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Labor: is the process by which a viable fetus (at the end of 28 weeks pregnancy or more) is expelled
from the uterus.

‫ اﺳﺒﻮع ﻳﺒﻘﻰ ﻛﺪه ﺑﻘﻰ اﺳﻤﻬﺎ وﻻدة ﻣﻬﻤﺎ ﻛﺎﻧﺖ‬28 ‫ﻫﻨﺎ ﺑﻴﺘﻜﻠﻢ ﻋﻦ اﻟﻮﻻدة ﻋﻤﻮﻣﺎ ﺑﻤﺠﺮد ﻣﺎ ﻋﻤﺮ اﻟﺤﻤﻞ ﻳﻌﺪى ال‬
‫اﻟﻄﺮﻳﻘﺔ اﻟﻠﻰ ﻫﺘﻮﻟﺪ ﺑﻴﻬﺎ اﻟﻔﻴﻤﻴﻞ‬

premature labor: when the duration of pregnancy is between the end of 28 and the end of 37
weeks (The normal duration of pregnancy is 49 Weeks or 280 days calculated from the first day of
the last menstruation).

Postmature labor: when the duration of pregnancy is 42 Weeks, more,

Prolonged labor: lasting more than 24 hours.

Precipitate labor: lasting less than 3 hours.

normal labor ‫ﻫﻨﺘﻜﻠﻢ ﻫﻨﺎ ﻋﻦ ال‬

‫ ﻳﺒﻘﻰ اﺳﻤﻬﺎ‬vaginal ‫ ﻣﻌﻴﻨﺔ ﻷن ﻣﺶ ﻛﻞ وﻻدة‬criteria ‫ ﻻزم ﻳﻜﻮن ﻟﻴﻬﺎ‬normal labor ‫ﻋﻠﺸﺎن ﻳﺒﻘﻰ اﺳﻤﻬﺎ‬
abnormal ‫ وﻟﻜﻦ ﻣﻤﻜﻦ ﺗﺒﻘﻰ‬normal ‫ ان اﻟﻮﻻدة‬vaginal ‫ ﻣﺶ ﻣﻌﻨﻰ اﻧﻬﺎ وﻟﺪت‬normal labor

‫ دى ؟‬criteria ‫اﻳﻪ ﻫﻰ ال‬

‫ ﻳﻴﺠﻰ ﻟﻮﺣﺪه ﻣﺶ ﻳﻴﺠﻰ ﺑﻮﺳﺎﺋﻞ ﺻﻨﺎﻋﻴﺔ ﻷن‬labor pain ‫ ﻳﻌﻨﻰ ال‬spontaneous ‫اول واﻫﻢ ﺣﺎﺟﺔ ﻻزم اﻟﻮﻻدة ﺗﺒﻘﻰ‬
‫ ﻛﺪه‬induction of labor ‫ اﺳﺒﻮع ﻓﺒﻨﻀﻄﺮ ﻧﺪﻳﻬﺎ ادوﻳﺔ ﻋﻠﺸﺎن ﺗﻌﻤﻞ‬42 ‫ اﺳﺒﻮع وﺑﺘﻮﺻﻞ‬40‫ﻓﻰ ﻓﻴﻤﻴﻠﺰ ﺑﺘﻌﺪى ال‬
without any ‫ ﻛﻤﺎن ﻻزم‬live ‫ وﻻزم ﻳﺒﻘﻰ‬single baby ‫ ﺗﺎﻧﻰ ﺣﺎﺟﺔ اﻧﻪ ﻻزم ﻳﺒﻘﻰ‬normal labor ‫ﻣﺶ ﻫﺘﺒﻘﻰ‬
‫ او‬mature baby ‫ وﻻزم ﻳﻜﻮن‬within 24 hours ‫ وﻻزم ﻳﺒﻘﻰ‬complications or interferences (except episiotomy)
‫ اﺳﺒﻮع ﻳﻌﻨﻰ ﻻزم ﺗﻌﺪى ﻋﻠﻰ اﻻﻗﻞ اﺳﺒﻮﻋﻴﻦ ﻓﻰ اﻟﺘﺎﺳﻊ وﻻزم‬38 ‫ ﻳﻌﻨﻰ ﻋﻤﺮه ﻋﺪى ال‬full term
presenting by the vertex ‫ﻳﺒﻘﻰ‬

‫ ﻋﺎدى‬normal labor ‫ ﻫﻴﺒﻘﻰ اﺳﻤﻬﺎ‬episiotomy ‫ ﻣﺎﻋﺪا ال‬vaginal delivery ‫ﻧﺎﺧﺪ ﺑﺎﻟﻨﺎ ان اى ﺗﺪﺧﻞ ﻫﻴﺒﻘﻰ اﺳﻤﻬﺎ‬

‫ ﻷن ﻣﻤﻜﻦ ﻳﺤﺼﻞ‬normal ‫ ﻣﻘﺪرش اﻗﻮل اﻧﻬﺎ ﻫﺘﻮﻟﺪ‬spontaneous ‫ ﺟﺎى‬labor pain ‫ﻳﻌﻨﻰ ﻟﻮ ﻋﻨﺪى ﻓﻴﻤﻴﻞ ﺑﺘﻮﻟﺪ وال‬
‫ اﻧﻬﺎ ﺗﻮﻟﺪ ﻃﺒﻴﻌﻰ‬trial ‫ او ﻫﺘﻜﻮن ﻣﺠﺮد‬vaginal ‫ اﺛﻨﺎء اﻟﻮﻻدة اﻧﻤﺎ اﻗﺪر اﻗﻮل اﻧﻬﺎ ﻫﺘﻮﻟﺪ‬complications

‫ ﻳﻌﻨﻰ ﻣﻴﻨﻔﻌﺶ اﺳﺒﻖ اﻻﺣﺪاث واﺟﺰم ان‬retrograde diagnosis ‫ اﺳﻤﻪ‬diagnosis of normal labor ‫ﻋﻠﺸﺎن ﻛﺪه‬
‫ ﻷﻧﻨﺎ ﺑﺎﻟﻔﻌﻞ‬antegrade diagnosis ‫ اﺳﻤﻪ‬cesarean section ‫اﻟﻔﻴﻤﻴﻞ ﻫﺘﻮﻟﺪ ﻃﺒﻴﻌﻰ اﻻ ﻟﻤﺎ ﺗﻮﻟﺪ ﻓﻌﻼ ﻋﻠﻰ ﻋﻜﺲ ال‬
‫ﻣﺤﺪدﻳﻦ ﻣﻦ ﻗﺒﻞ ﻣﺎ ﺗﻮﻟﺪ‬
1
‫‪when there is a single mature fetus, presenting by the vertex, the process of labor terminates‬‬
‫‪spontaneously. Through the birth canal, without any interference (except episiotomy) and without‬‬
‫‪complications to the mother or fetus, and within 24 hours.‬‬

‫ﻃﻴﺐ اﻳﻪ اﻟﻠﻰ ﻳﺨﻠﻰ اﻟﻔﻴﻤﻴﻞ ﻓﺠﺎة ﻛﺪه ﻳﺠﻠﻬﺎ ‪spontaneous labor pain‬؟‬
‫ﻟﻴﻪ اﻟﻮﺟﻊ ده ﺑﻴﺒﺪأ ﻳﺠﻠﻬﺎ ﻋﻨﺪ اﻻﺳﺒﻮع ‪ 38‬ﻣﺜﻼ ﻣﺶ اﻻﺳﺒﻮع ‪ 36‬؟‬

‫ﻋﻠﺸﺎن ﻧﺠﺎوب ﻋﻠﻰ اﻟﺴﺆال ده ﻫﻨﺪﺧﻞ ﻓﻰ ﺣﺎﺟﺔ اﺳﻤﻬﺎ ‪phases of labor‬‬

‫اﻟﻔﻴﻤﻴﻞ ﻃﻮل اﻟﺤﻤﻞ ﺑﺘﺒﻘﻰ ﻓﻰ ‪ phase‬اﺳﻤﻪ ‪ phase 0‬ﺑﻴﺤﺼﻞ ﻓﻴﻪ اﻳﻪ ؟‬

‫❶‬ ‫‪0‬‬

‫اﺛﻨﺎء ال ‪ phase0‬ﻳﻌﻨﻰ ﻃﻮل اﻟﺤﻤﻞ ﻫﺮﻣﻮن ال ‪progesterone‬ﺑﻴﻜﻮن ﻫﻮ ال ‪ predominant‬ﻳﻌﻨﻰ ﻫﻮ اﻟﻤﺴﻴﻄﺮ ﻛﻞ‬

‫ﺻﻐﻴﺮة وﻛﺒﻴﺮة ﺑﺘﺘﻌﻤﻞ ﺑﺴﺒﺒﻪ اﻣﺎ ﻫﺮﻣﻮن ال ‪ estrogen‬ﺑﻴﻜﻮن ‪ nondominant‬ﻳﻌﻨﻰ ﻧﺴﺒﺘﻪ ﻗﻠﻴﻠﺔ وﻣﺶ ﻣﺴﻴﻄﺮ‬

‫ﻻزم ﻧﻌﺮف اﻻول ‪ effect‬ﻛﻞ واﺣﺪ ﻓﻴﻬﻢ‬

‫‪ ‬ال ‪ progesterone‬ﺑﻴﻌﻤﻞ ‪ relaxation of uterine muscle‬و ‪spasm of lower uterine segment‬‬

‫‪ ‬ﻓﻰ ﺣﻴﻦ ان ال ‪ estrogen‬ﺑﻴﻌﻤﻞ اﻟﻌﻜﺲ ﺑﻴﻌﻤﻞ ‪irritability , excitability or contraction of uterine‬‬
‫‪ muscle‬و ‪relaxation of lower uterine segment‬‬

‫ﻟﻴﻪ ﺑﻴﺸﺘﻐﻠﻮا ﻋﻜﺲ ﺑﻌﺾ ؟ ﻷن ال ‪ progesterone‬ﺑﻴﻤﻨﻊ ﺗﻜﻮﻳﻦ اى ‪ receptors‬داﺧﻞ ال ‪smooth muscle of uterus‬‬
‫ﻃﻮل اﻟﺤﻤﻞ ﻓﻰ ﺣﻴﻦ ان ال ‪ estrogen‬ﺑﺒﻴﺴﺎﻋﺪ ﻋﻠﻰ ﺗﻜﻮﻳﻨﻬﺎ ﻓﻰ ﻧﻬﺎﻳﺔ اﻟﺤﻤﻞ‬

‫اﻳﻪ ﻫﻰ ال ‪ receptors‬؟ ﻫﻰ ‪receptors for oxytocin and prostaglandin‬‬

‫ﻣﻌﻨﻰ ﻛﺪه ان ﻟﻮ ﻋﻨﺪى ﻓﻴﻤﻴﻞ ﺣﺎﻣﻞ ﻓﻰ اﻻﺳﺒﻮع اﻟﻌﺎﺷﺮ ﻣﺜﻼ وادﻳﺘﻬﺎ ‪ oxytocin‬ﻣﺶ ﻫﻴﻌﻤﻞ ﺣﺎﺟﺔ ﻷﻧﻪ ال‬
‫‪ receptors‬ﺑﺘﺎﻋﺘﻪ ﻣﺶ ﻣﻮﺟﻮدة اﺻﻼ ﻋﻠﺸﺎن ﻛﺪه ﻻزم ﻳﺒﻘﻰ ﻓﻴﻪ ‪ estrogen‬ﻋﻠﺸﺎن ﻳﻘﺪر ﻳﺼﻨﻊ ال ‪receptors‬‬
‫ﻋﻠﺸﺎن ‪ oxytocin and prostaglandin‬ﻳﻘﺪروا ﻳﻌﻤﻠﻮا وﻇﻴﻔﺘﻬﻢ ﻟﻤﺎ ﻳﺘﻢ اﻓﺮازﻫﻢ ‪.‬‬

