Abnormal Labor and Distosia

Abnormal labor and Distosia

Beberapa Elemen dari “Primay Health Care”

Edukasi masalah kesehatan, metoda pencegahan cara mengatasinyaPromosi, mis: nutrisi,makanan dan air bersihKesehatan Ibu dan Anak, termasuk keluarga berencanaImunisasi

Kesehatan Ibu dan Anak

Keduanya adalah kelompok yang “vulnerable” pada komunitas. Perempuan pada usia reproduksi sebanyak 25% dari populasi. Jumlah anak-anak berkisar antara 40%- 45% dari populasi (negara berkembang). Karakteristiknya mortalitas dan morbiditas yang relatif tinggi.

Kematian Maternal

Nearly 2/3rds of maternal deaths worldwide results from five causes:

Hemorrhage (24%)Obstructed labor (8%)Eclampsia (pregnancy induced hypertension) (12%)Sepsis (15%)

Unsafe abortion (13%)

The other 1/3rd of maternal deaths worldwide results from indirect causes or an existing medical condition made worse by pregnancy or delivery:

MalariaAnemiaHepatitisAIDS Tuberculosis

Malnutrition

High Risk DeliveriesHigh Risk DeliveriesMother Mother Delivery Delivery Fetus Fetus

Toxemia of Toxemia of pregnancypregnancy

Prolonged laborProlonged labor Prematurity Prematurity

Diabetes mellitusDiabetes mellitus Breech Breech presentationpresentation

LBWLBW

Age < 20 yrsAge < 20 yrs Cord prolapseCord prolapse Fetal distressFetal distress

Age > 35 yrsAge > 35 yrs Multiple Multiple pregnancypregnancy

Meconium Meconium stained liquor stained liquor amnii amnii Parity 5 +Parity 5 + Premature rupture Premature rupture

of membranesof membranes

Persalinan AbnormalPersalinan Abnormal

Dystocia: difficult laborDystocia: difficult labor characterized by abnormally slow progress of characterized by abnormally slow progress of

labor labor common whenever there is disproportion between common whenever there is disproportion between

the presenting part of the fetus and the birth canalthe presenting part of the fetus and the birth canal

Abnormal LaborAbnormal Labor

Dystocia: difficult laborDystocia: difficult labor characterized by abnormally slow progress of characterized by abnormally slow progress of

labor labor common whenever there is disproportion between common whenever there is disproportion between

the presenting part of the fetus and the birth canalthe presenting part of the fetus and the birth canal


Dystocia:Dystocia: can result from several distinct can result from several distinct

abnormalities abnormalities involving the cervix, uterus, fetus, maternal involving the cervix, uterus, fetus, maternal

bony pelvis, or other obstructions in the birth bony pelvis, or other obstructions in the birth canalcanal..


Consequence of 4 distinct abnormalities that Consequence of 4 distinct abnormalities that may exist singly or in combination:may exist singly or in combination:

(1) (1) Abnormalities of the expulsive forces-Abnormalities of the expulsive forces- -- --either uterine forces insufficiently strong to either uterine forces insufficiently strong to efface efface and dilate the cervix (uterine and dilate the cervix (uterine dysfunction) dysfunction) inadequate voluntary muscle effort during the inadequate voluntary muscle effort during the

second stagesecond stage


(2) Abnormalities of the maternal bony pelvis- (2) Abnormalities of the maternal bony pelvis- that is, pelvic contraction that is, pelvic contraction

(3) Abnormalities of presentation, position, or (3) Abnormalities of presentation, position, or development of the fetusdevelopment of the fetus

(4)Abnormalities of soft tissues of the (4)Abnormalities of soft tissues of the reproductive tract that form an obstacle to fetal reproductive tract that form an obstacle to fetal descentdescent

Abnormal LaborAbnormal Labor ACOG simplified these abnormalities to:ACOG simplified these abnormalities to:

(1) Abnormalities of the (1) Abnormalities of the powers powers (uterine (uterine contractility and maternal expulsive effort)contractility and maternal expulsive effort)

(2) Abnormalities of the (2) Abnormalities of the passenger passenger (fetus)(fetus) (3) Abnormalities of the (3) Abnormalities of the passagepassage (the pelvis) (the pelvis)


Common Clinical Findings in Women with Common Clinical Findings in Women with Ineffective Labor:Ineffective Labor: Inadequate cervical dilation or fetal descentInadequate cervical dilation or fetal descent

protracted labor-slow progressprotracted labor-slow progress arrested labor-no progressarrested labor-no progress inadequate expulsive effort-ineffective inadequate expulsive effort-ineffective

“pushing”“pushing”


Fetopelvic disproportionFetopelvic disproportion excessive fetal sizeexcessive fetal size inadequate pelvic capacityinadequate pelvic capacity malpresentation or position of the fetusmalpresentation or position of the fetus

Ruptured membranes without laborRuptured membranes without labor


failure to progress :lack of progressive cervical failure to progress :lack of progressive cervical dilation or fetal descent dilation or fetal descent

cephalopelvic disproportion: obstructed labor cephalopelvic disproportion: obstructed labor due to disparity between fetal head and due to disparity between fetal head and maternal pelvismaternal pelvis

cesarean delivery is necessary with both casescesarean delivery is necessary with both cases


