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Normal Labor I

正常分娩
 The mode of expulsion of
the futus and placenta
The power
Labor The passage
The futus
Delivery Psychological factor

Factors affecting labor

Mechanism of occipital presentation
 The mechanism of normal labor in vertex
presentation
1. Engagement 衔接
2. Descent 下降
3. Flexion 俯屈
4. Internal rotation 内旋转
5. Extension 仰伸
6. Restitution and external rotation 复位、外旋转
7. Expulsion of fetus 胎儿娩出
 Mechanism of labor
• The process of labor and delivery is marked by change in fetal
position in relation to the maternal pelvis

• Engagement
(BPD decent to a level below the pelvic inlet
An occiput below the ischial spines is engaged)
• Flexion
• Decent
• Internal rotation
• Extension
• External rotation
 Normal labor II

• The characteristics of normal labor

• Normal labor stages
• Clinical management of normal labor
Symptoms and signs of the onset of the labor

• Painful uterine contraction

• a show
• effacement and dilation of the cervix
• rupture of membranes
 The differentiation of labor
In labor: 临产 (sign: regular uterine contraction with cervix
dilatation and descent )
spontaneous uterine contraction
with progressive dilation of the cervix
interval < 5 ’
lasting >30’’
intensity is middle or heavy

effacement and dilation of the cervix

to be short,taken up,dilated
the rupture of the membranes
at any time during labor
False labor: threatened labor 先兆临
产

1) false labor 假临产

2) lightening 胎儿下降感
3) show 见红
The mucus plug is expelled from the cervix
mixing with a little blood
 Three Stages of labor
The first stage --- dilatation of the cervical OS
• onset of labor to full cervical dilation(10cm)
• the latent phase ( onest to <3cm, <16h)
• the active phase(>3cm to 10cm, <8h)
初产妇 11 － 12h 经产妇 6 － 8h
 Three Stages of labor

The second stage -- expulsion of the fetus

10 cm to the delivery of the infant, <2h

初产妇 1 － 2h 经产妇 数分钟－ 1h
 Three Stages of labor

The third stage -- expulsion of the placenta

delivery of the infant to delivery of the
placenta,
5 － 15min
<30min
 Management of normal labor
The first stage:
• education, eating, walking,
• position(sitting, reclining, recumbent)
• monitoring of the fetal heart rate ,
• Palpation of cervix ( effacement ,dilation)
• uterus contractions (palpation or electronic
monitoring)
• Analgesia and anesthesia
partogram 产程图
Station is expressed in centimeters above or
below the level of the ischial spines.
 The second stage
• fetal heart rate
• maternal conditions:
pulse, blood pressure, respiratory rate ,
temperature, urine output, fluid intake…
• evaluation of progress of labor
station, position of the presenting part, status
of membranes, meconium, blood
• Pushing:
• with the onset of each contraction, the
mother is encouraged to inhale,hold her
breath, and push
• increase in intra-abdominal pressure
• aiding in fetal descent through the birth
cacal.
• Head visible on vulval gapping
• Crowning of head
• Laceration or Episiotomy
• Delivery of fetus
• Deal with umbilical cord
Crowning of head
Episiotomy
• Clinical course and treatment in
third stage
1. Clinical findings
2. treatment
 the third stage:
• waiting for up to 30 min
• Separation indication of placenta:
the fundus changes to a globular shape and firm
consistency
A gush of blood appears vaginally
The umbilical cord appears to lengthen

• delivery of placenta (spontaneously, manually

• inspection of the birth canal
• Repair of lacerations or episiotomy
胎盘剥 离 signs of placental separation
Detect placental abnormalities—accessory placenta
 Key word and questions
• Labor
• Delivery
• Engagement
• Effacement
• What are the four factors in labor and delivery?
• What is the mechanisms of labor ?
• What are the three stages of labor ?
• Explain the separation indications of placenta.