‫ﻟﻴﻪ ﻧﺴﺒﺔ ال ‪ progesterone‬ﺑﺘﺒﻘﻰ اﻋﻠﻰ ؟ ﻷن ال ‪ placenta‬ﺑﺘﻔﺮز ﻣﻨﻪ ﻛﻤﻴﺎت ﻛﺒﻴﺮة ﺟﺪا ﻃﻮل اﻟﺤﻤﻞ ﻓﺒﻴﺒﻘﻰ ﻫﻮ‬
‫‪ predominant‬وده اﻟﻠﻰ ﺑﻴﺨﻠﻰ ال ‪ uterus‬ﻃﻮل اﻟﺤﻤﻞ ‪ at resting state‬ﻣﺶ ﺑﻴﺤﺼﻞ ﻓﻴﻪ اى ‪ contractions‬دى ﻛﺎﻧﺖ‬
‫‪ phase 0‬ﺑﺎﺧﺘﺼﺎر‬

‫❷‬ ‫‪1‬‬

‫وﺑﻌﺪ ﻛﺪه ﺗﺪﺧﻞ ﻋﻠﻰ ‪ phase1‬ﺑﺘﺒﺪا ‪near to the full term‬‬

‫اﻟﻠﻰ ﺑﻴﺤﺼﻞ ﻓﻴﻪ ان اﻻﺳﺘﺮوﺟﻴﻦ ﺑﻴﺒﺪأ ﻧﺴﺒﺘﻪ ﺗﺰﻳﺪ واﻟﺒﺮوﺟﻴﺴﺘﻴﺮون ﻳﺒﺪأ ﻳﻘﻞ وده ﺑﻴﺤﺼﻞ ﺑﺴﺒﺐ ﻋﻤﻠﻴﺔ اﺳﻤﻬﺎ‬
‫‪ aging of placenta‬ان ال ‪ placenta‬ﺑﺘﺒﺪا ﺗﻀﻌﻒ وﻣﻘﺪار ﺗﺼﻨﻴﻌﻬﺎ ﻟﻠﺒﺮوﺟﻴﺴﺘﻴﺮون ﺑﻴﻘﻞ‬
‫‪2‬‬
 ‫ال ‪ placenta‬ﺑﻴﺒﺪأ ﻳﺤﺼﻠﻬﺎ ‪ degeneration‬وﺗﻘﻞ اﻧﺘﺎﺟﻴﺘﻬﺎ ﻣﻦ اﻟﺒﺮوﺟﻴﺴﺘﻴﺮون ﻓﺘﺰﻳﺪ ﻧﺴﺒﺔ اﻻﺳﺘﺮوﺟﻴﻦ وﺑﻴﺒﺪأ‬
‫ﺗﺰداد ﻧﺴﺒﺔ ﺗﺼﻨﻴﻊ ‪ receptors for oxytocin and prostaglandin in the uterine muscle‬ﻣﻨﺘﻈﺮ ﻓﻘﻂ اﻓﺮاز‬
‫‪oxytocin and prostaglandin‬‬

‫❸‬ ‫‪2‬‬

‫ﺛﻢ ﻧﻨﺘﻘﻞ ل ‪ .... phase2‬ﻫﻨﺎ ﺑﻘﻰ ﺑﻴﻜﻮن ال ‪ estrogen‬ﻫﻮ ال ‪ predominant‬و ال ‪ progesterone‬ﻣﻠﻮش اى ﻗﻴﻤﺔ‬

‫اﻧﺘﻘﺎﻟﻨﺎ ﻣﻦ ‪ phase 1‬اﻟﻰ ‪ phase 2‬ﻫﻮ ده اﻟﻠﻰ ﺑﻨﺴﻤﻴﻪ ‪ onset of labor‬او ان اﻟﻮﻻدة ﺧﻼص وﻗﺘﻬﺎ ﺣﺎن وﺑﻴﺒﺪأ اﻓﺮاز‬
‫‪ oxytocin and prostaglandin‬ﻛﺪه ﻛﺪه ال ‪ receptors‬ﺑﺘﺎﻋﺘﻬﻢ ﺑﻘﺖ ﻣﻮﺟﻮدة ﻓﺒﻴﺒﺪأ ﻳﺤﺼﻞ ‪uterine contractions‬‬

‫ﻫﻨﺎ ﻳﺎﺗﻰ اﻟﺴﺆال؟ ﻟﻤﺎذا ﻳﺘﻢ اﻓﺮاز ال ‪ oxytocin and prostaglandin‬ﺑﻜﻤﻴﺎت ﻛﺒﻴﺮة ﻓﻰ اﻟﻤﺮﺣﻠﺔ ﻣﻦ ‪ phase 1‬اﻟﻰ‬
‫‪ phase2‬؟‬

‫اﻻﺟﺎﺑﺔ ﻫﻨﺎ ﻫﻰ ‪ fetal adrenal gland‬وﻛﺄن ال ‪ normal labor‬ﻫﻰ ‪ message‬ﻣﻦ اﻟﺒﻴﺒﻰ ﻟﻸم ان ﻫﻮ ﺧﻼص ﺑﻘﻰ ﺟﺎﻫﺰ‬
‫وﻋﺎﻳﺰ ﻳﺨﺮج‬

‫ازاى ﺑﻴﺤﺼﻞ اﻟﻜﻼم ده ؟ اﻟﻠﻰ ﺑﻴﺤﺼﻞ ان ال ‪ fetal adrenal gland‬ﺑﺘﻔﺮز ‪ cortisone‬ﺑﺲ ﻛﻤﻴﺘﻪ ﻃﻮل اﻟﺤﻤﻞ ﺑﺘﺒﻘﻰ‬
‫ﻗﻠﻴﻠﺔ ﺟﺪا ﻟﻤﺎ ﺗﻮﺻﻞ ﻟﺤﺪ ﻣﻌﻴﻦ ﺑﻴﺒﺪأ ﻳﺮوح ﻟﻞ ‪ maternal circulation‬ﻳﻤﺸﻰ ﻓﻰ دم اﻻم وﻳﺮوح‬
‫ال ‪ posterior pituitary‬ﻳﺤﺜﻬﺎ ﻋﻠﻰ ﺑﺪء اﻓﺮاز ال ‪ oxytocin‬وﺗﺒﺪا ﻓﻌﻼ ﺗﻔﺮزه‬

‫وﻻزم ﻧﻜﻮن ﻓﺎﻫﻤﻴﻦ ان ‪ fetal adrenal gland is the last organ to be mature in the baby‬ﻳﻌﻨﻰ اﺧﺮ ‪organ‬‬
‫ﺑﻴﻨﻀﺞ ﻓﻰ ﺟﺴﻢ اﻟﺒﻴﺒﻰ ﻋﻠﺸﺎن ﻛﺪه ال ‪ normal labor‬ﻣﺶ ﺑﺘﺤﺼﻞ ﻏﻴﺮ ﻣﺎ ﻳﻜﻮن اﻟﺤﻤﻞ ‪ full term‬او ان اﻟﺒﻴﺒﻰ ﺑﻘﻰ‬
‫‪ mature‬ﻷﻧﻬﺎ ﺗﻌﺘﺒﺮ ‪ message‬ﻣﻦ اﻟﺒﻴﺒﻰ اﻧﻪ ﺧﻼص ﺑﻘﻰ ‪mature‬‬

‫‪ ‬ﻋﻠﺸﺎن ﻛﺪه ﻓﻰ اﻟﻔﻴﻤﻠﺰ اﻟﻠﻰ ﺑﻴﺒﻘﻮا ﺣﺎﻣﻞ ﻓﻰ ﺗﺆام ﻣﺜﻼ ﻣﻤﻜﻦ ﻳﻮﻟﺪوا ‪ normal labor‬ﻋﻨﺪ اﻻﺳﺒﻮع ‪ 36‬ﻣﺜﻼ ﻷن‬
‫ﻛﻤﻴﺔ ال ‪ cortisone‬اﻟﻠﻰ ﺑﺘﻔﺮز ﻓﻰ اﻟﻌﺎدى اﺗﻀﺎﻋﻔﺖ ﻷﻧﻬﻢ ﺑﻘﻮا ‪ 2 mature babies‬ﻓﻴﺤﻔﺰ اﻓﺮاز ال ‪ oxytocin‬اﺳﺮع‬

‫ﻣﻤﻜﻦ اﻟﻔﻴﻤﻴﻞ ﺗﺮوح ﻣﻦ ال ‪ phase 0‬اﻟﻰ ‪ phase1‬وﺑﻌﺪﻳﻦ ﺗﺮﺟﻊ ﺗﺎﻧﻰ ﻟﻞ ‪ phase 0‬وﻣﻤﻜﻦ ده ﻳﺤﺼﻞ ﺗﻠﺖ او ارﺑﻊ‬
‫ﻣﺮات ﻷن ‪ phase1‬ده ﻳﻌﺘﺒﺮ ‪ false labor pain‬ﺑﺲ ﻟﻤﺎ دﺧﻠﺖ ‪ phase2‬ﺧﻼص ﻛﺪه ﻣﺶ ﻫﻴﻨﻔﻊ ﺗﺮﺟﻊ ﺗﺎﻧﻰ وﻫﺘﻮﻟﺪ‬

‫‪The following clinical manifestations may occur in the last weeks of pregnancy or before the onset‬‬
‫‪of labor in some cases.‬‬

‫اﻟﻔﺘﺮة دى اﻟﻤﻘﺼﻮد ﺑﻴﻬﺎ ﻣﻦ اول اﻟﺒﻴﺒﻰ ﻳﺒﺪأ ﻳﺴﺘﻌﺪ ﻟﻠﻨﺰول ﻓﻰ اواﺧﺮ اﻟﺤﻤﻞ زى اﻧﻪ راس اﻟﺒﻴﺒﻰ ﺗﻨﺰل ﻓﻰ اﻟﺤﻮض‬
‫وﺣﺎﺟﺎت ﺗﺎﻧﻴﺔ ﺑﺮدو‬

‫‪❶ Engagement:‬‬

‫‪ It is the passage of the widest transverse diameter of the presenting port (the biparietal in cases‬‬
‫‪of the head) through the plane of the pelvic inlet.‬‬

‫ﻳﻌﻨﻰ ﻣﻦ اﻻﺧﺮ راس اﻟﺒﻴﺒﻰ ﺑﺘﻨﺰل اﻟﺤﻮض‬

‫‪3‬‬
 In the primigravida: engagement of the head occurs in the last 3 or 4 weeks of pregnancy due to
the tonicity ( (‫ﻗﻮة اﻧﻘﺒﺎض اﻟﻌﻀﻼت‬of the abdominal and uterine muscle.
 In the multipara, due to the decreased tonicity, the head commonly engages at the onset of labor
or even at the beginning of the 2nd stage of labor.

❷ Lightening:

This is the relief of upper abdominal pressure symptoms as dyspnea, palpitation, and dyspepsia due
to descent of the level of the fundus after engagement and due to shelfing of the uterus as at that
time the fundus of the uterus descends slightly and falls forward giving the upper part of the
abdomen special form Simulating a shelf detected in the Standing position.

N.B: In the standing position, shelfing brings the fetus in the direction of the axis of the pelvic inlet
and also Shelfing is one of the factors that lead to lightening.

