Progress Management of Chlidbirth

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Progress & Management of Chlidbirth : 

Progress & Management of Chlidbirth Bambang Widjanarko Obstetric & Gyncologic Departement FKK Muhammadiyah University Jakarta - Indonesia Clinical Lecture

The management of labour begins when the woman seeks admission to hospital which she does when she believes or knows that she is in labour : 

The management of labour begins when the woman seeks admission to hospital which she does when she believes or knows that she is in labour

Admission : 

Admission The history of the present labour is obtained : The frequency and strength of the uterine contraction Information about ‘show’ (blood or mucus) Membranes have broken ? General Examination : General appearance Blood pressure – pulse and temperature Abdominal palpation : presentation and position of the fetus

Admission : 

Admission Vaginal Examination : Effacement and Dilatation of the cervix Position and station of the presenting part Cardiotocogram for 20 minutes to establish that the fetus is not at obvious risk of becoming distressed

First Stage of Labour : 

First Stage of Labour The first stage of labour begins at an imprecise time The first stage of labour can be divided into : Latent Phase Active Phase The active phase of labour starts when the cervix is 3 – 4 cm dilated. During the active part of the first stage of labour, the fetal head descends more deeply into the maternal pelvis and flexes.

Specific Care In the First Stage : 

Specific Care In the First Stage Support and comfort the patient and inform her about the progress of labour Complete the partogram : Check pulse,temperature, and blood pressure Monitor the uterine contraction Monitor the fetal heart rate Perform a vaginal examination every 4 hour Determine the position of the head, in relation to the maternal pelvis

Second Stage of Labour : 

Second Stage of Labour Begins when the cervix is fully dilated Expulsive stage during which the fetus is forced through the birth canal Simultaneously with the uterine contraction, the patient push down to force the fetus lower in her pelvis

The 7 Cardinal Movement of The Fetus : 

The 7 Cardinal Movement of The Fetus Engagement Descent Flexion Internal Rotation Extension External Rotation Expulsion

Birth of the baby : 

Birth of the baby

Head : 

Head As the fetal head becomes visible the woman should be prepared for the birth When the area of visible head has increased to 5 cm and the perineum is thin and distended the vulva should be swab with betadine 1 : 1000. The medical attendant who will deliver the baby now scrubs up and puts on gloves and gowm. With each contraction, the fetal head is flexed by the index finger of one of the attendant’s hand, whilst the perineum is protected by a pad which covers the perineum and distended anus and is held in the attendant’s other hand

Head : 

Head The manoeuvres described permit the head to be born slowly To be born the fetal head now has to extend. The forehead, nose, mouth and chin emerge and the head is born. The baby’s eyes are swabbed with sterile water and the baby’s head is rotated ( or rotates it self ) – external rotation The attendand now puts a finger to feel if the umbilical cord is aroud the baby’s neck

Shoulder : 

Shoulder As the baby’s head rotates, mucus streams from is mouth and nose. With the next contraction, the rotated head is grasped gently between the attendant’s two hands, which are placed over the side of the head The head is drawn posteriorly, so the anterior shoulder is released from behind the pubic bones Following the birth of the anterior shoulder, the baby is swept upward in an arc to release the posterior shoulder, followed the body and the legs The mother should now be able to see and touch her baby.

Slide 32: 

Third Stage of Labour

Third Stage of Labour : 

Third Stage of Labour The third stage of labour extends from birth to the baby to the expulsion of the placenta and membranes There are two methods of managing the third stage of labour : Conventional management Active management

Conventional Management : 

Conventional Management The placenta and membranes are allowed to separate without interference. The ulnar border of left hand is placed in the uterine fundus, and the sign of placental separation are awaited. Sign of placental separation : A gush of blood The fundus rises in the abdomen and becomes spherical That part of the umbilical cord which can be seen at the vulva, lengthens In the fundus lifted upwards the umbilical cord does not shorten

Conventional Management : 

Conventional Management Ten to twenty minutes pass before these signs appear, No attempt is made to hasten the separation. Once the signs indicate that the placenta has been expelled from uterus and is lying in the vagina, a uterine contraction is obtained by ‘rubbing up’ the uterus. The contracted uterus is pushed down toward the pelvis to expel the placenta and membranes from the vagina. The expelled placenta is grasped and twisted around with continuing traction to make the membranes into a twisted cord and so that they are expelled intact

Active Management : 

Active Management As the fetal being born, an intramuscular injection of methergin 0.2 mg (if no contraindication) is given or oxytocin 10 unit ( if there are contraindication). The atendant left hand is placed on the uterus to detect the contraction. When the contraction uterus occurs, the left hand is placed suprapubically and pushes the uterus upward The right hands grasp the umbilical cord and try to pulls the placenta out the vagina in a controlled manner The mambranes are drawn out the vagina intact by twisting them into a rope and pulling them out with a sponges forceps or the hand.

Inspection of The Placenta and Membranes : 

Inspection of The Placenta and Membranes The placenta and membranes are held up by the umbilical cord and the fetal surface is examined The membranes are examined to make sure that no part remains in the uterus The maternal surface of the placenta is examined next, any clots being washed away, so the cotyledons can be inspected

Thank You : 

Thank You Bambang widjanarko Obstetrics & gynecologist

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