10 dets. What Is the Definition of Normal Labour
In this chapter, we discuss the normal work and delivery process. The definition and etiology of work is presented, followed by a discussion of the normal work flow. A discussion of alternative approaches to work management and controversial topics is also included. O`Driscoll K, Jackson RJ, Gallagher JT: Prevention of prolonged work. BMJ 2: 477, 1969 The characteristics of the mean cervical dilation curve are known as the Friedman work curve, and a number of definitions of labor prolongation and arrest were subsequently established. [6, 7] However, subsequent data from the modern obstetric population suggest that the rate of cervical dilation is slower and that the progression of labour may differ considerably from what the Friedman work curve suggests. [8, 9, 10] Placenta delivery usually occurs within 5 to 10 minutes of fetal birth, but is considered normal until 30 minutes after the fetus is born. Excessive traction should not be applied to the cord to avoid inversion of the uterus, which can cause severe postpartum bleeding and is an obstetric emergency. The placenta can also be separated manually by passing a hand between the placenta and the uterine wall.
After delivery of the placenta, examine it for completeness and the presence of 1 umbilical vein and 2 umbilical arteries. Oxytocin may be administered in the third stage to facilitate placental separation by inducing uterine contractions and reducing bleeding. Braxton-Hicks contractions, which are often irregular and do not increase in frequency with increasing intensity, must be distinguished from actual contractions. Braxton-Hicks contractions often disappear with the ability to walk or a change in activity. However, contractions that lead to labor tend to last longer and are more intense, resulting in a change in the cervix. True labor is defined as uterine contractions that result in cervical changes. If contractions occur without cervical changes, it is not labor. Other causes of cramps need to be diagnosed.
Gestational age is not part of the definition of work. The existence of the deceleration phase has been questioned.11 The debate about its existence is complicated by the short duration of this phase, shorter than the duration of the acceleration phase, and easy to overlook if cervical examinations are rarely performed. This phase rarely lasts more than 3 hours in a nullipar or 1 hour in a multipara. It usually extends 8 to 9 cm until the cervical dilation is complete. The descent curve reaches its maximum gradient parallel to the deceleration phase.13 The normal rate of descent of the current part is at least 1 cm/hour in the nulliparous part. Gülmezoglu AM, Villar J, Ngoc NT, et al. WHO multicenter randomized study of misoprostol in the management of the third phase of work. Lancet.
2001 September 1 358(9283):689-95. [Medline]. Peisner DB, Rosen MG: Latent phase of labor in normal patients: a reassessment. Obstet Gynecol 68:644, 1986 Women often present to obstetric triage with concern about the onset of labour. Common major complaints include painful contractions, vaginal bleeding/bloody spectacle, and leakage of fluid from the vagina. It is up to the physician to determine if the patient is in labor, defined as regular and clinically significant contractions with an objective change in cervical dilation and/or shedding. [1] When women first appear in the work and maternity unit, vital signs, including temperature, heart rate, oxygen saturation, respiratory rate and blood pressure, should be maintained and checked for abnormalities. The patient should undergo continuous cardiotocographic monitoring to ensure the well-being of the fetus. The patient`s prenatal record, including birth history, surgical history, medical history, laboratory and imaging data, should be reviewed. Finally, a history of the current disease, a systems examination and a physical examination, including sterile speculum examination, should take place. Patients can also describe what has been called lightning, which is the physical changes experienced because the fetal head enters the pelvis.
The mother can feel that her baby has become light. As the present fetal part begins to decline, the shape of the mother`s abdomen may change to reflect the fetal decline. Your breathing can be made easier as the strain on the diaphragm is reduced, while urination may become more frequent due to the extra pressure on the bladder. Once the patient`s medical history and physical examination are recorded and recorded, an assessment of the patient`s risk status and work situation is carried out so that the patient`s care can be individualized. Each institution should have a formal designation of the type of forms used for this purpose. In the United States, it is common to obtain intravenous access in most working patients, although nurse midwives often refrain from doing so. Some patients may request a heparin lock for a more comfortable walking ability at the onset of labor. If this is the case, intravenous solutions should be started at the first signs of dehydration or development of a complication. At the same time, intravenous access is obtained, a blood sample can be taken for a complete blood count and for a type and screening. In addition to the blood sample, a urine sample is taken for the determination of protein and glucose. If the working patient has not received antenatal care, the full range of the mother`s routine prenatal laboratory tests should be ordered. This panel may vary depending on the institution and the type of patient population.
During examination of the sterile speculum, doctors look for signs of rupture of the membrane, such as a buildup of amniotic fluid in the posterior vaginal canal. If the doctor is not sure whether or not a membrane rupture has occurred, additional tests such as pH tests, microscopic examinations to remove the fluid, or laboratory tests of the fluid may be the next step. [2] Amniotic fluid has a pH of 7.0 to 7.5, which is more alkaline than normal vaginal pH. A sterile examination with gloves should be performed to determine the degree of cervical dilation and excretion. Cervical dilation is measured by locating the outer cervical bone and spreading the V-shaped fingers and estimating the distance in centimeters between the two fingers. Extinction is measured by estimating the percentage of the remaining length of the diluted cervix relative to the unshaved cervix. During cervical examination, confirmation of the presenting fetal part is also required. Bedside ultrasound may be used to confirm the presentation and location of the part presenting the fetus. Special mention should be made of the position of the seat because of its increased risks in terms of fetal morbidity and mortality compared to the cephalic fetus. Effacement (assessment of cervical length, which can be expressed as a percentage of the normal cervix 3 to 4 cm long or described as the actual length of the cervix) While ACOG defines occupational dystocia as abnormal labor resulting from force abnormalities (uterine contractions or maternal expulsion forces), the passenger (position, size or presentation of the fetus) or passage (pelvis or soft tissues), Labour dystocia can rarely be diagnosed with certainty. [1] Often, a “failure of progress” is diagnosed in the first phase, when the uterine contraction pattern exceeds 200 Montevideo units for 2 hours, without a cervical change occurring during the active phase of labor. [1] Therefore, the traditional criteria for diagnosing active phase arrest are cervical dilation of at least 4 cm, cervical changes of 200 Montevideo units.