: ‫اﻟﻨﻘﻄﺔ دى ﻓﻴﻬﺎ ﺣﺎﺟﺘﻴﻦ ﻣﻬﻤﻴﻦ‬

shelfing ‫❶ اول واﺣﺪة ﻫﻰ ال‬

‫ اﻟﻔﺘﺤﺔ ذات ﻧﻔﺴﻬﺎ ﻣﺶ ﺑﺘﺒﻘﻰ ﻓﻰ ﻧﻔﺲ‬downward ,anterior ‫ ﺑﻴﺒﻘﻰ اﺗﺠﺎﻫﻪ‬pelvis inlet ‫اﻛﻴﺪ ﻋﺎرﻓﻴﻦ ان ال‬
baby ‫ اﻟﺮاس ﺑﺘﺴﻘﻂ ﻟﻘﺪام او ان ال‬engagement ‫اﻟﻤﺴﺘﻮى ﻳﻌﻨﻰ ﻣﺎﻳﻠﺔ ﻟﺘﺤﺖ ﻣﻦ ﻗﺪام ﺷﻮﻳﺔ ﻓﻠﻤﺎ اﻟﺒﻴﺒﻰ ﻳﻌﻤﻞ‬
fetus body become ‫ ﻓﺘﻼﻗﻰ اﻧﻪ ﺑﻴﺒﺪأ ﻳﺘﻐﻴﺮ ﻳﻌﻨﻰ‬pelvic inlet ‫ ﻋﻠﻰ ال‬perpendicular ‫ ﺑﻴﺘﻐﻴﺮ ﻋﻠﺸﺎن ﻳﺒﻘﻰ‬position
shelfing ‫ ده ﺑﺎﻟﻈﺒﻂ ﻫﻮ ال‬forward
4
 lightening ‫❷ ﺗﺎﻧﻰ ﺣﺎﺟﺔ ﻫﻰ ال‬

urinary bladder‫ ﻓﺎﻟﻀﻐﻂ ﻳﺒﺪأ ﻳﺰﻳﺪ ﻋﻠﻰ ال‬pelvis ‫ ﺑﺪات ﺗﻨﺰل ﺟﻮا ال‬fetal head ‫ وال‬engagement ‫ﻧﺘﻴﺠﺔ اﻧﻪ ﺣﺼﻞ‬
‫ وﻓﻰ ﻧﻔﺲ اﻟﻮﻗﺖ ﺑﻴﺒﺪأ اﻟﻀﻐﻂ ﻋﻠﻰ اﻟﻌﻀﻼت اﻟﻰ ﻓﻮق ﻳﻘﻞ ﻷن ﻣﺴﺘﻮى ال‬frequency of micturition‫وﻳﺒﺪأ ﻳﺮﺟﻊ ال‬
shelfing ‫ وده ﺑﻴﺤﺼﻞ ﻧﺘﻴﺠﺔ ﻟﻞ‬dyspnea, palpitation, and dyspepsia ‫ ﻧﺰل ﻟﺘﺤﺖ ﻓﻴﻘﻞ اﻋﺮاض زى‬fundus

❸ Pelvic pressure Symptoms

as frequency of micturition, and difficulty in walking, rectal tenesmus (it is a feeling of being unable
to empty the bowel)

 These occur after engagement.

❹ false labor pain:

phase1 of normal labor ‫ ده ﻋﺒﺎرة ﻋﻦ‬false labor pain ‫ال‬

irregular ‫ ﻓﻴﺒﺪأ ﻳﺤﺼﻞ‬predominant ‫ﻫﻨﺎ ﺑﻴﺒﺪأ اﻟﺒﺮﺟﻴﺴﺘﻴﺮون ﻳﻘﻞ واﻻﺳﺘﺮوﺟﻴﻦ ﻳﺰﻳﺪ واﻻﺳﺘﺮوﺟﻴﻦ ﺑﻴﺒﻘﻰ ﻫﻮ ال‬
‫ وﺗﻔﺘﻜﺮه اﻟﻢ اﻟﻮﻻدة ﺑﺲ ﻓﻰ اﻟﺤﻘﻴﻘﺔ اﻧﻪ‬36‫ ﺑﻴﺠﻰ ﻟﻠﻔﻴﻤﻞ ﻣﺜﻼ ﻓﻰ اﻻﺳﺒﻮع ال‬painful ‫ وﺑﺘﺒﻘﻰ‬uterine contractions
‫ﻻ ده ﻣﻤﻜﻦ ﻳﺨﻒ ﺑﺎﻟﻤﺴﻜﻨﺎت ﻋﺎدى‬

which are intermittent uterine contractions accompanied by variable degree of pain. they are
differentiated from true labor pains by being of short duration ,do not increase progressively and if
the cervix can admit the finger we notice that's the membrane don't bulge during the contractions
.these pains don't cause progressive cervical dilation. They are usually relieved by sedatives.

❺ Increased Vaginal discharge.

sign , symptoms ‫ ﻣﺤﺘﺎﺟﻴﻦ ارﺑﻊ ﺣﺎﺟﺎت ﻣﺘﻘﺴﻤﻴﻦ‬onset of Labor‫ ﻋﺸﺎن ﺑﻘﻰ ﺗﺸﺨﺺ‬normal labor ‫ﻳﻌﻨﻰ ﺑﺪاﻳﺔ ال‬

Symptoms:

(1) True labor pains. (2) the show.

Signs:

(1) Dilation of internal cervical. (2) Formation of the bag of fore water.

During pregnancy there are painless intermittent uterine contractions which are felt on palpating
the uterus. These are known as palmer sign in early pregnancy and as Braxton Hicks contractions in
late pregnancy.
5
 True labor contractions are:

‫ ﻣﻌﻴﻨﺔ‬characteristics ‫ﻋﻠﺸﺎن ﻧﺴﻤﻴﻪ اﻟﻢ وﻻدة ﻓﻌﻼ ﻻزم ﻳﺒﻘﻰ ﻟﻴﻪ‬

1. Painful causing colicky pain in lower abdomen and backache (cervical dilation)
2. They are regular and increase gradually in strength, duration, and frequency (progressive)
effective ‫اﻧﺘﻈﺎﻣﻪ ده ﻣﺶ ﻣﻌﻨﺎه اﻧﻪ ﺑﻴﻴﺠﻰ ﻓﺘﺮات ﻗﻠﻴﻠﺔ زى اﻧﻪ ﻣﺜﻼ ﻛﻞ ﻳﻮم ﻳﺠﻰ ﺳﺎﻋﺘﻴﻦ ﻫﻮ ﻛﺪه ﻣﻨﺘﻈﻢ ﺑﺲ ﻣﺶ‬
progressive ‫ﺑﺲ ﻻزم ﻳﻜﻮن‬regular ‫ﻋﻠﺸﺎن ﻛﺪه ﻣﻴﻨﻔﻌﺶ ﻳﺒﻘﻰ‬
increasing gradually in strength, duration and frequency ‫ﻳﻌﻨﻰ‬

‫ دﻗﺎﺋﻖ وﻛﻞ وﻛﻞ‬10 ‫ ﻛﻞ‬contractions 3:4‫وﺑﺘﻴﺠﻰ ﺣﻮاﻟﻰ ﻣﻦ‬40:50 sec ‫ ﺑﺘﺴﺘﻤﺮ ﻣﻦ‬normal uterine contraction ‫ال‬
‫ ﻳﺒﻘﻰ ﻫﺘﺨﻠﺺ اﻟﺴﺎﻋﺔ‬10 ‫اﻟﺴﺎﻋﺔ‬contraction ‫ ﺛﺎﻧﻴﺔ ﻳﻌﻨﻰ ﻟﻮ ﺑﺪات ال‬40 : 50 ‫ زى ﻣﺎ ﻗﻮﻟﺖ ﺑﺘﺴﺘﻤﺮ ﻣﻦ‬contraction
regular , progressive , effective ‫ ﺛﺎﻧﻴﺔ وﺗﻘﻌﺪ راﺣﺔ دﻗﻴﻘﺘﻴﻦ وﻫﻜﺬا ﻛﺪه اﻻﻟﻢ اﺻﺒﺢ‬50‫ و‬10

3. they are effective, associated with cervical dilation

cervical dilation‫ ﻋﻦ ﻃﺮﻳﻖ ال‬effective ‫ﺑﻨﻌﺮف اﻧﻪ‬

4. They are accompanied by hardening of the uterus.

‫ ؟ ﻷﻧﻬﺎ ﻣﻤﻜﻦ ﻳﻜﻮن ﻋﻨﺪﻫﺎ ﻣﻐﺺ ﻛﻠﻮى ﻣﺜﻼ وﺗﺤﺴﺒﻪ اﻟﻢ اﻟﻮﻻدة ﻫﺘﻴﺠﻰ ﺗﺤﻂ اﻳﺪك ﻋﻠﻰ‬hardening of the uterus ‫ﻟﻴﻪ‬
labor pain ‫ ﻳﺒﻘﻰ ده ﻣﺶ‬lax ‫ﻟﺴﻪ‬uterus ‫ﺑﻄﻨﻬﺎ ﺗﻼﻗﻲ ال‬

5. they are usually increased by enema because a full rectum reflex inhibits uterine contractions
enema ‫ ده ﺑﻴﺰود اﻟﻢ اﻟﻮﻻدة وده ﺑﻨﺴﻤﻴﻪ‬empty rectum , empty bladder ‫ﻟﻤﺎ اﻟﻔﻴﻤﻴﻞ ﻳﻜﻮن ﻋﻨﺪﻫﺎ‬

6. The bag of forewater becomes tense during contraction.

7.doesn't relieve by analgesics.

It is a blood-stained mucous discharge noticed at the start of labor. The mucus is the cervical
mucous plug which normally fills the cervical canal and is expelled when the cervix starts to dilate.
The blood is caused by separation of the membranes from the lower uterine segment or minute
laceration of cervical mucosa. Labor usually starts within 24 hours after the passage of the show.
the show ‫ ﻫﻰ ال‬onset of labor ‫وﺗﺎﻧﻰ ﻋﻼﻣﺔ ﻣﻦ ﻋﻼﻣﺎت ال‬

show ‫ ﻫﻮ ده ال‬bloody mucous ‫ اﺛﻨﺎء اﻟﺤﻤﻞ ﺑﻴﺒﻘﻰ ﻣﻘﻔﻮل ب‬cervix ‫ﻋﺎرﻓﻴﻦ ﻃﺒﻌﺎ ان ال‬

‫ ﻷﺳﺒﺎب ﻛﺘﻴﺮة‬onset of labor ‫ ﻋﻠﻰ ال‬sure sign ‫ ﻣﺶ‬the show ‫ﻣﻬﻢ ﺟﺪا ﻧﻌﺮف ان ال‬

