Prot iP duration of tatent 1s 78 ACTIVE PHASE fe + When Cxig Zemdilated ufetu ” Pally dilated i;2, locm. # Main role :— Cx dilates during. active. oe ¥ Minimum rate oP cx ditatation rg eS Jorn /Powr- Fouts what te the Intre-uternine Preure during TSt 440g, of Labour 2 Amit 40-50 taal lo Fous+ Whey the merobrane rufture during Labour ? Ant Membranes refture at the end of TH stoge aoa Sh Stadt of abo + Sm the 3rd stage of Labour baby hos te undergo Cardinal movement of labour. a Engagement a). |, Descent aye Female. 4) seal Onternal rotation 5) |_ Hooaey — . Crowning. to s)[_ em Ploy extension , with hy Read op te baby delivered] DL Riser | Restitution. 9) [eral — external rotakion, e+ And uu'th lexternal rotation ; whole of the ay op boty delivered . ENGAGEMENT 2 taken the. Aargest transverse diameter of petal hand yt | Possed through the Pelvic inlet- H Largest transverse diameter tye Bifarretal, cliameter ef the fetal feod. 4 yl By Parretal diameter come or reach to Pelvic mek, Hat means head tay engaged. » Size RP Petue adequate te arje of Pelvig Canta. of. non Engogement:i= | + OcelPito ~ Post. Position: m/c cause af non - engagement, + CePRalo — Pelvic digProPorbional. (cP9). Either the head ig big or Pelvis tg So short: ee ees Qn Primus) 36-38 weeky. ny Muti Paroug =) Ot the onget of tabour- 7 36-33 usekg fread Joe clown’ in Pele , te. wold Peed Aightening and fundes AIGHE Les. 3. CROWNING ¢— ; Thon the uberug Contracts , the Road of boby, going Come down : That atage, whore the hood of baby ty Pormanerst /, Cont'nu. visible at the mothers ferineum , whedhor Phere te Contraction or relaxatton of the uterug oe a « When Crowning hos occur , then only aftdlotomy dos te 3h 2 Best timeop Pisictomg given—> pfter teod cranny: ! hog occur :. 4 + Head of the baby tf normally detivered oy feeenze] 8). Aj. RESTITUTION ?— Choulderlg movement: ope + And wit dhoulder's movement , Finally au of the tody wiv be delivered => antro-uterine Pretture durin 474 _ stage of Lebour . dmg joo- (90mm. | std-STAGE OF LABOUR F- %& Human Placenta ig dediduste in nature fe Placenta thede after baby'tbirth on Hs cum. “PASSIVE MANAGEMENT: SEO +9n ths, no need +2 do anything for Placental birth. + But; leading 18 Por IS thutes, ten we don't do Posive manage cmert becauge of oceurener of Post —Ruttium Aasmorrhoge Hen we do Active peed ace LPP ay 38 we are doing this wanogement: , duration op 3°4 stage bewmey 5 minutes ty 2 Lt ty decreases Qnd Chan lg des too: co of PP TI ste s aPler the. delivery of thoulder of baby’, we us cae me give uterotenic agente 4 mother. # Best uterotonie ty oxytocin, an Ce ee gl Helge uberotont = Ge crotonice uteruy Contracee | ton pre —metrine. of uterus alto Contrack€ dng Midd te layer nd then , there ig no bleeding. De" stef once te boby Aas delivered donot cut He UmbiltCudt immediately because, rae of bared ree Ab He Placenta, Lo His U called af delowed Cord Chun OF we can ait dordte Pulsation ty cord and SLUt}2 He bleot , wLatever lord fr-Om Cord wae ’ He baby, [mene we Javer Soom Slovd , uabrck Leseffices to Prevent anemea in baby,Abie the delivery ef baby"er before He cord cut , we tte Placer the -tray below the poert t Lobdamen, carp gf o +4 Placenta iy delivered agy tts method Is colled of Controlled Placental traction or ModiPred Brandt: Andes See Tico eating Qe (Ean Cxbthe th: techie - » when we are Pasting the uterug ufward and tractiongy the.» Cord): dounusard cae forward , Placenta tf ein ag Isversion af the eters 3— aa once the Placentea fae CaO gue: 1 5G Bee uderue Aothat uterw Contracty mosh delayed Cord clumping i= SSS Ore SES PL | There Are some. tonditiong, in whick we dont ciao | | 1), JB baby i Preterm and | Somd ef blood Coning. te baby, than we udu do early cord clumping. 