Valdez, Ivan Paul A.

Junior Intern
 OUTLINE

 Objectives
 Definitions
 Mechanism of Labor
 Friedman’s curve
 Management of Stages of Labor
 Lacerations of the Birth Canal
 Episiotomy and Repair
OBJECTIVES:
1. To understand and recognize a normal labor
pattern.
2. To understand the mechanism of labor for a
cephalic presentation.
3. To understand the meaning of the following
germs: Presentation, position, lie, station,
effacement, dilatation.
4. To understand the phases and stages of labor.
TRUE LABOR FALSE LABOR
- regular intervals - irregular intervals
- gradually shorten - intervals remain long
- intensity gradually - intensity remains
unchanged
increases
- back and abdomen - lower abdomen
- cervix dilates - cervix does not
dilate
- not stopped by - relieved by sedation
sedation
 Labor

•When in the presence of perceived

uterine contractions, there is
progressive cervical dilation and
descent of the presenting part which
leads to the eventual expulsion of the
products of conception, the patient is
in labor.
FIGURE 2:FRIEDMAN’S CURVE
 MANAGEMENT OF FIRST STAGE OF LABOR

Average Duration
Nulliparous women – 8 hours
Parous women – 5 hours
Maternal position during labor

The position she finds most

comfortable (lateral recumbency)
 Subsequent vaginal examinations

Based on the character of uterine

contractions
Frequent vaginal examinations
increase the risk of infection
Effective contractions, the cervix
will dilate at 1-2 cm per hour
Maternal vital signs

Temperature and pulse – every 1

to 2 hours
BP is obtained between
contractions
Temperature elevation – checked
hourly
Oral intake

Food should be withheld during

active labor and delivery
Intravenous Fluids

To administer oxytocin

To prevent dehydration and
acidosis
Urinary Bladder Function

Bladder distention can lead to

obstructed labor and to subsequent
bladder
MANAGEMENT OF SECOND STAGE OF
LABOR
Identification
- full dilatation of the cervix, the
onset of the 2nd stage of labor
- begins to bear down
- develops the urge to defecate
 Duration
median duration : 50 minutes in nulliparas
20 minutes in multiparas
- FHR
low-risk fetus : at least every 15 min.
high-risk fetus : at least every 5 min.
- Maternal expulsive efforts
legs : half-flexed.
take a deep breath as soon as the next uterine
contraction begins, and with her breath held.
- Preparation for delivery
dorsal lithotomy position in order to increase the
diameter of the pelvic outlet.
preparation for delivery entails vulvar & perineal
cleansing.
SPONTANEOUS DELIERY

Delivery of the head

 crowning
- encirclement of the largest
head diameter by the vulvar ring
Ritgen Maneuver
- delivery of a child’s head by
pressure on the perineum while
controlling the speed of delivery by
pressure with the other hand on
the head
Delivery of shoulders

 the sides of the head are grasped with the

two hands & gentle downward traction
applied until the anterior shoulder appears
under the pubic arch
 next, by an upward movement, the
posterior shoulder is delivered
 hooking the fingers in the axillae should
be avoided
Clearing the nasopharynx

Minimize the likelihood of

aspiration of amniotic fluid debris
and blood
Clamping the cord

cut between two clamps placed 4

or 5cm from the fetal abdomen
Timing of Cord Clamping
- to clamp the cord after 1st
thoroughly clearing the infant's
airway, all of which usually takes
about 30 seconds
 MANAGEMENT OF THIRD STAGE OF
LABOR
As long as the uterus remains firm
and there is no unusual bleeding,
watchful waiting
until the placenta is separated.
No massage is practiced.
Signs of placental separation

 Calkin’s sign
 Sudden gush of blood
 Uterus rises in the abdomen
 Umbilical cord protrudes further out
of the vagina
Delivery of the placenta

 Placental expression should never be

forced before placental separation
 uterus is lifted cephalad with the
abdominal hand
 manual removal of the placenta
- If at any time there is brisk
bleeding and the placenta cannot be
delivered
“4th stage” of labor

 The hour immediately following delivery is

critical
 Vital signs are checked every 15 to 30
minutes
LACERATIONS OF THE BIRTH CANAL

 1. 1st-degree lacerations : fourchette,

perineal skin, vaginal mucous membranes.
2. 2nd-degree lacerations : the fascia and
muscles of the perineal body but not the
rectal sphincter.
3. 3rd-degree lacerations : the skin, mucous
membrane, perineal body and anal sphincter.
4. 4th-degree lacerations : through the rectal
mucosa to expose the lumen of the rectum.
EPISIOTOMY AND REPAIR

 Importance of Episiotomy
- Prevents pelvic relaxation
- Shoulder dystocia or breech delivery
- Forceps or vacuum extractor operations
- Occiput posterior positions
- Instances where failure to perform
episiotomy will result in perineal rupture
Characteristic Midline Mediolateral
Surgical easy more difficult
repair
Faulty healing rare more common
Postoperative minimal common
pain
Anatomical excellent occasionally
results faulty
Blood loss less more
Dyspareunia rare occasional
Extensions common uncommon