‫ وﻣﻤﻜﻦ ال‬contractions ‫ او اى‬preterm pain ‫ ﻣﺜﻼ ﺑﻤﺠﺮد ﻣﺎ ﻳﺠﻠﻬﺎ ﻣﺜﻼ‬28 ‫ ده ﻳﻨﺰل ﻓﻰ اﻻﺳﺒﻮع ال‬show ‫ﻣﻤﻜﻦ ال‬
‫ ﻳﻨﺰﻟﻪ ﺑﺴﻬﻮﻟﺔ ﻋﻠﺸﺎن ﻛﺪه دﻛﺎﺗﺮة اﻟﻨﺴﺎ ﻣﺶ ﺑﻴﻬﺘﻤﻮا ﺑﻴﻪ ﻛﻌﻼﻣﺔ ﻋﻠﻰ اﻟﻮﻻدة‬false labor pain

symptoms ‫ﻋﻠﺸﺎن ﻛﺪه ﻓﻮق ﻛﺎﺗﺒﻴﻨﻪ ﺿﻤﻦ ال‬

6
 Friedman ‫ ﺗﺒﻌﺎ ﻟﻜﻴﺮف اﺳﻤﻪ‬cervical dilation ‫ ﻷﻧﻪ ﻫﻮ اﺻﻼ اﻟﻠﻰ ﻫﻴﻌﻤﻞ ال‬true labor pain ‫ ﻋﻠﻰ ال‬sure sign ‫ده‬
curve

‫ ﻓﻰ‬latent phase ‫ وده ﻣﺶ ﺳﻬﻞ اﻧﻪ ﻳﺤﺼﻞ اﺑﺪا ﻣﻤﻜﻦ ال‬active ,latent phase of first labor stage ‫ﺑﻴﺤﺼﻞ اﺛﻨﺎء‬
‫ اﺣﻴﺎﻧﺎ ﺑﻴﺘﻢ ﺗﺸﺨﻴﺼﻪ ﻋﻦ‬latent phase ‫ ﺳﺎﻋﺔ ﻋﺸﺎن ﻛﺪه ال‬20 ‫ ﻳﺴﺘﻤﺮ ل‬3 cm ‫ اﻟﻰ ﻫﻮ اﻗﺼﻰ ﺣﺎﺟﺔ‬primi ‫ﻓﻴﻤﻴﻞ‬
cervical dilation ‫ ﻷن ﺑﻴﺘﻢ ﻓﺤﺼﻬﺎ ﺑﻴﻼﻗﻰ ﻣﻔﻴﺶ‬false labor pain ‫ﻃﺮﻳﻖ اﻟﺨﻄﺄ‬

‫ ﻛﻞ ﺳﺎﻋﺔ وﻧﺺ ﻓﺘﺤﺘﺎج وﻗﺖ ﻃﻮﻳﻞ‬1cm ‫ ﺑﻴﺰﻳﺪ ﺑﻤﻌﺪل‬10 cm ‫ ل‬cervical dilation ‫ ﺑﻴﻮﺻﻞ ال‬active phase ‫ﻓﻰ ال‬
cervical dilation ‫ﻋﻠﺸﺎن ﺗﻘﻮل اﻧﻪ ﻓﻴﻪ‬

A closed internal os (The opening into the uterus from the cervix) means that labor has not started,
however, the external os (vagina) or even internal os may admit 1or 2 fingers before the onset of
labor, especially in a multi gravida.

The lower pole of the fetal membranes (chorion and amnion) separates forms the lower uterine
segment to form a bag of water which bulges through the cervix and becomes tense during uterine
contraction (a sure sign).
‫ ؟‬bag of forewaters ‫اﻻول ﻻزم ﻧﻌﺮف ازاى اﺗﻜﻮﻧﺖ ال‬

, ‫ اﻛﻴﺪ ﻃﺒﻌﺎ‬amniotic fluid ‫اﻟﺒﻴﺒﻰ ﻣﻮﺟﻮد ﻓﻰ ال‬

‫ ﻟﻤﺎ‬uterus ‫ ﺑﻴﺒﻘﻰ ﻻزق ﻓﻰ ﺟﺪار ال‬amniotic membrane ‫ال‬
‫ ﺑﻴﻜﻮن‬receptors ‫ زى ﻣﺎ ﺑﻴﻜﻮن ال‬phase1,2 ‫اﻻﺳﺘﺮوﺟﻴﻦ ﺑﻴﺰﻳﺪ ﻓﻰ‬
collagen ‫ ﻣﻦ اﺳﻤﻪ ﺑﻴﻜﻮن‬collagenase enzyme ‫اﻧﺰﻳﻢ ﻣﻬﻢ ﺟﺪا اﺳﻤﻪ‬
‫ ﻟﻞ‬structure ,thickness ‫ ﻓﺒﻴﻌﻤﻞ‬amniotic membrane ‫ﺑﺘﺎع ال‬
‫ اﻟﻠﻰ ﺑﺘﻨﺰل ﻋﻠﻰ ﺷﻜﻞ داﻳﺮة‬fetal head ‫ ﺗﺤﺖ ال‬amniotic membrane
‫ ﻋﻠﻰ‬circular ‫ ﻧﺎزﻟﺔ‬head ‫ﻧﻔﺴﻪ ﺑﻴﺒﻘﻰ داﻳﺮه ﺑﺮدو ﻓﺘﺒﻘﻰ ال‬cervix ‫وال‬
girdle of contact ‫ اﻻﺗﻨﻴﻦ ﻣﻊ ﺑﻌﺾ ﺑﻴﻌﻤﻠﻮا ﺣﺎﺟﺔ اﺳﻤﻬﺎ‬cervix
cervix ‫ﻓﻴﺒﻘﻰ راس اﻟﺒﻴﺒﻰ ﻗﺎﻓﻠﺔ ﻋﻠﻰ ال‬
‫ اﻟﻠﻰ ﺗﺤﺘﻴﻪ ﺑﻴﺒﻘﻰ ﻣﻔﻴﻬﻮش اى‬amniotic membrane ‫ﻓﺠﺰء ال‬
‫ اﻟﻠﻰ ﻓﻮﻗﻪ ﻳﻌﻨﻰ ﺑﻘﻰ ﻓﻴﻪ‬amniotic fluid‫ ﻣﻊ ال‬communication
amniotic fluid‫ ﺗﺤﺖ ال ال‬amniotic ‫ ﻓﻮق و ال‬amniotic fluid
bag of forewaters ‫ اﻟﻠﻰ ﺗﺤﺖ ﺑﻨﺴﻤﻴﻪ‬
bag of hindwaters ‫ واﻟﻠﻰ ﻓﻮق اﺳﻤﻪ‬

weakening of the ‫ ﻟﻮ زاد ﻣﻊ‬intra uterine pressure ‫ ﺑﻴﺒﻘﻰ ﻓﻴﻪ‬uterine contractions ‫اﻳﻪ اﻫﻤﻴﺘﻪ ؟؟ اﺛﻨﺎء ال‬
‫ اﻟﻠﻰ‬amniotic fluid ‫ ده ﻓﺼﻞ ال‬girdle of contact ‫ ﻟﻤﺎ اﺗﻌﻤﻞ‬rupture ‫ي‬amniotic membrane ‫ ال‬amniotic fluid
amniotic ‫ ﻓﺎﻧﺖ ﻛﺪه ﺣﻤﻴﺖ ال‬bag of forewaters ‫ اﻟﻠﻰ ﻓﻮق ﻣﺶ واﺻﻞ ﻟﻞ‬pressure ‫ﻓﻮق ﻋﻦ اﻟﻠﻰ ﺗﺤﺖ ﻓﺎﺻﺒﺢ ال‬
‫ ﻃﻮل اﻟﻮﻻدة‬rupture ‫ ﻣﻦ اﻧﻪ ي‬membrane
7
 ‫ اﻟﻘﻔﻠﺔ اﻟﻠﻰ ﺗﺤﺖ دى ﻛﺎﻧﻚ زودت ال‬increase intra uterine pressure ‫اﻟﻔﻴﻤﻴﻞ ﺑﺘﺤﺲ ﺑﺎﻟﻢ اﺛﻨﺎء اﻟﻮﻻدة ﺑﺴﺒﺐ‬
‫ ﻳﺒﻘﻰ زاﻳﺪ ﺟﺪا ﻓﺘﻌﻤﻞ‬intra uterine pressure ‫ وﺑﺘﺨﻠﻰ ال‬cervix ‫ ﺟﻮا وﻗﺎﻓﻞ ﺗﺤﺖ ﻋﻠﻰ ال‬pressure
‫ وده اﻟﻠﻰ ﺑﻴﺨﻠﻰ اﻟﻔﻴﻤﻴﻞ ﺗﺤﺲ ﺑﺎﻟﻢ اﻟﻮﻻدة‬some sort of uterine ischemia

cervical ‫ ده اﺣﺪ اﺳﺒﺎب اﻻﺣﺴﺎس ﺑﺎﻟﻢ اﻟﻮﻻدة ﺑﻞ اﻧﻪ ﻣﻦ اﻟﺤﺎﺟﺎت اﻟﻠﻰ ﺑﺘﺴﺎﻋﺪ ﻋﻠﻰ ال‬girdle of contact ‫ﻳﻌﻨﻰ ال‬
‫ ﻳﻌﻨﻰ ﻣﺜﻼ ﻟﻮﻋﻨﺪك ﺣﺎﺟﺔ ﺿﻴﻘﺔ وﻋﺎﻳﺰ ﺗﻨﺰل ﻓﻴﻬﺎ ﺣﺎﺟﺔ ﺑﺘﺤﺎول ﺗﺪﺧﻠﻬﺎ وﺗﺠﻴﺒﻬﺎ ﻳﻤﻴﻦ وﺷﻤﺎل ﻟﻐﺎﻳﺔ ﻣﺎ ﺗﺪﺧﻞ‬dilation
‫ ﻣﻦ ﻧﺎﺣﻴﺔ اﻟﺮﺣﻢ(ﺑﻴﺒﻘﻰ ﺻﻐﻴﺮ ﺗﻘﻮم‬cervix ‫ ) ال‬internal os ‫ ال‬cervix ‫ ﻣﻊ ال‬fetal head ‫ﻫﻮ ده ﻧﻔﺲ اﻟﻠﻰ ﺑﻴﺤﺼﻞ ال‬
‫ ﻏﻴﺮ ﻣﺮﺗﺒﻂ ﻓﻘﻂ‬cervical dilation ‫ اذن ال‬dilation ‫ ﻟﺤﺪ ﻣﺎ ﻳﺤﺼﻠﻪ‬cervix ‫ ﻋﻠﻰ ال‬compression ‫ ﺗﻌﻤﻞ‬fetal head ‫ال‬
griddle of contact ‫و‬fetal head compression ‫ ﺑﻞ ﻣﺮﺗﺒﻂ ﻛﻤﺎن ﺑﺎل‬labor pain ‫ﺑﺎل‬

oxytocin ‫ اﻟﻠﻰ ﺑﻴﺰود‬Ferguson reflex ‫ اﺳﻤﻪ‬reflex ‫ ﺑﻴﻌﻤﻞ‬compression on lower uterine segment ‫ﻛﻤﺎن ﺑﻘﻰ ان‬
: ‫ ﻋﻤﻠﺖ اﻛﺘﺮ ﻣﻦ ﺣﺎﺟﺔ‬griddle of contact ‫ ﻳﺒﻘﻰ ﺣﺮﻛﺔ ال‬secretion

bag of hind waters ‫ ﻋﻦ ال‬bag of forewaters ‫ﻓﺼﻞ ال‬-

bag of forewaters ‫ ﻋﻦ ال‬intra uterine pressure ‫ﻓﺼﻞ‬-
uterine contractions ‫ زود‬, cervical dilation ‫زود ال‬, labor pain ‫ زود ال‬-

