Gynekologicko - porodnická klinika Lékařské fakulty MU a FN Brno head of the department: doc. MUDr. Vít Weinberger, Ph.D Labour and delivery Obstetrics and Gynecolgy https://muni.brandcloud.pro/storage/10488/images/620x/49d0c631906bdfd14af652571fd2b858.png?87d88502 5df2c5c13a2eca6c9cc41e9a Eliška Gazárková Adobe Systems •Labour = process by which the fetus is delivered •Live birth - newborn has at least one signs of life regardless of pregnancy duration •Stillbirth - fetus born without signs of life and •Weighting 500g and more •If weight cannot be determined, born after finished 22. week of gestation •If the duration of pregnancy cannot be determined, at least 25cm long Definition Adobe Systems •estimated data of the labour according: • •first fetal movement •date of the conception •ultrasound measurement •date of the last menstrual period • •average pregnancy duration: •40 weeks ( 280 days ) from the last date of the menstrual period •38 weeks ( 266 days ) from the conception Labour date Adobe Systems •Premature labour •24 – 36 gestational weeks •Term labour •38 – 42 gestational week •Post term labour •after 42 gestational week • •until 24 gestational week = abortion Labour date Adobe Systems • •Vaginal / Caesarean section •Spontaneous / induced labour •Medicamental labour (spontaneous beggining) •Operative labour (VEX, forceps) ̶ Overview Adobe Systems ØOnset of labour – uterine contractions become regular and cervical effacement and dilatation becomes progressive. Ø4 stages Ø3 factors affecting progression of labor (3 P) •Power – uterine activity •Passage – birth canal •Passenger – position, presentation, size Overview Adobe Systems •Uterine activity •Relaxed during pregnancy •Mild irregular non-progressive contractions may occur - Braxton Hicks contractions • (dolores praesagientes) • may be falsly preceived as onset of labour •During labour regular contractions and retraction of myometrium •Frequency, length of contractions and time between contractions is monitored • Abdominal muscles • •Gravitation Labour forces Adobe Systems Labour forces - disorders Adobe Systems •Bony pelvis ̶Aditus pelvis ̶Amplitudo pelvis ̶Angustia pelvis ̶Exitus pelvis •Soft tissue ̶Lower uterine segment ̶Vaginal walls ̶Vulva ̶Pelvic floor muscles ̶Perineum ̶ Birth canal Adobe Systems •Pelvic diamteres ̶Disatntia bicristalis ̶Distatntia bispinalis ̶Distantia bitrochanterica ̶Conjugata externa •Pelvimetry Birth canal Martin pelvimeter; 34,0 cm Adobe Systems Birth canal - disorders Adobe Systems •The most freqent fetus presentation – cephalic. •Fetus head - ( size, shape ) – influence on conduct of labour, labour outcome •Skull: two frontal bones, two parietal bones, two temporal bones, one occipital bone •Joints: frontal, saggital, lambdoid, occipital •Fontanelle – big and small Fetus Adobe Systems •Preparatory stadium (dolores praesagientes, preparing of uterine muscles, going down uterus, cervical slimy secretion) ̶ •Onset: regular uterine contractions which cause progress in cervical effacement and dilatation •End of the I. stage: complete cervical dilatation •Latent phase and active phase (from 3 cm) •According to our standards no longer than 10 hours (regardless of the use of epidural) ̶ I. Stage of labour Adobe Systems •Fetal wellbeing – CTG, amniotic fluid color •Mothers wellbeing – blood pressure •Labour progression – dilatation of cervix I. Stage of labour – monitoring Adobe Systems ̶Secondary arrest of labour – previously adequate progress ̶Primarily dysfunctional labour – slow from onset ̶Causes: ̶ I. Stage of labour – disorders Adobe Systems •Onset: complete cervical dilatation (end of the first stage) •End of the II. stage: delivery of the baby •Pasive – descent of the neonates head through birth canal •Active – active pushing efforts of the mother •According to our standards no longer than 60 minutes II. Stage of labour Adobe Systems •Head delivery •Flexion •Progression •Internal rotation •Extension (around symphysis) •External rotation II. Stage of labour Adobe Systems •Shoulders delivery •Rotation of the anterior shoulder behind symphysis •Delivery of the anterior shoulder •Delivery of the posterior shoulder •Rest of the body •Usually passively follows after delivery of the head and shoulders II. Stage of labour Adobe Systems II. Stage of labour – disorders Adobe Systems Shoulder dystocia Shoulder Dystocia - Stepwards Adobe Systems •expeling placenta and fetal membranes •From delivery of fetus until delivery of placenta •Should not take longer than 60 minutes •Active management – use of uterotonics III. Stage of labour Adobe Systems •Retention of placenta – manual extraction in general anesthesia ̶ III. Stage of labour - disorders Operace ve III. době porodní Adobe Systems •First two hours after delivery •Complications most commonly occur during this time IV. Stage of labour Adobe Systems ̶Postpartum bleeding (4 T) •Tone – uterine hypotonia •Trauma – birth canal trauma (vaginal wall, perineum, cervix, hematma) •Tissue – retention of part of the placenta •Thrombin – coagulopathy IV. Stage of labour – disorders Adobe Systems •Anamnesis •Examination – external + internal = obstetric •blood presure, pulse, body temperature •Nonstress test - cardiotocography •Ultrasound - position, estimated weight, (doppler sonography) Delivery room incoming Adobe Systems •Partogram Delivery monitoring No description available. Adobe Systems •Patient monitoring •blood presure, pulse, body temperature, pain, psychical status •uterine contractions – external examination and monitoring •labour progression – internal examination •bleeding and coagulability •Fetal monitoring •Fetal heart rate - cardiotocography (external, internal ) •intrapartal fetal pulse oxymetry •S – T analysis ( fetal EKG ) •Amnionic fluid quality •ultrasound examination - presentation, Delivery monitoring Adobe Systems ̶Indication: •Obstetric (Prodloužené těhotenství, FGR, uteroplacentární insuficiencie, diabetes, … ) •Medical (Závažná hypertenze, renální onemocnění, …) ̶Methods: •Mechanical: • Hamilton manouver – separation of the membranes from the cervix leads to the local release of prostaglandins • Cervical dilatators •Pharmacological: Prostaglandins, Oxytocin •Other methods (questionable effectivity but not harmful): sexual intercourse, herbal remedies (raspberry leaf tea), nipple stimulation Induction and preinduction of labour Adobe Systems Thanks for your attention!