Management of Normal

Labor and Delivery

Normal Labor and Delivery

Definition of labor: uterine contractions
that cause cervical change
term pregnancy: 37-42 weeks
preterm: <37 weeks
Postdates pregnancy: >42 weeks

Identification of Labor
Uterine contraction that cause cervical
change
Vaginal Exam:
note dilation, effacement, consistency, station
Ruptured membranes?
, nitrazine test
sterile speculum
infrequent vaginal exams if PROM

Stages of labor
First Stage-- stage of cervical effacement
and dilation
Begins when uterine contractions of sufficient
frequency, intensity, and duration are attained
to bring about effacement and progressive
dilation of the cervix
Ends when the cervix s fully dilated (10 cm) to
allow passage of the fetal head

Divisions of First Stage of Labor

Divides 1st stage into latent and active
phase:
latent phase: onset of labor is defined
according to Friedman as the point at which
the mother perceives regular contractions
regular ctx take place along with cervical softening
and effacement

Latent Phase Labor

<4 cm dilated
Contractions may or may not be
painful
Dilate very slowly
Can talk or laugh through
contractions
May last days or longer
May be treated with sedation,
hydration, ambulation, rest, or
pitocin
Prolonged latent phase: defined
as greater than 20 hours in a
nullipara and greater than 14
hours in a parous woman

Active Phase Labor

At least 4 cm dilated
Regular, frequent, usually
painful contractions
Dilate at least 1.2-1.5
cm/hr
Are not comfortable with
talking or laughing during
their contractions

First Stage of Labor

Contractions
Interval
10 to 20 minutes between contractions: early labor
3 to 5 minutes between contractions: late labor

Duration
20 second long contraction: early labor
40 to 80 second long contraction: late labor

Quality
Uterus can be dented (poor quality): early labor
Uterus is hard (good quality): late labor

First Stage of Labor

Management

Fetal Heart Rate should be between 120 160 BPM

Mother should be coached to relax and
conserve energy between contractions

Maternal Monitoring and

Management during Labor
Maternal Vital Signs every 4 hours
if temperature: chorioamnionitis: need to
treat with antibiotics that will cover gram
negative and anaerobes (ampicillin and
gentamicin
Analgesia

Assessing Progress of Labor

Vaginal Exam
1. Cervix

Soft or Hard
Effaced or Thick
Dilatation

2. Presentation
Part (cephalic, breech, shoulder)
Flexion, Extension
Station

 Partograf

Stages of labor
Second stage of labor-- stage of expulsion of the
fetus
begins when dilatation of the cervix is complete and
ends with delivery of the fetus

Duration of Second Stage

Primigravida: 50 minutes, max 2 hours
Multiparous: 20 minutes or less, max 1 hours

Contractions
Interval: 2 to 3 minutes
Duration: 50 to 100 seconds

Second Stage of Labor

Management
Mother may feel urge to push, coach to push
only during a contraction once the cervix has
been determined to be fully dilated

Episiotomy
Perform to avoid unnecessary tearing when
head is crowning
Controlled delivery avoids need for episiotomy
in most cases

Ritgen Maneuver

Erbs palsey

Second Stage of Labor

Delivery of head CONTROL head to
prevent explosive delivery
and subsequent tearing
Check for presence of
cord around neck
Aspirate oral and nasal
cavities with bulb syringe
Deliver anterior shoulder
with downward pressure
Complete delivery and
HANG ON TO BABY!

Second Stage of Labor

Clear airway,
Assess
respirations,
Resuscitate if
necessary
Clamp cord when
pulsations cease
Leave 3 - 6 inches
of cord on baby

Second Stage of Labor

Episiotomy
Anesthetize with pudendal block or infiltration
Put two fingers into the vagina along the
posterior wall
Place one blade of scissors between fingers
inside vagina, other blade outside vagina
toward anus
Cut to approximately 1 inch away from anus
during a contraction

Robekan Perineum- Tatalaksana grade II

Robekan Perineum- Tatalaksana grade III

Tehnik penyambungan otot

sfingter ani

Robekan Perineum- Tatalaksana grade IV

Pain Relief
Narcotics
Continuous Lumbar Epidural
Paracervical Block
50/50 nitrous/oxygen
Psychoprophylaxis (Lamaze breathing)
Hypnosis

Anesthesia During Delivery

Local
Pudendal Block
Epidural
Caudal
Spinal
50/50 nitrous/oxygen

Stages of labor
Third stage of labor-- stage of separation of
separation and expulsion of placenta
begins immediately after delivery of the fetus
and ends with delivery of the placenta and
fetal membranes
Acitive management controlled cord
traction, oxytocin, uterine massage

Check the Placenta