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

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normal labor and delivery afe

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

definition
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
the four factors for labor
The four factors for labor
  • Force (contraction)
  • birth canal (bony canal)
  • fetus (lie,position ,presentation,weight)
  • psychical-factors
the contractions
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
bony pelvis
Bony pelvis
  • The planes of pelvis
  • inlet plane (promontory)
  • mid plane of pelvis(ischial spines)
  • outlet plane(two intersecting triangles)
mechanism of labor
Mechanism of labor
  • Engagement*
  • Flexion
  • Decent
  • Internal rotation
  • Extension
  • External rotation
symptoms and signs of the onset of the labor
Symptoms and signs of the onset of the labor
  • Painful uterine contraction
  • a show
  • effacement and dilation of the cervix
  • rupture of membranes
slide11
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
stages of labor
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
management of normal labor
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)
the second stage
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
slide15
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.
slide16
Head visible on vulval gapping*
  • Crowning of head*
  • Laceration or Episiotomy
  • Delivery of fetus
  • Deal with umbilical cord
the third stage
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
the fourth stage
“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
thanks for your attention
THANKS FOR YOUR ATTENTION

Lin Jianhua

M.D., Ph.D., Professor

Dep. of Obstet. & Gynecol.

Renji Hospital Affiliated to SJTU School of Medicine