‫ ﺑﺮدو‬circular ‫ اﻟﻠﻰ ﺑﻴﺒﻘﻰ‬cervix ‫ ﻋﻠﻰ ال‬circular ‫ ﻳﻨﺰل‬fetal head ‫ ﻫﻮ اﻧﻪ ال‬griddle of contact ‫اﻟﻤﻬﻢ ﺗﻌﺮف اﻧﻪ‬
bag of hindwaters ‫ﻋﻦ ال‬bag of forewaters ‫ﻓﻴﻔﺼﻞ‬

circular ‫ ﻓﺘﺒﻘﻰ‬9.5 x 9.5 cm diameter ‫ ﺑﺘﻜﻮن ﻧﺎزﻟﺔ ب‬fetal head ‫ﻣﻬﻢ ﻧﻌﺮف اﻧﻪ ال‬

tense amniotic fluid with ‫ ﻻزم ﻳﻜﻮن ﻋﻨﺪﻫﺎ ﺣﺎﺟﺔ ﻣﻬﻤﺔ ﺟﺪا‬true labor pain ‫ﻟﻜﻦ ﻋﻠﺸﺎن ﻧﻘﻮل ان اﻟﻔﻴﻤﻴﻞ ﻋﻨﺪه‬
‫ ﻓﻘﻂ‬formation of bag of forewaters ‫ ﻻ ﻧﻜﺘﻔﻰ ب‬.. uterine contractions

true labor pain ‫ ﻣﺤﺘﺎج ارﺑﻊ ﺣﺎﺟﺎت اﻛﺘﺮ واﺣﺪة ﻣﻮﺛﻮق ﻓﻴﻬﺎ ﻫﻰ ال‬onset of labor ‫ﻳﺒﻘﻰ ﻋﻠﺸﺎن ﺗﺸﺨﺺ ال‬

Cervical dilation, the show are not reliable marks of labor,

cervical ‫ ﻻﻧﻪ ﺑﻴﺤﺘﺎج وﻗﺖ ﻃﻮﻳﻞ ﺟﺪا ﻋﺸﺎن ﻳﺘﻼﺣﻆ ﻛﻤﺎن ﻓﻰ ﻓﻴﻤﻴﻠﺰ ﺑﻴﺤﺼﻠﻬﻢ‬reliable ‫ ﻣﺶ‬cervical dilation ‫ال‬
‫ ﻋﺎدى‬full term ‫ ﻣﺜﻼ ﻣﻦ اﻟﺸﻬﺮ اﻟﺨﺎﻣﺲ وﻳﻜﻤﻠﻮا ال‬cm 4 ‫ل‬dilation

True labor pain, tense amniotic fluid, or tense bag of forewaters are reliable ones.

���‫ﻻ ﺗ�ﺴﻮ�ﺎ �ﻦ ﺻﺎﻟﺢ د‬

8
 stages of labor ‫ ﻫﻮ اﻟﻠﻰ ﺑﻴﻜﻮن ال‬phase 2 ‫ﻻزم ﻧﻌﺮف ان‬

Starts with the onset of true labor pains and ends when the cervix becomes whole fully dilated
(about 10 cm diameter or 5 fingers). With full cervical dilatation the birth canal in felt as one
continuous canal. The end of the first stage of labor is marked by rupture of membrane and
drainage of amniotic fluid, In Primigravida the duration of the first stage in about 14-16 hour
( ‫ ﺳﺎﻋﺔ‬12 ‫)اﻟﺪﻛﺘﻮر ﻗﺎﻟﻬﺎ ﺑﻤﺘﻮﺳﻂ‬and in multipara about 8 hours.
rupture of membrane and drainage of amniotic fluid ‫ و‬cervical dilation ‫اﻟﻤﺮﺣﻠﺔ اﻻوﻟﻰ ﺑﺘﺘﻌﻠﻢ ب ال‬

rupture of membrane ‫ ﺛﻢ ﺑﻌﺪﻫﺎ ﻳﺤﺼﻞ‬10 cm ‫ ﻟﺤﺪ ﻣﺎ ﻳﻮﺻﻞ ل‬cervical dilation ‫ﺑﻴﺤﺼﻞ‬

‫ ؟؟‬rupture ‫ ﺑﻲ‬membrane ‫ ﻟﻴﻪ ال‬.... ‫ﻃﻴﺐ دﻟﻮﻗﺘﻰ ﺑﻘﻰ ﻋﻨﺪﻧﺎ ﺳﺆاﻟﻴﻦ‬

‫ ﺑﻴﺒﻘﻰ‬cervix ‫ ال‬stage1 ‫ ﻟﻤﺎ ﻧﻴﺠﻰ ﻟﻨﻬﺎﻳﺔ ال‬9.5 x 9.5 cm ‫ ﻛﺎﻧﺖ‬fetal head ‫ ﺑﺘﺎع ال‬diameters ‫اﺣﻨﺎ ﻋﺎرﻓﻴﻦ اﻧﻪ ال‬
‫ ﻳﻌﻨﻰ ﻫﻴﺤﺼﻞ‬fetal head ‫ ﺑﻘﻰ اوﺳﻊ ﻣﻦ ال‬cervix ‫ ﻣﻌﻨﻰ ذﻟﻚ ان ال‬10 cm ‫ ﻳﻌﻨﻰ ﺑﻴﺒﻘﻰ‬fully dilated
‫ ﻋﻦ ﻃﺮﻳﻖ‬amniotic fluid ‫ ﻣﻌﻨﻰ ذﻟﻚ اﻧﻪ ﻛﻞ ال‬bag of hindwaters ‫ وال‬bag of forewaters ‫ ﺑﻴﻦ ال‬communication
9
 ‫ال ‪ gravity‬ﻫﻴﻨﺰل ﻓﻰ ال ‪ forewaters‬ﻣﺠﺮد ﻣﺎ ﻳﺤﺼﻞ ‪ uterine contraction‬واﺣﺪة ﻳﻘﻮم ال ‪ membrane‬ي ‪rupture‬‬
‫وﻳﻨﺰل ﻛﻞ ال ‪ amniotic fluid‬ﻋﺸﺎن ﻛﺪه ﺑﻴﺤﺼﻞ ﻓﻰ ﻧﻬﺎﻳﺔ ال ‪ first stage‬ﻳﻜﻮن ال ‪ cervix‬ﺑﻘﻰ ‪fully dilated‬‬

‫ﻧﻴﺠﻰ ﻟﻠﺴﺆال اﻟﺘﺎﻧﻰ اﻳﻪ أﻫﻤﻴﺔ اﻧﻪ ي ‪ rupture‬ﻓﻮ اﻟﻮﻗﺖ ده ﺑﺎﻟﺬات ؟‬

‫‪ ‬اول ﺣﺎﺟﺔ اﻧﻪ ﺑﻴﻌﻤﻞ ‪ lubrification‬ﻳﻌﻨﻰ ﺑﻴﺴﻬﻞ ﺧﺮوج اﻟﺒﻴﺒﻰ‬

‫‪ ‬ﺗﺎﻧﻰ ﺣﺎﺟﺔ اﻧﻪ ﺑﻴﻌﻤﻞ ‪: washing up of the vagina‬ال ‪ vagina‬ﺑﻴﺒﻘﻰ ﻣﻠﻴﺎن ﺑﺎل ‪ dirties‬ﻛﻤﺎن ال ‪vaginal acidity‬‬
‫ﺑﺘﺒﻘﻰ اﻗﻞ ﻣﻦ ‪3‬ﻳﻌﻨﻰ ‪ highly acidic‬ﻳﻌﻨﻰ ﻟﻮ اﻟﺒﻴﺒﻰ اﺗﻮﻟﺪ ﻓﻰ اﻟﻮﺳﻂ ده ﻣﻤﻜﻦ ﺗﺒﻮظ ﻋﻴﻨﻪ ﻋﺸﺎن ﻛﺪه ال ‪amniotic‬‬
‫‪ fluid‬ﻫﻮ ‪ alkaline‬ﻓﺒﻴﻌﻤﻞ ‪ washing up‬ﻻى ‪ micro organisms‬ﻛﻤﺎن ﺑﻴﻌﺎدل اﻟﻮﺳﻂ اﻟﺤﺎﻣﻀﻰ ده ﻣﻦ اﻧﻪ ﻳﺆذى اﻟﺒﻴﺒﻰ‬

‫‪ ‬ﺗﺎﻟﺖ ﺣﺎﺟﺔ وﺟﻮده ‪ bag of forewaters‬ﺑﻴﺴﺎﻋﺪ ال ‪cervical dilation‬‬

‫❷‬

‫‪Starts with full cervical dilatation and ends with delivery of the fetus (1-2 hours in Primipara, 1/2:1‬‬
‫‪hours in multipara‬‬
‫❸‬

‫‪Starts with complete delivery of the fetus and ends with expulsion of the placenta and membranes‬‬
‫‪(10:30 minutes both primipara and multipara).‬‬
‫ﻛﻞ ‪ stage‬ﺑﻴﻨﺰل ﺣﺎﺟﺔ‬
‫‪ stage 1 ‬ﺑﻴﻨﺰل ال ‪amniotic fluid‬‬

‫‪ Stage 2 ‬ﺑﻴﻨﺰل اﻟﺒﻴﺒﻰ‬

‫‪ stage 3 ‬ﺑﻴﻨﺰل ال ‪placenta , membranes‬‬

‫ﻛﻞ ‪ stage‬ﻣﺪﺗﻬﺎ ﺗﺨﺘﻠﻒ ﻟﻮ ﻛﺎﻧﺖ اﻟﻔﻴﻤﻴﻞ ‪ primi or multi‬ﻣﺎﻋﺪا ال ‪ third stage‬ﻣﺪﺗﻬﺎ ‪ fixed‬ﻣﻦ ‪ 10‬اﻟﻰ ‪ 30‬دﻗﻴﻘﺔ‬

‫ال ‪ uterine contractions during the third stage‬ﺑﺘﻔﻀﻞ زى ﻣﺎ ﻫﻰ ‪ the same power and magnitude‬وده ﻫﻴﺪﺧﻠﻨﻬﺎ‬
‫ﻓﻰ ﻣﻮﺿﻮع ﺗﺎﻧﻰ وﻫﻮ ان ال ‪ uterine muscle‬ﺑﻴﺤﺼﻠﻬﺎ ‪ contraction , retraction‬ﻳﻌﻨﻰ ﻃﻮل اﻟﻌﻀﻠﺔ ﺑﻴﻘﻞ‬

‫ﻣﻌﻨﻰ ذﻟﻚ ان ال ‪ surface area‬اﻟﻠﻰ ﺗﺤﺖ ال ‪ placenta‬ﺗﺒﺪا ﺗﻘﻞ ﻟﻐﺎﻳﺔ ﻣﺎ ال ‪ placenta‬ﺗﻨﻔﺼﻞ ﺧﺎﻟﺺ وﺗﺨﺮج‬

‫ﻓﻴﻪ ﺳﺆال ﻣﻬﻢ ﻫﻨﺎ وﻫﻮ اﻧﻪ ﻫﻞ ال ‪ third stage‬ﺑﺘﺒﻘﻰ ‪ painful‬وﻻ ‪ painless‬؟‬
‫ال ‪ third stage‬ﺑﺘﺒﻘﻰ ‪ painless‬رﻏﻢ اﻧﻪ ال ‪ contraction‬ﺑﻴﻔﻀﻞ ﺑﻨﻔﺲ اﻟﻘﻮة او ﻳﻤﻜﻦ اﻗﻮى ﺗﻔﺴﻴﺮ اﻟﻜﻼم ده اﻧﻪ ﻓﻴﻪ‬
‫ﻧﻮﻋﻴﻦ ﻣﻦ ‪ labor pain‬واﺣﺪ ﻧﺘﻴﺠﺔ ‪ compression on perineum‬اﻟﺘﺎﻧﻰ ﻧﺘﻴﺠﺔ ال ‪ uterine contractions‬اﺛﻨﺎء ال ‪third‬‬
‫‪ stage‬ال ‪ compression on perineum‬ﺧﻼص ﻣﺒﻘﺎش ﻣﻮﺟﻮد ﻷن اﻟﺒﻴﺒﻰ ﺧﺮج ﻛﺪه اول ﻧﻮع ﺧﻼص‬

