Normal Labor and Delivery(AFE) 正常分娩

1. Normal Labor and Delivery(AFE)正常分娩 Lin JianhuaM.D., Ph.D., Professor Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine

2. definition • Term delivery(labor): 37-42weeks • pre-term delivery: 28- <37 weeks • post-term delivery: 42 weeks • Abortion: <28 weeks • 85% of women spontaneous labor and delivery between 37-42 weeks • LMP :last menstrual period • EDC: expected date of confinememt

3. The four factors for labor • Force (contraction) • birth canal (bony canal) • fetus (lie,position ,presentation,weight) • psychical-factors

4. The contractions • increase in frequency and duration • uterus can be felt to harden during contraction • lasting about 30-45 seconds • interval between contractions to be 5 min’ • the pain of labor is a character

6. NST CST

8. Bony pelvis • The planes of pelvis • inlet plane (promontory) • mid plane of pelvis(ischial spines) • outlet plane(two intersecting triangles)

9. Mechanism of labor • Engagement* • Flexion • Decent • Internal rotation • Extension • External rotation

10. Symptoms and signs of the onset of the labor • Painful uterine contraction • a show • effacement and dilation of the cervix • rupture of membranes

11. The show • The mucus plug is expelled from the cervix • mixing with a little blood the rupture of the membranes • at any time during labor effacement and dilation of the cervix • to be short,taken up,dilated

12. Stages of labor • The first stage: • onset of labor to full cervical dilation(10cm) • the latent phase ( onest to <3cm, <16h) • the active phase(>3cm to 10cm, <8h) • The second stage: • 10 cm to the delivery of the infant, <2h • The third stage: • delivery of the infant to delivery of the placenta, <30m’ • The fourth stage: • 2 hours after delivery of the placenta

13. Management of normal labor • The first stage: • education, eating, voiding, • position(sitting, reclining, recumbent) • monitoring of the fetal heart rate , • dilation of cervix and frequency • severity of uterus contractions(auscultation or electronic monitoring)

14. The second stage • :--- < 2 hour • fetal heart rate • maternal conditions: • pulse, blood pressure, respiratory rate , • temperature, urine output, fluid intake… • evaluation of progress of labor • cervical dilation, station,position of the • presenting part, status of membranes, • meconium, blood

15. 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.

16. Head visible on vulval gapping* • Crowning of head* • Laceration or Episiotomy • Delivery of fetus • Deal with umbilical cord

19. the third stage: • waiting for up to 30 min’ • the uterus decreases in size • delivery of placenta(spontaneously, manually • inspection of the birth canal • evaluated for lacerations

20. “The fourth stage” • postpartum uterine hemorrhage ,1% • uterus palpation through the abdominal wall is repeats • the amount of blood on pads are monitored • pulse and BP are monitored • use of drug : oxytocin

21. THANKS FOR YOUR ATTENTION Lin Jianhua M.D., Ph.D., Professor Dep. of Obstet. & Gynecol. Renji Hospital Affiliated to SJTU School of Medicine