13. INTRAPARTUM MONITORING, INTRAPARTUM CARE AND NORMAL DELIVERY-1.pdf - Intrapartum monitoring intrapartum care and normal delivery DR MARGARET KILONZO


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Intrapartum monitoring, intrapartum care and normal delivery DR MARGARET KILONZO, LECTURER, OBS/GYN DEPARTMENT, UoN 1
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OUTLINE/LEARNING OBJECTIVES Why monitor labor? Overview of labor Initial evaluation of the woman in labour What to monitor in labor Maternal wellbeing- vital signs, general condition, bleeding, urine volume Fetal well being- FHR monitoring, colour and smell of amniotic fluid/liquor Progress of labour- Cervical dilatation, fetal descent The passage/ passenger- Cervical dilation, pelvic adequacy, caput, moulding Uterine contractions Partograph as a tool for monitoring labor Intrapartum foetal heart rate(FHR) monitoring 2
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Aims of management of labor To achieve delivery of a healthy baby To recognize and treat potential abnormal conditions before significant hazard develops for the mother and/or baby. 3
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Overview of Normal labor The World Health Organization (WHO) defines normal birth as "spontaneous in onset, low-risk at the start of labor and remaining so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. 4
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Criteria for normal labor Spontaneous in onset Of a single Mature fetus (37 completed weeks, <42 weeks) In vertex presentation Through the birth canal (vaginal delivery) Within reasonable time (At least 4 hours, <18 hours) Without complications to the mother Without complications to the baby 5
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Recognizing Labor (Characteristics of true labor) Regular uterine contractions which increase in frequency and intensity Accompanied by cervical effacement and dilatation Not stopped by analgesics +/- show- Bloody show (a small amount of blood with mucus discharge [ie, mucus plug] from the cervix) may precede the onset of labour by as much as 72 hours 6
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Definitions Attitude: This refers to the posturing of the joints and relation of foetal parts to one another. The normal foetal attitude when labour begins is with all joints in flexion (fetus folded onto itself). Lie : This refers to the longitudinal axis of the foetus in relation to the mother's longitudinal axis (i.e., transverse, oblique, or longitudinal (parallel). Presentation : This describes the part of the foetus lying over the inlet of the pelvic or at the cervical os. (Foetal part foremost in the pelvis) 7
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Definitions Point of Reference of Direction : This is an arbitrary point on the presenting part used to orient it to the maternal pelvis [usually occiput, mentum (chin) or sacrum]. Position : This describes the relation of the point of reference to one of the eight octanes of the pelvic inlet (e.g., LOT: the occiput is transverse and to the left). 8
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Lie, presentation, attitude, &position LONGITUDINAL LIE VERTEX PRESENTATION: LOA 9
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LONGITUDINAL LIE VERTEX PRESENTATION: Left occiput posterior position 10
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FREQUENCY OF VARIOUS PRESENTATIONS AT TERM Vertex 96% Breech 3.5% Face 0.3% Shoulder 0.4% 12
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Mechanisms of Normal Labour
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