‫اﻟﻨﻮع اﻟﺘﺎﻧﻰ اﺣﻨﺎ ﻋﺎرﻓﻴﻦ اﺻﻼ ان اﻟﻠﻰ ﺑﻴﻌﻤﻞ ‪ pain‬زﻳﺎدة ‪ intra uterine pressure‬اﻟﻠﻰ ﺑﺘﻌﻤﻞ ‪ ischemia‬ﻓﺒﺘﺴﺒﺐ‬
‫‪ pain‬ﺑﺴﺒﺐ وﺟﻮد ال ‪ girdle of contact‬ﺑﻌﺪ وﻻدة اﻟﺒﻴﺒﻰ ﺧﻼص ال‪ girdle of contact‬ﻣﺒﻘﺘﺶ ﻣﻮﺟﻮدة ﻓﻠﻤﺎ ﻳﺤﺼﻞ‬
‫‪ uterine contraction‬ال ‪ pressure‬ﻣﺶ ﻫﻴﺰﻳﺪ ﻷﻧﻪ ﺟﻮا ﺑﻘﻰ ﻓﺎﺿﻰ وﻣﻔﻴﺶ ﺣﺎﺟﺔ ﻗﺎﻓﻠﺔ ال ‪cervix‬‬

‫ﻻزم ﻧﺒﻘﻰ ﻋﺎرﻓﻴﻦ اﻧﻪ رﺑﻨﺎ ﺧﻠﻖ اﻟﺴﺖ ﺗﻮﻟﺪ ﺑﻮﺟﻊ ﻣﻬﻤﺎ ﻛﺎﻧﺖ اﻟﻄﺮﻳﻘﺔ اﻟﻠﻰ ﻫﺘﻮﻟﺪ ﺑﻴﻬﺎ ﻷﻧﻪ اﻟﻠﻰ ﺑﻴﺘﻌﺐ ﻓﻰ ﺣﺎﺟﺔ ﺑﻴﻌﺮف‬
‫ﻗﻴﻤﺘﻬﺎ‬
‫‪10‬‬
 ❶

 Retraction is a term for shorting of muscle.

 They are regular, involuntary, intermittent, increase in frequency, strength and duration as labor
progresses (at 1st they recur ‫ ﺗﺘﻜﺮر‬every 10-20 minutes and last few seconds but later on they recur
every few minutes and last one to two minutes).
 Uterine contractions during labor are accompanied ty retraction (contraction followed by
permanent shortening; the values of which are:
(a) to dilate the cervix, (b) to expel the fetus.
(c) to separate the placenta, (d) to control postpartum hemorrhage.
 The uterus during labor shows the phenomenon of polarity (the upper segment is more active
and lower segment is more passive ) so as to dilate the cervix and expel the fetus.
 During the uterine contraction, the intrauterine pressure is raised up to 40mmHg in the 1 stage,
and 120mm Hg in the 2 stage. The pressure at which the woman feels pain is 25mm Hg.
 During labor the uterine contractions are felt by the patients as colicky pain in the abdomen
which is referred to the lower back. During contractions the uterus becomes hard when felt
abdominally .True labor pains are accompanied by progressive dilatation of the cervix and the
membranes bulge through the cervix when felt during the contraction.
‫ﻛﻞ ده ﻣﺘﻔﺴﺮ ﻓﻮق‬

The secondary force concerned in labor consists of the voluntary bearing down effort brought
about by strong contractions of the diaphragm and abdominal muscles. When the head stretches
the pelvic floor, bearing down occurs involuntarily by a reflex mechanism. This bearing down is
needed for spontaneous expulsion of the fetus during the 2™ stage and may also occasionally expel
the separated placenta in the 3 stage.
Dilation of the cervix:
Cervical dilation is due to:
(a) Contraction and retraction of the uterus.
(b) Contractions and retractions also push the bag of forewaters before rupture of membranes or
the presenting part after rupture of the membranes through the cervix helping in its dilation.
(c) The changes in the cervix during pregnancy (glandular hypertrophy, oedema and increased
vascularity) make the cervix dilatable.
11
 In primigravida:
The internal os dilates at 1st and the cervical canal becomes opened up from above downwards and
becomes incorporated into the lower uterine segment so that the cervix becomes thin and the
external os only remains undilated. this is called taking up or effacement of the cervix and it's
followed by the external OS in multiparous effacement and dilation of cervix occur simultaneously .
Expulsion of the placenta and membranes:
after delivery of the fetus the uterus retracts the area of the placenta site diminishes .the inelastic
placenta doesn't diminish in size so it's separates

(A) 1st stage: little effect.

(B) 2nd stage: pulse May increase Up to 100., slight rise of temperature (37.5), systolic B.P may
slightly increase during pains, edema and congestion of conjunctiva, the minor injuries to the birth
canal (as minor cervical lacerations, perineal tears especially in primigravidae)
(C) 3rd stage: blood loss from the placental site 100 - 200 Cc, blood loss from laceration or episiotomy
100 cc
‫ ﻳﻌﻨﻰ ﺳﻨﺘﻴﻤﺘﺮ ﻣﻜﻌﺐ‬Cc

‫ ﻫﻮ ﻧﺼﻒ ﻟﺘﺮ‬normal labor ‫ﻣﺘﻮﺳﻂ ﻓﻘﺪ اﻟﺪم ﻓﻰ ال‬

‫ ﻟﺘﺮ‬1 cesarean section ‫اﻣﺎ ال‬

���‫ﻻ ﺗ�ﺴﻮ�ﺎ �ﻦ ﺻﺎﻟﺢ د‬

12
 Delivery of fetus and placenta after 20 weeks of pregnancy (after viability) through abdominal and
uterine incision
‫اﻟﻄﺮﻳﻘﺔ دى ﻣﻦ اﻟﻮﻻدة ﺑﺘﺘﻌﻤﻞ ﻣﻦ اﻳﺎم اﻟﻔﺮاﻋﻨﺔ ﻛﺎﻧﻮا ﺑﻴﻔﺘﺤﻮا ﺑﻄﻦ اﻟﻔﻴﻤﻞ اﻟﺤﺎﻣﻞ ﺑﺎى ﺧﻨﺠﺮ ﻳﺎﺧﺪوا اﻟﺒﻴﺒﻰ وﻛﺪد ﻛﺪه‬
to cut ‫ ﻣﻌﻨﺎﻫﺎ اﻟﺤﺮﻓﻰ‬Caesar ‫ وﺳﻤﻴﺖ ﺑﻬﺬا اﻻﺳﻢ ﻧﺴﺒﺔ ﻟﻼﺳﻢ اﻟﻼﺗﻴﻨﻰ‬bleeding and infection ‫اﻟﻔﻴﻤﻴﻞ ﺑﺘﻤﻮت ﻣﻦ ال‬

Incidence:
The rising rate of cesarean section is considered problem all over the world, due to complications
of presence of uterine scar in subsequent pregnancy including rupture uterus and placenta
accreta. The rate of caesarean section reach 25-30%in USA , and in Egypt reach 42-50%.
indications:

1. Absolute contracted pelvis: one or more of pelvis diameters is reduced

2. Soft tissue tumor obstructing labor
3. Pelvic bone tumor
4. Placenta previa centralis.
‫ﻓﻰ اﻟﺤﺎﻟﺔ دى اﻟﻤﺸﻴﻤﺔ ﺑﺘﺒﻘﻰ ﺗﺤﺖ اﻟﺒﻴﺒﻰ ﻓﻼزم ﻋﻠﺸﺎن ﺗﻄﻠﻊ اﻟﺒﻴﺒﻰ ﺗﻘﻄﻊ اﻟﻤﺸﻴﻤﺔ ﻓﻨﻀﻄﺮ ﻟﻌﻤﻠﻴﺔ ﻗﻴﺼﺮﻳﺔ‬

5. Active lower genital tract infection with herpes

6. Stricture of cervix or vagina : Cervical stenosis ‫ﻳﻌﻨﻰ ان ﻋﻨﻖ اﻟﺮﺣﻢ او اﻟﻤﻬﺒﻞ ﺑﻴﺒﻘﻰ ﺿﻴﻖ‬
‫ ﺣﺘﻰ ﻟﻮ اﻟﺒﻴﺒﻰ ﻣﻴﺖ‬CAESAREAN SECTION ‫ ( ﻛﺪه ﻻزم ﺗﻌﻤﻞ‬transverse ) ‫ﻓﻰ ﺣﺎﺟﺔ ﻛﻤﺎن اﻧﻪ ﻟﻮ اﻟﻌﻴﻞ ﺟﺎى ﺑﺎﻟﻌﺮض‬

7. Maternal request
‫ﻟﻮ اﻻم ﻃﻠﺒﺖ اﻧﻬﺎ ﺗﻮﻟﺪ ﻗﻴﺼﺮى ﻳﺒﻘﻰ ﺧﻼص ﻛﺪه ده ﻗﺮارﻫﺎ ﻫﻰ‬
13
 Maternal:
 Cephalopelvic disproportion: occurs when there is mismatch between the size of the fetal head
and size of the maternal pelvis, resulting in "failure to progress" in labor for mechanical reasons
‫ اوى او اﻟﺒﻴﺒﻰ ﺣﺠﻤﻪ ﻛﺒﻴﺮ اوى‬contracted ‫ ﺑﻴﺒﻘﻰ‬pelvis ‫ﺑﻤﻌﻨﻰ اﻧﻪ ال‬

 Other types of placentae previa

 Abnormal uterine action in normal labor
 Previous uterine scar
 Previous repair of genital descends.
 Certain case of DM or preeclampsia ‫ﻟﻮ اﻻم ﻋﻨﺪﻫﺎ ﺳﻜﺮ او ﺗﺴﻤﻢ ﺣﻤﻞ‬
 Old primigravida
‫ﻟﻮ اﻻم ﻛﺒﻴﺮة ﻓﻰ اﻟﺴﻦ واول ﻣﺮة ﺗﺨﻠﻒ‬

Fetal:
 Large fetus
 Malpresentations e.g., breech
‫او ﻫﻮ ﻧﺎزل ﺑﺮﺟﻠﻴﻪ ﻫﻴﺒﻘﻰ ﻛﺪه ﻫﻨﻀﻄﺮ ﻧﻔﺘﺢ ﻗﻴﺼﺮى اﻣﺎ ﻟﻮ ﻧﺎزل ﺑﺮﺟﻠﻴﻪ ﺑﺮدو ﺑﺲ ﻣﻴﺖ ﻣﺜﻼ ﻻ ﺳﺎﻋﺘﻬﺎ ﻫﺘﺴﻴﺒﻪ ﻳﻨﺰل ﻟﻮﺣﺪه‬
‫ﺣﺘﻰ ﻟﻮ ﻫﺘﻀﻄﺮ ﺗﻜﺴﺮ ﻋﻀﻤﻪ‬

 Fetal distress : baby isn't receiving enough oxygen through the placenta.
 Repeated intrauterine fetal death before last week of pregnancy
 Some case of Rh isoimmunization

1. Elective cesarean section

The operation is done before onset of labor usually one or two weeks before expected date of
delivery
‫اﻟﻨﻮع ده ﺑﻴﺤﺪدوا اﻟﻌﻤﻠﻴﺔ اﺻﻼ وﻗﺒﻞ ﻣﻴﻌﺎدﻫﺎ ﺑﺎﺳﺒﻮﻋﻴﻦ ﺗﻼﺗﻪ‬

2. Selective caesarean section: after onset of labor.

‫ ﻳﺒﺪأ وﺑﻌﺪﻳﻦ ﺗﺪﺧﻞ اﻟﻌﻤﻠﻴﺎت‬onset of labor ‫اﻣﺎ اﻟﻨﻮع ده ﺑﻴﺴﺘﻨﻮا ال‬
14
 ‫ﻣﻮاﺻﻔﺎت اﻟﺠﺮح‬

 Skin incision for cesarean section

 Transverse semilunar incision, made in subcutaneous tissue and skin,
 2-3 cm above the symphysis pupis.
 Had less postoperative pain, with rapid recovery for intestinal movement.
 Leave strong scar with more cosmetic appearance.