3) 32 beoby Rog birth ouPhy xia (Pyfou'a jee immediate early Cord ee ale Sf mother (4 Hiv tive, 4), Convultiong (ip mother ty drabetrc) , DEwWVveRy Of PLACENTA By CARD TRACTION :— ea Before giving traction to Placenta , ue Rave to ~ dure Hot Placenta or detached from the uterus Signa ef Placentel detachgnent!— i Dt Inoludes | Per abdominal’ and fer vaginal | igng , Which we examine,PeR ABDOMINAL PER VAGINAL Riba ee eee =, bterug utll become firm & | — Guth of blood comng out globular- poe ee = When Placenta will sefarate, — Bae on of LE diag ot Lower segment retained fart of Placepta ty | op uterus - the main a° cause of Post pun He -Huy there tg a bulgg Partuen Posmorrfroge : on Internal of , Known af | >So He ae bo Hes Placenta Pubs on our Rand and examme the seh ennge mised ee Placenta . A Bub cP ue usu do curreteze of uterug for missed parte Placento , Hen offerors Can occur in uterts, usftel ity Known Asherman syndrome. Mou + what ts PreciPttate Labour 2 Ari -3f Whale Process af Lobour ComPlebe within 2 Pours. 4 Szage of Labor ee a en f » Duration ep sth stage of Labour tt | four During this stoge » PRysiological chibs can be exPerienced aay mother (ije tBivering in body), + Progress of Labour ossersed hy fartodrams— ‘dilatation “94 CH the method for o#asnng. ascend $7 Paod. Process of. Aabour , given 4y. WHO in the safe motherbood Programme. < Sy & X~ Oey, — Mine Dotes, (723)a may * Thee Lines are cbated ufon:— i > Prolonged latent Phase of Labour rye 78Are. > Inthe active PRose , unimuin rate of Cx dilatation ts Lom [four + Ake. t they Partograns when He Labour is deft of te alent Une that meine Labour MW Progratting norinal. + Sf Labour going toward’ right oP alert Hine ; 14 ls now Prolonged Hobour: Then we prove 45 give’ orytdn + SP te touches the action [ine , weshould Aave te take dome action tye, we Rave te do —C-deetioo or Porceptsdeli vay or vaccum » or dave ty give i a in » SF only cx ditatation 14 occuring om x oncu Katy , dub prog tes carad of Feod | then Hey ty haba Parckograty ten tt te Colled of cervitograr,; PELVIS 2 Peluls ty “mode uP of ‘two enominate 2— = Publis Sdeunm — Igchum, +The fart oP Pelyig titer above. Ainea, fluid, is called og False Pelvié Jt only sufforts the uffer Part. of Petuis, ¢ The Part bel owe lineafelvis, tg Called of True feluig 36 suPowds Ha Lower Part off Pelvis.TROE PELVIS HAS v Pelu'e Tree ass bet ae Bra CERT AINamPoRTanT DIAMETER $— (NADOR DiAMETER) . SES LE eels bie Seete Ae teiieen r — io | DIANETER INLET MiD-CAVITY ovT-LeT | { AP OMeTeR lem MH -LU5 Cr 13m } Crave conavenr} OBLIQLE 18cro TRANSVERSE 13cm TOC Why DIAMETER escang) (vores DIAMETER DIAMETER BL PELVIC INLET 7 Gt Ros ada iesesy? TRUE ConaUGATE, OBSTETRICAL CONJUGATE. DIAGONAL CONTUGATE +941 the distance. blo uffer border ef. Puble tym Py aie and dacra}’z Promontory. St le Um, + Jt le the distan@ = [+94 Ty the distance bfa| blo middie of the Aowe, border ofHe Pubs ~ symPhu sie Publ aymfRysis and and dccnat Promortry sacral Promontory, * SEI10-10'Sem, 2 St ty \Qcm-—s + Small AP diameter of Pelvic, inlet “i obstetrical Congfug ete That's uahy rf a Petar Rend Cross thls diameter , then WE AM Poster Pro atl other conjugater So He obidetra) Conjugate 1 smog innPortant: “Normal delivery is not done, Fi fetus Pood ts not doing > TR obstetrical Conjugate. sig Zlocm ; then Re ~ delivers of Boab 4, vagina ig never Possible. CONTRACTED PELVIS: - eee eek Qn which Pelvis tg Zloem. a Critical obatetrical Confugate a Sa et + SB obstetric Conjugate ig Legg tan thig value 1 wach wormal delivery ig not Possible end that value i loom. SR gy Ried