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Physiological delivery (Stages of labour: (1st Stage: opening of the…
Physiological delivery
- indicators:
lowering of the uterine fundus – two weeks before delivery,
contractions,
cervical ripening,
pressure on the bladder,
- Symptoms of the upcoming labour:
pain in the sacral bone region,
diarrhoea, nausea, vomiting,
palpitation, headache,
pressure on the rectum,
increase in vaginal secretion,
Indications for admission around the due date:
rapture of amniotic sac
regular uterine contractions
haemorrhage from the reproductive track
cervical dilation without contractions
post-term pregnancy
incorrect CTG
other pathologies such as increase in RR, gestational cholestasis, diabetes
C-sections indications before the beginning of contractions
Uterus
-
-
Uterine contractions remodel the uterus into two parts:
active – main body of uterus
passive – „the lower parts”
(cervix & Aschoff Syndrome)
Types of delivery
- Incorrect/non-physiological delivery:
It can happen spontaneously and without medical help
but
There is higher perinatal risk for the mother and the foetus
(for example breech delivery)
- Pathological labour:
can’t end up with vaginal delivery and without medical help
and
there is a great perinatal risk for the mother and the foetus
(for example, delivery in the transverse position)
- Normal labour:
Physiological labour:
can happen spontaneously, by the vaginal route, without medical help
and there is normal perinatal risk for the mother and the foetus
Stages of labour:
- 1st Stage: opening of the cervix
primagravida: first the cervix is shortening then it is dilated
multipara: effacement and dilation take place at the same time
Timing:
Primagravida – up to 18 hours
Multipara – up to 12 hours
- 2nd Stage: Delivery of the foetus:
crowning
the shoulders following the head in its transverse lie
then posterior shoulder and torso being delivered
cutting of the umbilical cord
protection of the perineum
episistomy
- 3rd stage
– placental detachment and delivery:
Schultze's mechanism - central
Duncan’s mechanism - parietal
- 4th Stage
– early puerperium (2 hours)
close observation
bleeding from the reproductive tract
constriction of the uterus
blood pressure
perineum and other soft tissue of the canal
Cardinal movements
- 1st head movement– „flexion”
occurs as the effect of the uterine contractions’ force transmitted by fetal vertebral column
on asymetrically supported fetal head
- 2nd head movement – „internal rotation”
the foetal occiput is facing the pubic symphysis - „correct rotation”
it may happen that the foetal face is under the pubic symphisis
- „incorrect rotation”
- 3rd head movement – „extension”
support point = rotation axis
– occiput in the lower edge of the pubic symphysis
- 4th head movement – „external rotation”
after the head has been delivered
the face is torwards:
1 – right mother’s thigh (more frequently)
2 – left mother’s thigh