Incision is done in lower uterine segment, in transverse direction about 10 cm, and closed later into
double layer closure, it had many advantages over upper segment
 produce less bleeding
 strong scar with less liability to rupture
 less liability to infection
 less liability to paralytic ileus
 less liability to postoperative adhesion
 lower rate of mortality
Mostly all cesarean sections Is done by that technique
‫ اﺣﺴﻦ ؟‬lower segment ‫ﻟﻴﻪ ال‬

‫ اﺣﺴﻦ ﻓﻴﺴﻤﺢ ﺑﻌﻤﻠﻴﺔ ﺗﺎﻧﻴﺔ‬repair ‫ اﻗﻞ وﻳﺨﻠﻰ ال‬bleeding ‫ اﻗﻞ ﻳﺒﻘﻰ‬surface 

15
 ‫ ﻫﻮ اﻟﻠﻰ ﺑﻴﺤﺼﻠﻪ‬upper segment ‫ ﻣﺶ ﺑﻴﺤﺼﻠﻪ اى ﺣﺎﺟﺔ ﻓﻰ ﺣﻴﻦ ان ال‬lower segment ‫ ﻛﻤﺎن اﺛﻨﺎء اﻟﻮﻻدة ال‬
‫ ﻣﻤﻜﻦ ﺗﻔﺘﺢ‬contraction ‫ ﺳﺎﺑﻘﺔ وﺣﺼﻞ‬scar ‫ ﻓﺎﻟﻔﻴﻤﻴﻞ دى وﻫﻰ ﺣﺎﻣﻞ ﻟﻮ ﻋﻨﺪﻫﺎ‬contraction

placenta ‫ وﺟﺮﺣﺖ ال‬upper segment ‫ ﻫﺘﺒﻘﻰ ﻣﺸﻜﻠﺔ ﻟﻮ ﻓﺘﺤﺖ ﻓﻰ ال‬upper segment ‫ ﻣﻮﺟﻮدة ﻓﻰ ال‬placenta ‫ ﻛﻤﺎن ال‬

paralytic ‫ ﺑﻴﺒﻘﻰ ﻋﻨﺪﻫﻢ‬upper segment ‫ ﻓﺎﻟﻠﻰ ﺑﻴﻌﻤﻠﻮﻫﺎ ﻓﻰ ال‬intestine ‫ ﻗﺮﻳﺐ اﻛﺘﺮ ﻣﻦ ال‬upper segment ‫ ﻛﻤﺎن ال‬
paralysis ‫ وده ﻣﻌﻨﺎه ان اﻻﻣﻌﺎء ﻣﺒﺘﺘﺤﺮﻛﺶ او ان اﻻﻣﻌﺎء ﺣﺼﻠﻬﺎ‬ileus

increased intra-abdominal pressure ‫ وﻓﻴﻪ‬contracted ‫ ﺑﻴﺒﻘﻰ‬upper segment ‫ ﻛﻤﺎن ﻛﻨﺎ ﻗﻮﻟﻨﺎ ﻗﺒﻞ ﻛﺪه ان ال‬
rupture ‫ ي‬uterus ‫ﻓﻤﻤﻜﻦ ﻟﻤﺎ اﺟﻰ اﻓﺘﺢ ﻓﻴﻪ ال‬

lower segment ‫اﻛﻴﺪ ﺑﺮدو ﻓﻴﻪ ﻋﻴﻮب ﻟﻞ‬

‫ اﺛﻨﺎء اﻟﻮﻻدة‬bladder trauma ‫ ﻓﻤﻤﻜﻦ ﻳﻌﻤﻞ‬bladder ‫ ﻫﻮ ﺑﻴﺒﻘﻰ ﻗﺮﻳﺐ ﻟﻞ‬

upper segment is wide ‫ اﻗﻞ ﻓﻰ اﻟﻌﺮض ﻓﻰ ﺣﻴﻦ ان ال‬lower segment ‫ ان ال‬
upper segment ‫ ﻳﺘﺠﺮح ﻷﻧﻪ اﺻﻐﺮ ﻋﻠﻰ ﻋﻜﺲ‬uterine artery ‫ ﺑﺘﺰاد ﻓﺮص ان ال‬lower segment ‫ ﻛﻤﺎن ﻓﻰ ال‬

Vertical incision done in upper segment of uterus about 10 cm the uterus after that closed into
three layers it is easy to be done and take short time ,
but had many disadvantages
 produce more bleeding
 weak scar with more liability to rupture
 more liability to infection
 more liability to paralytic ileus
 more liability to postoperative adhesion
 higher rate of mortality.
Indications:
 Difficulty or dangerous to reach lower segment due to presence of fibroids, varicosities or
adhesions
 Bad maternal condition needs rapid delivery.
 Repaired vesicovaginal fistula
 Cesarean hysterectomy indicated
 Postmortem cesarean section
‫ﻳﻌﻨﻰ اﻻم ﻣﺎﺗﺖ ﻓﻴﺤﺎوﻟﻮا ﻳﻨﻘﺬوا اﻟﺒﻴﺒﻰ ﺑﺄي ﻃﺮﻳﻘﺔ‬
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 ❸

Vertical incision in lower uterine segment had many advantages over transverse incision:
 less bleeding as midline is the least vascular area away from uterine vessels and ureter
which may be injured in transverse incision
 less liability to pelvic thrombosis
 repair is more anatomical as the flaps are equal thickness
Disadvantages:
incision may extend downwards into bladder and vagina, or extend upward to upper uterine
segment led to weakening of scar
‫ ﻳﺒﻘﻰ ﻛﺄﻧﻚ‬upper uterine segment ‫ ﻟﻞ‬extension ‫ ﺑﺲ ﻣﻤﻜﻦ ﻳﻌﻤﻞ‬transverse ‫ ﺑﺪل‬vertical ‫ﻃﻴﺐ ﻟﻮ ﺟﻴﻨﺎ ﻧﻔﺘﺢ‬
cervix ‫ ﺗﺤﺖ ﻟﺤﺪ ال‬extension ‫ﻣﻌﻤﻠﺘﺶ ﺣﺎﺟﺔ او ﻳﻌﻤﻞ‬

lower segment transverse ‫ﻋﻠﺸﺎن ﻛﺪه اﺣﺴﻦ ﺣﺎﺟﺔ ﻫﻮ‬

Combined transverse incision in lower uterine segment, longitudinal incision in upper segment.
 Very weak scar.
Indication: case of impacted shoulder
‫ وﺟﻴﺖ ﺗﻄﻠﻊ اﻟﺒﻴﺒﻰ ﻣﻌﺮﻓﺘﺶ ﺗﻄﻠﻌﻪ ﻓﺘﻀﻄﺮ اﻧﻚ ﺗﻔﺘﺢ ﺑﺎﻟﻄﻮل‬lower segment transverse ‫ده ﺑﻴﺤﺼﻞ ﻟﻤﺎ ﺗﻜﻮن ﻓﺘﺤﺖ‬
‫ﻋﻠﺸﺎن ﺗﻌﺮف ﺗﻄﻠﻌﻪ وده ﻃﺒﻌﺎ اﺳﻮأ اﻷﻧﻮاع‬

Cesarean section is done followed by removal of uterus.

‫ وﺑﻌﺪﻳﻦ ﺗﺸﻴﻞ اﻟﺮﺣﻢ ﻳﺘﻌﻤﻞ اﻣﺘﻰ ؟‬caesarean section ‫ﻳﻌﻨﻰ ﺗﻌﻤﻞ‬

Indications:
 uncontrollable postpartum hemorrhage
 some cases of rupture uterus, placenta accrete. ‫ﻣﻤﻜﻦ ﻣﻨﻀﻄﺮش ﻧﻌﻤﻠﻬﺎ ﻷﻧﻬﺎ ﻣﺶ ﺧﻄﻴﺮة ﻟﻠﺪرﺟﺔ دى‬
 multiple fibroids needing hysterectomy.
 some case of cervical cancer with pregnancy
❻

Tubal sterilization can be done during cesarean section as a method of contraception.

‫ﻳﻌﻨﻰ ﺑﻌﺪ اﻟﻌﻤﻠﻴﺔ اﻟﻘﻴﺼﺮﻳﺔ ﺗﻌﻤﻞ رﺑﻂ ﻟﻘﻨﺎة ﻓﺎﻟﻮب ﻋﺸﺎن اﻟﺴﺖ ﻣﺘﺤﻤﻠﺶ ﺗﺎﻧﻰ‬
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 ❼

If a pregnant woman has a cardiac arrest and the fetus is viable, post-mortem Caesarean section
should be carried out without delay. For speed, this would be best done via midline skin and uterine
(‘classical’) incisions. Not only can a baby's life be saved, but also resuscitation of the mother is
facilitated (less pressure on the diaphragm and improved venous return).
‫ ﻋﻠﺸﺎن ﻧﻠﺤﻖ اﻟﺒﻴﺒﻰ ﺑﺲ ﻓﻰ ﻧﻔﺲ اﻟﻮﻗﺖ ﻣﺶ ﻣﻨﻄﻘﻰ ﻷﻧﻪ ﻓﻰ‬cesarean section ‫ﻳﻌﻨﻰ اﻻم ﻣﺎﺗﺖ ﻓﻬﻨﻀﻄﺮ ﻧﻌﻤﻞ ﻟﻬﺎ‬
‫اﺣﺘﻤﺎل ﻛﺒﻴﺮ اﻧﻪ ﻛﺪه ﻛﺪه ﻫﻴﻤﻮت‬

 the surgical removal of the uterine contents after abortion

 Miniature cesarean section done before 20 weeks of pregnancy, before viability of fetus

Patient may allow delivering normal after cesarean section if the indication of the first cesarean
section is not present in subsequent pregnancy. If vaginal delivery is allowed continuous electronic
fetal monitoring is indicated.
‫ﻳﻌﻨﻰ ﻣﻤﻜﻦ ﻳﺴﻤﺢ ﻟﻬﺎ اﻧﻬﺎ ﺗﻮﻟﺪ ﻃﺒﻴﻌﻰ ﺑﻌﺪ وﻻدة ﻗﻴﺼﺮﻳﺔ ﻟﻮ راح اﻟﺴﺒﺐ اﻟﻠﻰ ﻛﺎن ﻣﺨﻠﻴﻬﺎ ﺗﻮﻟﺪ ﻗﻴﺼﺮى‬

Repeated cesarean section can be done if the indication of cesarean section is still present like
contracted pelvic
Complications:
low risk pregnancy ‫ﺑﻤﺠﺮد ﻣﺎ اى ﻓﻴﻤﻴﻞ ﺗﻮﻟﺪ ﻗﻴﺼﺮى ﻓﻬﻰ ﻛﺪه ﻫﺘﻌﻴﺶ ﻣﺮﻳﻀﺔ ﻃﻮل ﻋﻤﺮﻫﺎ واﺻﺒﺢ اﻟﺤﻤﻞ ﺑﻌﺪ ﻛﺪه ﻣﻦ‬
high risk ‫ل‬

