Labour

1:34:00 PM


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N O R M A L . D E L I V E R Y

[ source: https://obgconsult.wikispaces.com/Labour+%26+the+Placenta ]

Semalam was hectic. Aku witnessed normal delivery and masuk OT untuk tengok Appendectomy. Emm, hahaha aku sebenarnya serius tak sangka pun dapat witness normal delivery semalam. Sebab aku still in surgical posting. So memang zero habis laaa about O&G. Niat asalnya hanyalah nak jadi chaperone untuk Amirul and Nain. Alih - alih aku and Audi jugak yang witnessed the delivery. Hahaha.


Team for today 

Aku membayangkan melahirkan anak itu susah (memang susah pun) dan yeaaa, macam mana aku tengok kat dalam movie or drama kan. Turn out, whoaaa waktu tu patient's dilatation baru 7 cm, tapi aku dah nervous macam aku pulak yang nak beranak. Nervous, aku rasa muka pucat and mata aku berair. 

The mother decided to push. Sepanjang proses tu, aku almost pitam tengok. The mother teran sikit je, but dah nampak kepala baby slow slow keluar. The nurse told her to fix her hip, orang kata 'jangan angkat punggung' gituuu. Then dah nampak muka baby ! The nurse betulkan position baby (extenal rotation where head immediately rotate to transverse position. Shoulders align themselves to antero-posterior diameter of pelvic outlet) untuk elakkan sebarang complications waktu nak tarik baby keluar dari rahim si ibu. Kalau kita belajar dalam buku katanya baby tu akan sendirinya position himself kan, but yang aku tgk ni nurse yang tolong betulkan position kepala baby tu waktu kepala dia dah nampak kat pelvic outlet. Waktu nurse tarik the baby keluar, amniotic fluid and darah nifas semua keluar sekali. That time mata aku dah start berpinar and rasa nausea. Ini sebab aku tak makan pagi ke buat aku rasa lemah macam ni?

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Apapun, the baby was healthy. No jaudice. Just a bit bluish, paler colouration of body. Baby tu menangis, and at that very moment aku bersyukur yang semuanya selamat. Masha-Allah,  besar sungguh kuasa Allah !

Aku tengok sendiri macam mana rupanya tali pusat yang connect between baby to the placenta. Yeaaa, sebijik macam dalam buku teks. Semua yang aku tengok ni depan mata aku semuanya sebijik macam dalam youtube and buku teks. Tak adalah sebijik sangat pungggg, tapi more or less.



Pathophysiology of Labour


Hormonal
Progesterone maintains uterine quiescence (suppress PGs, prevent Oxytocin release)
Oestrogen opposes the action of progesterone. 
Fetally produced cortisol may also contribute to the conversion of progesterone to oestrogen
Myometrium
Cervix

Mechanism of Labour


7 cardinal movements of labour:


Think of the following according to the 3 altered shapes of the pelvic canal:
pelvis.JPG

1 Engagement- when the widest part of the presenting part has passed successfully through the inlet. Occurs in vast majority prior labour. If more than 2 fifths of the fetal head if palpable abdominally, the head is not yet engaged.

2 Descent- this is secondary to uterine action, helped by voluntary use of abdominal musculature and the Valsalva manoeuvre (pushing) in the active phase of the second stage of labour.

3 Flexion- happens as head descends into the narrower mid-cavity. Important in minimizing the presenting diameter of the fetal head and happens due to the surrounding structures.


4 Internal rotation- so that the sagittal suture lies in the AP diameter of the pelvic outlet (the widest diameter) on reaching the sloping gutter of the levator ani muscles. OP position persistence is associated with extension of the fetal head and possibly obstructed labour or need for Caesarean section.

5 Extension- the well-flexed head now extends and the occiput escapes from underneath the symphysis pubis and distends the vulva- ‘crowning’ of the head. The symphysis pubis acts as a fulcrum point as the bregma, face and chin appear in succession over the posterior vaginal opening and perineal body. This extension and movement minimize soft-tissue trauma by utilizing the smallest diameters of the head for the birth. This extension and movement minimize soft-tissue trauma by utilizin ghte smallest diameters of the head for the birth.


6 Restitution/External rotation- when the head is delivering, the occiput is directly anterior. The slight rotation of the occiput through one-eighth of a circle is called restitution.
External rotation- shoulders rotate into the direct AP plane.

7 Expulsion




The 3Ps:
Powers- uterine contractions, 3-5/10min
Passenger- size, lie, presentation, attitude (flexion etc), position, station, fetal abn
Passage
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Labour Pain


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Staff nurse siap tanya soalan killer waktu aku berdiri tunggu sebelah patient. Omggg malu gila sebab tak dapat jawab soalan time tu sebab aku datang hopital memang zero wehhh pasal O&G. Lepas tu terus stress and migraine attack. Staff nurse tanya, 'how to monitor in labour?'

Monitoring in Labour



Vaginal Exam in Labour
  • Effacement
  • Dilatation*
  • Station +/- ischial spine
  • Position (fetal)
  • Presenting part (diamond vs triangle)**
[+] regular exam
[+] FHR monitor/CTG

*Assessing cervical dilatation: The Bishop Score (3 pts x 5 criteria)
    • Dilatation of cervix
    • Consistency of cervix
    • Length of cervical canal
    • Position of cervix
    • Station of presenting part
    • Assessing presenting part
ve_in_labour.JPG


Effacement :

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