ayame07

Normal labor(parturition)
3 stage: 1. dilatation. 2. expulsive. 3. placental(the most to be careful)
lasting time: stage 1: for hours, stage 2: <2hr, stage 3: minutes
intrauterine pressure: stage1: 40mmHg, stage2: 60mmHg, stage3: 80mmHg

what happen in pelvis when delivery
cervix fully dilation
→uterus to vagina = elongated tube
→muscle of pelvis floor and perineumstratch backward
→bowel conpressed
→bladder being pulled into abdomen

increasing strengh and pain when muscle contraction
1.hypoxia of the muscle
2.compression of nerve ending in myometrium
3.cervical stretch and dilation

regular waves of compression
from cornua (from uterus fundus 兩側)
to lower segment of uterus

for monitering uterine contraction, CTG will be performed

onset of labor begins with regular painful contraction, together with
1) a show of blood
2) mucus passage from the cervix(the operculum)
3) membrane rupture particularly in multiparous patients(>2 baby at once)

uterus muscle fiber: contraction→relax and retract→contraction→relax and retract....

placenta: accreta(invase into uterus)
increta(to myometrium)
percreta(to serosa)

during delivery, the fetus will
1)descent(occipital-trasvers position)
2)internal rotation(occipital rotate to anterior - OA position)
3)flexion(chin to chest)
4)extension

after delivery, the baby
1) suction before cutting umbilicus→ 2)warmth → 3)breath

CTG=Continuous cardiotocography
6Qs: 1) baseline normal 140-160 bpm
2) variation of the baseline (usually within 5-10 bpm, 看小wave的振幅)
3) decelebration(減速-受到stress後會減速再恢復)(abnormal-V wave, U wave)
4) uterine activity, frequency of contraction
5) what may mostly cause the problem
6) what to do next

to evaluate time of labor
Bishop score:
1)station深度(手指進去長度=胎頭深度,剛好等常(約5cm):0 往外:+1,+2... 往內:-1,-2...)
2)dilation擴張程度
3)effacement厚度
4)position(手指進去時directly touch:anterior, IN-TO the cervix: posterior)
5)consistency of cervix-硬度

Parameter\Score 0 1 2 3
Position Posterior Intermediate Anterior -
Consistency Firm Intermediate Soft -
Effacement 0-30% 40-50% 60-70% 80%
Dilation <1 cm 1-2 cm 2-3 cm >3 cm
Fetal station -3 -2 -1,0 +1,+2