Mechanism of labour and use of partogram
- 1. Mechanism of labour and use of partogram Pavemedicine.com
- 2. Definition of labour Painful, regular uterine contractions. Progressive effacement(shortening) and dilatation of cervix. Causing descent and rotation of fetal head Full dilatation contractions become expulsive leading to delivery of baby. Delivery of placenta and membranes follows.
- 3. COMPONENTS OF LABOUR The powers Uterine contractions The passages bony pelvis, and soft tissues The passenger fetus
- 4. Onset of labour Stimuli - maternal (stretch, hormones) & fetal (? adrenal) Painful contractions. Show. Rupture of membranes. Shortening and dilatation of cervix.
- 5. First stage of labour Latent phase effacement dilation 0-3cm. Active phase dilation 3-10cm.
- 6. Stages of labour Second stage - from full dilatation until baby born. Third stage - From birth of baby until placenta and membranes delivered.
- 7. The powers- contractions Painful. Increase in frequency to 1:2-3 Increase in strength. Cervix pulled up Head passes down like toe through hole in sock
- 8. Diagnosis tocograph measures frequency and duration of contractions not intensity and tone intensity - gauge by amount of pain analgesia use, change in pain strength - gauge by abdominal palpation midwife, yourself
- 9. Passages- the pelvis Bony pelvis Brim - ovoid Cavity - circle Outlet - ovoid Pelvic floor slopes directing presenting part forward under pubic arch
- 10. Passenger - the baby
- 11. Flexion Encouraged by downward pressure from contractions. Brings smallest diameter into engagement Posterior fontanelle lower than anterior
- 12. Internal rotation and extension Second stage - descent Presenting part reaches sloping pelvic floor. Causes lowest point (occiput) to rotate forward Further descent , head extends.
- 13. Crowning Extending head stretches perineum gradually. Greatest diameter passes through vulva.Further extension allows forehead face and chin to escape.
- 14. Restitution and external rotation After internal rotation head twisted on shoulders. Delivers facing down. Anterior shoulder rotates on hitting pelvic floor into wider AP diameter of pelvis. Neck untwists, causing head to turn sideways.
- 15. Delivery of body Top shoulder escapes from under pubic arch Bottom one slides over perineum Oxytocic given to mother to help with 3rd stage Rest of body follows. Cord clamped and divided.
- 16. Third stage Contractions cause separation of placenta. Pushed down into lower segment Signs - lengthening of cord,uterus rises up, small gush of blood, placenta felt in vagina
- 17. Active management of 3rd stage This reduces blood loss Oxytocic given after delivery of anterior shoulder. Hand placed suprapubically pushes up gently Cord traction.
- 18. Haemostasis Uterus contracts after delivery This compresses vessels. Reducing blood loss
- 19. Management of labour Fetal & maternal observations. Encourage to mobilise Pain relief - TENS, Entonox, Opiates, Epidural. Antacids, Ranitidine- reduce acidity and risk of aspiration.
- 20. Partogram Used in established labour to check progress Plots cervical dilatation. Alert and action lines Maternal T, P, BP, urine, contractions. Fetal heart rate, descent, moulding & caput. Liquor Fluids & drugs.
- 21. Fetal observations Admission CTG to check well being Intermittent monitoring by listening in after contractions