labor and delivery

Question 1

theories of labor initiation

Answer 1

• 3 theories :
  1. chemical theory ( hormone )
• H helps initiating labor
• progesterone ↓ just b4 labor
• ↑ estrogen, ↑ oxytocin, ↑ Pg
• estrogen changes the cervix for dilation n effacement
• oxytocin initiates uterine contraction
  2. mechanical theory
• in transverse line, presenting part is absent → cervix not dilated properly → post-term delivery
• pressure of AF
  3. fetal theory
• fet during intrauterine life has production of H ( 1st pituitary gl H wh is ACTH ) → affect adrenal gl → production of steroids wh pass thru placenta → ↑ estrogen → initiation of labor

Question 2

characteristics of stages

Answer 2

1. 1st stage / dilation stage
   - fr diag of labor to full dilation of cervix

• divided into
  ● Latent phase : begins w onset of labor n ends when cervis is 3-4cm dilated
• slow state of dilation <0.6cm/hr
  ● Active phase : fr 4cm till full dilation
• cervix begin to widen, stretch n thinned
• 3 division
  a) acceleration : dilation rate = >0.6cm/hr

b) max slope of dilation = rate >1.2cm/hr ( nullipara ), >1.5cm ( multi ), cervix >5cm

c) deceleration : cervix >9cm but not completely effaced
- contraction 10-15min apart for 30-90s
- rate of cervical dilation 1cm/hr in primagravida, 2cm/hr for multigravida
- the memb may be ruptured artificially or spontaneously
- must monitor b/p, PR, tº n fetus condition
- perform VE every 4hrs not more

2. 2nd stage / expulsive stage
   - fr full dilation of cervix to delivery of fetus
   - expulsion of baby occur
   - full dilation of cervix should be confirmed by VE if head isn’t visible
   - primagravida last <> 1-2hrs, multigravida last 20-40min

• There are 2 phase.
  a) Phase 1 : There is no maternal urge to push and the fetal head is high and the sagittal suture is in the transverse position.
  b) phase 2 : There is a maternal urge to push the head is low and the sagittal suture is in the anterior posterior position
• Women will get expulsive reflex with each contraction and take a deep breath hold it and strain down.
• Early in the 2nd stage it does not matter what position the woman adopts.
• Comfortable position is head up right and her hands behind her knees.

3. 3rd stage / placental stage
   - fr delivery of fetus to delivery of placenta
   - This normally takes between 5-10 minutes.
   - If longer than 30 minutes it should be regarded as prolonged.
   - Separation of placenta occurs because of the reduction of volume of the uterus due to uterine contraction and retraction of the lattice-like arrangement of the myometrial muscle fibres.
   - A cleavage plane develops within the desidua basalis and the separated placenta lies free in the lower segment of the uterine cavity.

Question 3

differential diagnosis between true and false labor

Answer 3

True labour
● contraction is irregular at first
● but over time, contraction start coming at regular & shorter intervals, become more intensive & last longer.
● Pain start in lower back & wrap around abdomen
● Pain persist & progress irregardless of position & acitivty

False labour
● Contraction is unpredictable
● Pain is of irregular interval, length & intensity
● Pain centered in lower abdomen
● Contraction may subside on their own, or when start or stop an activity or change position