1. Shock either hemorrhagic or neurogenic

2. Primary Hemorrhage due to injury of large uterine vessels or uterine atony.
3. Secondary hemorrhage or reactionary hemorrhage
4. Thrombosis and pulmonary embolism
5. Injury to urinary bladder and ureters
6. Anesthetic complications.
7. Genital tract infections
8. Urinary tract infection and uterovesical fistula formation
9. Complications of skin incision including infection, hematoma formation or burst abdomen.
10. Rupture of uterine scar in subsequent pregnancy.
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 ‫ ﻋﻦ ﻃﺮﻳﻖ اﻧﻬﺎ ﺗﻌﻤﻞ‬infertility ‫ دى ﺗﺴﺒﺐ ﻟﻬﺎ‬scar ‫ وﻣﻤﻜﻦ ال‬rupture ‫ ت‬scar ‫ﺗﻜﻮن ﻫﻰ ﺣﺎﻣﻞ ﻋﺎدى ﺟﺪا وﻓﺠﺄة ال‬
adhesion of the fallopian tube

11. Placenta accrete in subsequent pregnancy.

Definition: It is the period after delivery during which the changes produced by pregnancy regress.
 It takes 6 weeks (42 days).
pregnancy ‫ ﻋﻜﺲ اﻟﻠﻰ ﺣﺼﻠﺖ ﻓﻰ ال‬changes ‫اﻟﻔﺘﺮة دى ﺑﻴﺤﺼﻞ ﻓﻴﻬﺎ‬

1. Temperature: Slight reactionary rise not more than 0.5°C which drops back to normal within 24
hours. = Slight rise may occur at 2 day (start of lactation).
Puerperal fever ‫ ﺳﺎﻋﺔ ﺑﺲ ﻟﻮ زادت ﻋﻦ ﻛﺪه ﻳﺒﻘﻰ اﺳﻤﻬﺎ‬24 ‫درﺟﺔ اﻟﺤﺮارة ﺑﺘﺮﺗﻔﻊ ﻣﻦ ﻧﺺ درﺟﺔ ﻟﺪرﺟﺔ ﻓﻰ اول‬

2. Pulse: Slight slowing of pulse rate which then becomes normal except if hemorrhage or infection
occur.
3. RBCs count & Hb%: Gradually becomes normal except there is blood loss more than usual.
‫ ﻟﺘﺮ ﻓﺎﻷم ﺑﻴﺒﻘﻰ ﻋﻨﺪﻫﺎ‬١ ‫ ﺑﺘﻔﻘﺪ ﺣﻮاﻟﻰ‬caesarean section ‫ اﻷم ﺑﺘﻔﻘﺪ ﺣﻮاﻟﻰ ﻧﺼﻒ ﻟﺘﺮ اﻣﺎ ﻓﻰ ال‬normal labor ‫ﻓﻰ ال‬
‫ ﻋﻠﺸﺎن ﺗﻘﺪر ﺗﻌﻮض‬iron replacement ‫ ﺑﺴﺒﺐ اﻟﺪم اﻟﻠﻰ ﻓﻘﺪﺗﻪ وﺑﺘﺤﺘﺎج‬anemia

4. GIT: Tendency to constipation in early period due to :

 Atony of intestine, abdominal & perineal muscles.
 Loss of fluids.
‫ﺑﻴﺠﻠﻬﺎ اﻣﺴﺎك ﺑﺴﺒﺐ اﻧﻬﺎ ﻣﺶ ﺑﺘﺘﺤﺮك ﻛﺘﻴﺮ واﻧﻬﺎ ﻣﺶ ﺑﺘﺸﺮب ﺳﻮاﺋﻞ ﻛﻔﺎﻳﺔ‬

5. Weight: Loss of weight due to: = evacuation of uterine contents (fetus, placenta & amniotic fluid). ,
Excessive sweating.
6. Skin: there is tendency to excessive sweating
7. Postpartum psychosis: the joy after delivery is often followed in a few days by mild and transient
depression and fits of crying
‫ﻳﻌﻨﻰ ﺑﻴﺠﻴﻠﻬﺎ اﻛﺘﺌﺎب ﻣﺎ ﺑﻌﺪ اﻟﻮﻻدة‬

8. Menstruation: 6-8 weeks after delivery if not lactating female

9. Urinary tract:
 Polyuria in the first few days to excrete water retention during pregnancy.
Retention of urine is common due to - Recumbent position. ‫اﻧﻬﺎ ﺗﺒﻘﻰ ﻧﺎﻳﻤﺔ ﻋﻠﻰ ﺟﻨﺒﻬﺎ‬
19
  Laxity of abdominal and bladder wall. - Reflex inhibition from episiotomy. - Urethral
compression by edema or hematoma
‫ وان ﻛﺎن ﺑﻌﺾ اﻟﺴﺘﺎت‬protein Uria ‫ﻓﻰ اﻟﺪم ﻓﺒﻴﻌﻤﻞ‬peptone ‫ ﺑﺴﺒﺐ وﺟﻮد‬frequency of micturition ‫ﺑﻴﺤﺼﻠﻬﺎ‬
reflex ‫ ﻓﺒﻴﺤﺼﻞ‬episiotomy‫ ﺑﺴﺒﺐ ال‬urine retention ‫ﺑﻴﺤﺼﻠﻬﻢ اﻟﻌﻜﺲ ﻳﻌﻨﻰ ﺑﻴﺤﺼﻠﻬﻢ‬

10. Breasts:
 Colostrum is secreted in the first 3 days
Mechanism & start & location:
 After placental delivery there will be withdrawal of estrogens which was inhibiting the action of
prolactin on the breast acini. Thus, breast acini will respond to hyperprolactinemia by milk
formation which starts on the 3day.
 Sucking stimulates prolactin secretion from lactotrophs of anterior pituitary milk production
by breast acini. Also, sucking stimulates oxytocin release  contraction of myoepithelial cells
around breast acini  milk ejection (milk let down)
11. After pains: - Due to painful uterine contractions occurring in early puerperium and increases
during sucking (oxytocin release).

②
1. Uterus: - Regressive involution till the end of puerperium.
After delivery the weight of the uterus is 1000 gm and length is 20 cm and by the end of 6 week: its
weight is 50 gm and its weight is 7cm. —
symphysis pubis‫ ﺑﻴﺮﺟﻊ ﻣﻜﺎﻧﻪ ﺗﺤﺖ ال‬uterus ‫ﻋﻨﺪ اﻻﺳﺒﻮع اﻟﺘﺎﻟﺖ ال‬

2. Cervix: - At first the cervix is soft flabby and patulous. it becomes closed by the end of the first
week.
3. Lochia - Is the discharge of genital tract during puerperium.
 In the 1st week, the lochia is red (Lochia rubra) consisting of blood clots and decidual shreds.
 In the 2nd week, it because yellowish (Lochia serosa) consisting mainly of leucocytes. –
 In the 2nd week, It becomes white (Lochia alba ) consisting of leucocytes & mucus –
Resistance of red lochia occurs in subinvolution offensive lochia indicates infection
‫ وﺑﻴﻌﺪى ﺑﺘﻼت ﻣﺮاﺣﻞ‬vagina ‫ اﻟﻠﻰ ﺑﻴﺨﺮج ﻣﻦ ال‬discharge ‫ده ال‬
‫ وده ﺑﻴﺒﻘﻰ ﻟﻮﻧﻬﺎ اﺣﻤﺮ‬lochia rubra ‫اول ﺣﺎﺟﺔ‬
‫ ﻳﻌﻨﻰ ﻟﻮﻧﻬﺎ اﺻﻔﺮ‬lochia serosa ‫وﺗﺎﻧﻰ ﺣﺎﺟﺔ اﺳﻤﻬﺎ‬
‫ ﻟﻮﻧﻬﺎ اﺑﻴﺾ‬lochia alba ‫واﺧﺮ ﺣﺎﺟﺔ‬
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 ‫ﻟﻤﺎ ال ‪ placenta‬ﺑﺘﺘﻮﻟﺪ ﺑﺘﺴﻴﺐ ﻣﻨﻄﻘﺔ ﻛﺒﻴﺮة ﻣﺠﺮوﺣﺔ ‪ raw area‬ﻓﻰ ال ‪ endometrium‬ﻛﺄﻧﻪ ﺟﺮح ﺑﻴﺒﺪأ ﻳﻨﺰل دم اﺣﻤﺮ‬
‫ﻣﺘﺠﻠﻂ وﻟﻤﺎ ﻳﺒﺪأ ﻳﺤﺼﻞ ‪ healing‬ﻳﺒﺪأ ﻳﻨﺰل ‪ serous discharge‬ﻟﻮﻧﻪ اﺻﻔﺮ وﺑﻌﺪ ﻛﺪه ﻟﻤﺎ ﻳﺤﺼﻞ ‪ complete healing‬ﺑﺘﺒﻘﻰ‬
‫اﻓﺮازات ﺑﻴﻀﺎ ﻟﻐﺎﻳﺔ ﻣﺎ ﺗﺨﺘﻔﻰ ﺗﻤﺎﻣﺎ‬

‫وﻣﻤﻜﻦ ﻳﺤﺼﻞ ﺗﻐﻴﺮات ﻓﻰ ﺣﺠﻤﻬﺎ او رﻳﺤﺘﻬﺎ ﺑﺴﺒﺐ ‪ infection‬او ﻏﻴﺮه او ﻓﻰ اﻧﻬﺎ ﺗﺴﺘﻤﺮ ﻟﻤﺪه اﻛﺘﺮ ﻣﻦ اﻟﻤﻌﺘﺎد زى ﻣﺜﻼ‬
‫ال ‪ lochia rubra‬ﻣﻴﻨﻔﻌﺶ ﺗﺰﻳﺪ ﻋﻦ ‪5‬و‪ 7‬اﻳﺎم‬

‫‪ ‬ﺑﻞ ﺗﺨﻴﻠﻮا اﻧﻬﺎ ﻣﻤﻜﻦ ﻣﺎ ﺗﺠﻴﺶ ﻟﻨﺎس ﺧﺎﻟﺺ وده ﻃﺒﻌﺎ ‪abnormal‬‬

‫ﻣﻬﻢ ﺑﻘﻰ ﻧﻌﻤﻠﻬﺎ ‪exercise‬‬

‫ﻷﻧﻬﺎ ﺑﻌﺪ اﻟﻮﻻدة ﺑﻴﺤﺼﻞ ‪ weakness of pelvic floor muscles, weakness of the uterine ligament‬ﻷﻧﻬﺎ ﺑﺘﺒﻘﻰ ﻣﺸﺪودة‬
‫ﺟﺎﻣﺪ وﺑﻌﺪﻳﻦ ﻳﺤﺼﻠﻬﺎ ‪relax‬‬

‫ﻓﺎ اﺣﻨﺎ ﻋﺎﻳﺰﻳﻦ ﻧﻌﻤﻠﻬﺎ ‪ strength‬و ‪ stretch‬ﻟﻞ ‪pelvic floor muscle‬‬

‫ﺗﻌﻤﻠﻬﺎ اﻣﺘﻰ ؟‬

‫‪ ‬ﻟﻮ ﻓﻴﻪ ‪ incision‬ﻳﺒﻘﻰ ﻧﻌﻤﻠﻬﺎ ﺑﻤﺠﺮد ﻣﺎ ال ‪ incision‬ﻳﻠﺘﺌﻢ ﻧﻘﺪر ﻧﺒﺪأ ﻣﻌﺎﻫﺎ‬

‫ﺑﺲ ﻛﺪه ﺧﻠﺼﻨﺎ‪ ،‬ﺑﺎﻟﺘﻮﻓﻴﻖ داﺋﻤﺎ‪.‬‬

‫ﻻ ﺗﻨﺴﻮﻧﺎ ﻣﻦ دﻋﺎﺋﻜﻢ‬

‫وﻛﻞ ﻋﺎم و أﻧﺘﻢ ﺑﺨﻴﺮ‬

‫ﺛﱰاﺑ�ﺴﺖ ﺗ�‬
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