normal labour, first stage by yin moe
TRANSCRIPT
Dr. Yin Moe HanSenior Lecturer
Obstetr ics & Gynaecology DepartmentSchool of Medicine, UCSI University
normal, mature, alivenormal, mature, alive vertex presentationvertex presentation spontaneous expulsionspontaneous expulsion per vaginumper vaginum within 24 hourswithin 24 hours without complicationswithout complications
NORMAL LABOUR
07/31/1207/31/12 221st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
STAGES OF LABOURFirst stage of labourFirst stage of labour
Second stage of labourSecond stage of labour
Third stage of labourThird stage of labour
Fourth stage of labourFourth stage of labour07/31/1207/31/12 441st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
FIRST STAGE OF LABOURonset of labour onset of labour
8-12 hours8-12 hours
full dilatation of the cervixfull dilatation of the cervix (10 cm)(10 cm)
Latent Phase –--- 0 – 3 cmLatent Phase –--- 0 – 3 cm Active Phase –--- 4 – 10 cmActive Phase –--- 4 – 10 cm
07/31/1207/31/12 551st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
SECOND STAGE OF LABOUR
full dilatation of the cervix full dilatation of the cervix
up to up to 1 hour1 hour
birth of the foetusbirth of the foetus
07/31/1207/31/12 661st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
THIRD STAGE OF LABOUR
birth of the foetusbirth of the foetus
5 - 15 mins not > 30 mins5 - 15 mins not > 30 mins
delivery of placenta and delivery of placenta and membranesmembranes
07/31/1207/31/12 771st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
FOURTH STAGE OF LABOUR
UP TO 2 HOURS AFTER DELIVERYUP TO 2 HOURS AFTER DELIVERY
07/31/1207/31/12 881st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
DIAGNOSIS OF LABOUR
1.1. Diagnosis and confirmation of labour Diagnosis and confirmation of labour
2.2. Diagnosis of stage and phase of labour Diagnosis of stage and phase of labour
3.3. Assessment of engagement and descent of the fetusAssessment of engagement and descent of the fetus
4.4. Identification of presentation and position of the fetus Identification of presentation and position of the fetus
07/31/1207/31/12 10101st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
DIAGNOSIS AND CONFIRMATION OF LABOUR
Suspect or anticipate labour i f the woman hasSuspect or anticipate labour i f the woman has : : Intermittent abdominal painIntermittent abdominal pain Associated with blood-stained mucus discharge (show)Associated with blood-stained mucus discharge (show) Watery vaginal discharge or a sudden gush of waterWatery vaginal discharge or a sudden gush of water
Confirm the onset of labour if there isConfirm the onset of labour if there is :: Cervical effacement—the progressive shortening and thinning of Cervical effacement—the progressive shortening and thinning of
the cervix during labourthe cervix during labour Cervical dilatation—the increase in diameter of the cervical Cervical dilatation—the increase in diameter of the cervical
opening measured in centimetresopening measured in centimetres
07/31/1207/31/12 11111st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
EFFACEMENT AND DILATATION OF THE CERVIX
07/31/1207/31/12 12121st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
DESCENT Abdominal palpationAbdominal palpation
Assess descentAssess descent in terms of f i f ths of fetal in terms of f i f ths of fetal
head palpable above the head palpable above the symphysis pubissymphysis pubis
Head entirely above the Head entirely above the symphysis pubissymphysis pubis f ive-f if ths (5/5) palpablefive-f if ths (5/5) palpable
Head entirely below the Head entirely below the symphysis pubissymphysis pubis zero-fif ths (0/5) palpablezero-fif ths (0/5) palpable
Descent of the fetal headDescent of the fetal head
07/31/1207/31/12 13131st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
MECHANISM OF NORMAL LABOUR
Cardinal movements of labour (LOA)
Engagement and descent
Flexion Internal rotat ion to OA
Extension Restitut ion External rotat ion
07/31/1207/31/12 15151st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
DELIVERY OF ANTERIOR SHOULDER
07/31/1207/31/12 22221st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
BODY BORN BY LATERAL FLEXION
07/31/1207/31/12 23231st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
ASSESSMENT OF PROGRESS OF ASSESSMENT OF PROGRESS OF LABOURLABOUR
latent phaselatent phase measuring changes in cervicalmeasuring changes in cervical effacementeffacement and and dilatationdilatation
active phaseactive phase measuring the rate of cervical measuring the rate of cervical dilatationdilatation and fetal and fetal descentdescent
second stagesecond stage assessing further fetal assessing further fetal descentdescent
07/31/1207/31/12 25251st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
PROGRESS OF THE FIRST STAGE OF LABOUR
Plot Plot on a partograph on a partograph once the woman enters once the woman enters the the active phaseactive phase of of labour. labour.
Alternatively, plot a Alternatively, plot a simple graph of simple graph of cervical cervical dilatation (cm) on the dilatation (cm) on the vertical axisvertical axis against time against time (hours) on the horizontal (hours) on the horizontal axis. axis.
07/31/1207/31/12 26261st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han
VAGINAL EXAMINATIONS
11stst stage of labour - stage of labour - 4 hourly4 hourly
22ndnd stage of labour stage of labour - - hourly hourly
After rupture of the membranesAfter rupture of the membranes
Record following after each VERecord following after each VE colour of amniotic fluidcolour of amniotic fluid cervical di latationcervical di latation descentdescent (can also be assessed abdominally)(can also be assessed abdominally)
Plot the findings on partographPlot the findings on partograph
Cervix not dilated on 1st VE
may not be possible to diagnose labour
If contractions persist
re-examine the woman after 4 hours for cervical changes
if there is effacement and dilatation, the woman is in labour
if there is no change, the diagnosis is false labour
07/31/1207/31/12 27271st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han