AP-diameter ig measured Clinically 2 Ari+ Diagonal conjugate. # abrcR AP diameter ig Least tnfortant or significant ? Art? TRue Conjugate. ' « True Conjugate a), diagonal Confugate — | >, to —] Oi seetrierl Gn igale =) EOlagabetnCary pik: ot 3 cals a) ess oes ; 2 : >) [lo Sem « Trangverse diameter of tree =), Distance blo two Porter Lnep will see be the -bransveree dva finde,+ ORLique diameter s__ eee Cee Olatance bla gacro-"Liae goin of one tid2 and farieto Rintnence of other side. A MID-PELVIC or feLvic cavITy 3 ES Sra eae + Jt Les over the chral gffne. 1 OBstetrical afgnificance of Ischfal sftme 3 — grea CIC Cea ESE) I). When Be Ore doing cardinal movement ithe on tHettme of engagement sine head rit Lifer on dike techial 4sPines- a). Head ig taken at © (30) - station , 2 12 Read tt on techral sfine. (Sehial 2 7 ‘ . SPi 3). ThenMFobation of Bead occun Me 8 | | and Read Comer at tgchial afine- 4), Levator an? muscle originating from teh'al sfine and | when head touches then Levator ant muse , Le ud! dive retiatan @ te Read end tb att be Plested saad 5). Internal fidandal nerve Of tre Level of tachial afte} — Shwe Pane te Block P. nerve Sfine ty tho dite of to give: anaesthesia . — Plane of feast feluic diameter. Roueg + Boundries af Plane of feast Pelwe drameber 2 Sur Antetionlys— Pubte syrPripscg acttachee te Levator Onf Mugla te, udval sPine and Hen sacro ~ £Pinoug AU et ensts | e teeta Su — Sg (Sacred) vertebroe. au Quse = hich Plane. cg fraP. tm obstructed diametery— And Plane of least Pluie diameter « fiO13 + DP diameter of. mid — Pelvis 2 Pikes: Btétan ies‘ bfia: Locer! border ef. Pubic ayoa heyy and guntion ble S, 8 Ss - je UN-W5em, Quer. Dutance b/w woo wehral fine? — f 4 Png» Ig brantverse diameter (S4Pirous ay) ep red cals uns which one fy the smallest diameter of Pelvizo , Ang+ — Bhsfinovg diameter. 8: OUTLET i Ques 41 AP diameter ef Sutleb ? Tay Sithond ble Lower border oP Puble yn Physue and gunction oP sacrococcygeal border. Quart Trangverte diameter ty what) Any Oistane b/d two iychial tuberosity . Jt ts alto called of Bituberow diameter. Guess Rat 13 the mallet, diameter of outlet? dts Posterior gaggital dianweber of outleh - And Lf the diztene b/us gacrococeygeat gunetion and the Place ulere “AP and Trangveize diauck: Ore Posing , ; # Angle b/w Pubic bones ty called of subPdre angke- On femates Hs Gngle > 25-40 res Ne ae 280) pon core Pelviz ig mildly contracted , we Con try Por “vaginal deliverg jig called og Trial oP Labour:TRIAL OF LABOUR! — We Know that Pelvic inlet ty wildly contracted and Se aReee u a VR fe ioe seed i \). Trial of Rabour never yf md Pelvitg ste Contracted. a), Sf the outlet ty Contracted. 3) DR female Has hoot diseate Hen we only da C-sechioy 4). 92 Pewale Pog Previour C-section - " FETAL SKULLI= Sutwre seParating two frontal boneg are called Frontal 4 Fronted Suture, » Suture which seParates Frontal Ant. Fortaible 3 Parietell ronal Suture, and Parietal bones ig called | Sagittal» Of Corona) surture- \ Post. fontanelle. + Suture ube sePurates | Oceriray Lambdoid seiture two faretal bones ty cottedor Li. sogittal Suture + cuture which defabate Partetal 2 occiPital bones iy callid 24 Lambdoid Suture. Fontanelle ap 6 Pontonelle at the birth of babies. — >Tuio fontanele are tmPortoné 2— Anterior fontanelle. Posterior Lontanelle + diamond #hofed. * Triangular. in choPe- + Bonded -by Antertor * Bonded by sagittal & deft & Ey — Fronted suture Lambdoid sutwure- — Left and r1g ht coronal guture| + Closes at ether Immediately. — Sagittal Suture (closes atte after birth or after 6 Ulijg years old. months of berth.r + All tranaverse, diameter of Petal seul are fmaller than the BP diameter TRANSVERSE DIAMETER §— SSS Mfsg —> by MASTOID diameter 4-5 Tino —> 9 TeNPoRAL > Bem SO —> sufer SUBPARIETAL 1 85cm i PRetty> gi-PARIETAL ow q.509 inten cia tu berg eeetronsvente diaacieg Largest AP—diameter => Mentovertical diameter sp loca of Petut “Peod a, Crerverdehgel cllameteny. 9 ier Hy Band dots delivered the AP diameter’ Comes Pirbt. And Huy dea. os vary trPortant ola. for engaging Be aes ier pias) eel barenteen gran why Vaginal delivers Can never + 97d horgest AP diameter (4 Monbverticall dia weber Whiek ig equal to acc'Pitefrontal dlameler nS om PARTS of FETAL SkULL 2 a I ea east rae ned a It 16 ‘divided Inte 3 arte: — ' : I). Vertex > Parti ef Her tkult ying ig the Polson! anil aed anterior Pontanelte. ‘ 8): g OCC Oren of Skull ties blo Ho cunts Pontanelle and He root of nose Ond su Pracrblbal region .3). £ Renee area blw root of nose , suPraorbditelregion | te chin. + In anencefhabas of Faken, Pacer ts He Wi) Presentation: Relationsh7P blio mather's aPine and fetal 4Pine , called og Longitudinal Ave. And tt ig He ufo Le. OR Babylt sfine Lie at one angle of mother's sfine called 94 oblique Lie. OR Baby's Pine Mer at He 46 angle te molber's shine Called Of trontverse Lo. —> Sq. ak Hig n n vaginal delivery Canttecenur | whether alive or dead 1 So we Pave to SoG ieeeo, PRESENTATION t+ ts te Pant of Petug Lie in Lower Nes peters goetee eee y soar of uterus - Sn lorpitudina) Lie — role cefRabie eres = are bracck. S Sn transverse Mer Sn — toutder Presentation Manogement!— C-section for dood babrey. + Neglected Shoulder Pretentation, manage by C: section. » 3n He a . there Can be Pand Prolalte Cie babys bend can come down from vagina) « Management ;— c gection.ao Mo in tranaverse MMe . Arst High CRanceg of Coming out of Cord or cord Prd abee. + IP Presentation ig cePfhabic ten Hot fart exactly 1st ove, He internal O4 Fre Presenting Port + Sm cePhatic Pregentation Can be — vertex 4 — Grow = Face Sn brow Presentation > voginal delivery wy not Possible. SHenoiein ato nee Siar =. eae = + JK the bony Point of the referrance on the Presenting | Part- ‘ > SP verter Prezentation , HenttereferrancePoint yasy OC Puck [| Soa cbrow 4 * ay ae SuPaorbte i i Face. | Oc Oe® » ” A shin] merit | i > Transverse li i 55 verse lie. ~ " => dorsum o-bobs | fine |. # mle Position tg deft: océPi-to Transverse, (Let ), which if Pollouresl “by AEE weerPtts Antertor Sp cose of face Presentation Ip the baby 18M menkotraniverse Position } Vaginal delivery, ta not fous % If mentoanterior fosrtin , , Oe tee Hoon on Poaterror et s n not Po-saitle Hen we fare tp clo Cesarean 4ection. OCCIPITO POSTERIOR Pos iTION => « direct oceiPut Position 4 gacrum. % Of tufPose , during voginal delivery aby ig fy aceite Posterior Postion , then what we Paw t dod dye gust watt and watch -1 baby uly take time tetome in Anterior Position. DeeP Trang verse: arrestin * Role Waa ere en eet + When oceiPut trey transverse for Veen hour . ~ Baby ts tongitudtnal + vaccum delivery Ge » Ventussed a, > 34 oPtionsmanual rotation of teod Pollowed by forces me ; ler Sag ar aterel ancl stare DeeP Sacral arregt g— SS : Management 1). Cesarean section. HY 9). SP Pelvi'g ta very brood » wecan.try Pace ts Pubts delivers. BREECH PRESENTATION ge 2 al + mIC Comte of Greeck .P . ia Preterm elfen 2 Sn dePbote terug agaty Breach» P. Management of breech. P 2, =e Maneuvers whick are Wed are aftrative:= ). EPSIOTOMY 2— Sea SS Steorgicably Plarined Incision , given on the Posterior vaginal Wall | te Pacilttake the delivers Pf the head v- Median afigiotomy , — AL angie LU5° inediolateral ePisiotory., - Lateral Sats ~ d-4hafed n + levator an! Inui @re not cut during median Peck, Medion EPISjoToMY MEDIOLATERAL EPISIOTOMy te iat nest Se + Muscles are nok cut: » Musdes are, cecb- ° Bleading lees, Bleadhiing. ($ more. © ReParr ‘ty cosy. + Refatr fs df PPPoube- Sea bs very Good . Healing ig not good, « DysParuntea uu be legy io DysParunia i$ more. Udn duning | : Onl fogera: and Vong a eeog oF wouscleg iS cub , But anu dowd). Vrogenit . 1 — GBalbosPongrous 5 not be injured, i P DISADVANTAGE 3— of madian ePrsictams | 2 i then » Jf medfan efisiotomy extenda 4 anus 3Phincter , fecal Incontinence Can ocow- in females Q ywost foreword. used efraictomy ADVANTAGE: g—. of. Medio lecteral, ePisio tomy, ere Fo EM et ( BE never Injure tHe anus Rigid Perinenin Uke in Primigrautda (Q) feral: —> Instrumental delfvers ; 5 petit ae ecco Feod “tn breach . —> Macrosomia p ° Times Siving ePsrotormy =) lon p crowning tg occwy. o And op we do nat do efiys en 4 Rear” Can” gee tue Perineal tear. 2, ForcePS DELIVERY 2— Vesna (when Le neaded), on Us 00M 114 Called o¢ a TyPes oP -dPPtication af Porcefs s -' Postlonsticed . Reaition of Yetel Rend | —— Parceta ited, I).nk JEPBascaction + Head of fot aby ees eae roe aren + Kyelland!s forcege (Gutclated these danas | Pine. Reads son-engaded: «Md - Pelure aPilreadiod- tg at te. 7 9) Pelvirg aff ve a Peer Cre 0-4tbabion o tsbateh . StmPgon ‘|: Heod t engaged, B Low Porcofs apPlicatibn. Head iy ingbelo the level of 4-4 Eatin butnot reack att vulval region - *Heod ‘engaged, a4). quitter foreofs.|- read 6 ae + wrighey's Poreopes , vf velval atlet | yp yo par of 6 veibie Byors the. birth Canal uta De erigeer baad mm He level of outlea: # sPedal tyfe & Forceps used in Heod delivery tn breach} => fifer'4 Porcefs. é + 4 & Kietland's forceps 4. only these “can rotate the Rood of _ baby + Also K/a Rotational forceps, So used In deeP transverse arrest: : i conditions fy which forcePs we tan Contraction h utere ns ‘4 Jot P< biadder should be empty. , nn. engaged- Peuis SPotd ve adeqrar Cnto contracted Paluig or no cP). ut, SP Cervix 1, cae dilakd | Rood of fotus Ut at He devel of +9 station or beloio tt and Petal digtresns Usbet te te management? Au+ Forcofs Sree Quiz Head of Retwe ts not engaged or at -|gtation, and fete hay fetal diigtrese » what Ute man aps Ania Cesarean ection. 7‘ %& Maximum tyrisg caf. fercebe for deltvery => 3. Jd after Zbieg 9 |b n Peod t¥ not delivered Hen we fave, te Cheose, Cegamean section. * More @nd more ea for forceps cos Lead ty rau track. eto lal Hy Ee Ute of ma. of mother's genital| OR vaccum OCCU 3). Delivery wit vaccum r— o Sritial Pregiure for vaccum we. —> 0-9 &4 [ore ° Find Preswre non’ a > OB Rg (ane ADVANTAGE 3— eee OF He cervie c4 only bem dilated ; Hen even we can -afPly » the vaccum for delivery. ‘ 3): Vaccum Can rotate He ead of baby ye in deeP trangverse arregt vaccum YW He bet management for eee DISANVANTAGES 3 — pesca I) 947 can dead to Lot of trauma Ae fetus. — Intracranial Rarmorrhage of Portus, — Retinal, n ~ Subgalial oS ’ 2). Vaécum should never be ued in Preterm delivery , Hege’ “Babiee fone soft oad - a): JE baby Pag sui fected bleeding digorden. ujs JE cane be, afPined iy any other Pretentation except | vertex Pregentatton . and doef tenaver ' ee oe Oce'pttal ocei Pisco} anten'or fos terforK Marientinm Pulls Por deltvery uth Vaecury 3 tre, Novem Inter changing. i» clcliv es oe Prccaduresefier Sher: ead, watt force fy. “conTRACTED PeLvis es ooo. wag Ory of tnaferdiameter of Pelvis led boy Vgtho , te called Of Contracted Pelviz. o sf obatetxical Conjugate 4 4 tocm Naegle '& Pelvig :.. eee cone ala of facrurm ts absent’ Management !— Cedarean section. Roberts felviz .— ee ee SS eo Both ala op dacrum are absent’ Manofement :— Cesarean section,