Friedman curve: subdivided labor into Friedman curve: subdivided labor into phases and depicted it onto curvesphases and depicted it onto curves

Divides 1st stage into Divides 1st stage into latent and active phaselatent and active phase


latent phase: onset of labor is defined according to latent phase: onset of labor is defined according to Friedman as the point at which the mother Friedman as the point at which the mother perceives regular contractionsperceives regular contractions

regular contractions take place along with regular contractions take place along with cervical softening and effacementcervical softening and effacement

prolonged latent phase: defined as greater than prolonged latent phase: defined as greater than 20 hours in a nullipara and greater than 14 hours 20 hours in a nullipara and greater than 14 hours in a parous womanin a parous woman


Active phase:Active phase: cervical dilation rate of 1.2 cm/hr for nulliparas cervical dilation rate of 1.2 cm/hr for nulliparas

and 1.5 cm/hr for parous womenand 1.5 cm/hr for parous women cervical dilation of 3 or 4 cm or more, in the cervical dilation of 3 or 4 cm or more, in the

presence of uterine contractions can be taken to presence of uterine contractions can be taken to reliably represent the threshold for active laborreliably represent the threshold for active labor

nullipara on average dilate 1.2 cm/hour and nullipara on average dilate 1.2 cm/hour and multips on average dilate 1.5 cm/hour multips on average dilate 1.5 cm/hour (minimum) (minimum)

Abnormal LaborAbnormal Labor Active Phase Cont’d:Active Phase Cont’d:

Protraction:Protraction: slow rate of cervical dilation or slow rate of cervical dilation or descentdescent

For nulliparas: <1.2 cm dilatation/hr or < 1 cm descent/hrFor nulliparas: <1.2 cm dilatation/hr or < 1 cm descent/hr For multiparas: <1.5 cm dilatation/hr or <2 cm descent/hrFor multiparas: <1.5 cm dilatation/hr or <2 cm descent/hr Treat with expectant management/oxytocinTreat with expectant management/oxytocin

Arrest:Arrest: complete cessation of dilatation or descent complete cessation of dilatation or descent Arrest of dilatation: 2 hours with no cervical changeArrest of dilatation: 2 hours with no cervical change Arrest of descent: 1 hour without fetal descentArrest of descent: 1 hour without fetal descent


Second Stage: begins when cervical dilation is Second Stage: begins when cervical dilation is complete and ends with expulsion of fetuscomplete and ends with expulsion of fetus

Median duration for nullips: 50 minMedian duration for nullips: 50 min Until recently, limited to 2 hours without epidural and to 3 Until recently, limited to 2 hours without epidural and to 3

hours with epiduralhours with epidural Median duration for multips: 20 minMedian duration for multips: 20 min

Until recently, limited to 1 hour without an epidural and to Until recently, limited to 1 hour without an epidural and to 2 hours with an epidural2 hours with an epidural

Can be longer with bigger babies and regional Can be longer with bigger babies and regional anesthesiaanesthesia


interventions other than cesarean delivery interventions other than cesarean delivery must be considered before resorting to this must be considered before resorting to this method of delivery for failure to progressmethod of delivery for failure to progress i.e operative vaginal deliveryi.e operative vaginal delivery


Diagnosis of Inadequate Labor:Diagnosis of Inadequate Labor: Active phase disorders: Active phase disorders: (1)Protraction disorders (1)Protraction disorders (2)arrest disorders(2)arrest disorders


Before the diagnosis of arrest during the first stage Before the diagnosis of arrest during the first stage of labor is made, both these criteria must be met:of labor is made, both these criteria must be met:

Latent phase has been completed, with the Latent phase has been completed, with the cervix dilated 4 cm or morecervix dilated 4 cm or more

A uterine contraction pattern of 200 Montevideo A uterine contraction pattern of 200 Montevideo units or more in a 10-minute period has been units or more in a 10-minute period has been present for 2 hours without cervical changepresent for 2 hours without cervical change

Should there be a “2 hour” Rule?Should there be a “2 hour” Rule?

Rose et al (1999) recently challenged the “2 Rose et al (1999) recently challenged the “2 hour” rule on the grounds that a longer time, hour” rule on the grounds that a longer time, i.e. 4 hours is necessary before concluding that i.e. 4 hours is necessary before concluding that the active phase of labor has failed and the active phase of labor has failed and William Obstetrics agreesWilliam Obstetrics agrees


Causes of inadequate expulsive forces:Causes of inadequate expulsive forces: Heavy sedation or conduction analgesiaHeavy sedation or conduction analgesia Maternal exhaustionMaternal exhaustion

Maternal Effects of Dystocia:Maternal Effects of Dystocia: Intrapartum infection– especially in the setting of ROMIntrapartum infection– especially in the setting of ROM Uterine rupture– esp with prior C/SUterine rupture– esp with prior C/S Fistula formationFistula formation Pelvic floor injuryPelvic floor injury Fistula formationFistula formation


Fetal Effects of Dystocia:Fetal Effects of Dystocia: Caput Succedaneum:Caput Succedaneum:

If the pelvis is contracted during labor a large caput If the pelvis is contracted during labor a large caput succedaneum frequently develops on the most dependent succedaneum frequently develops on the most dependent part of the fetal head part of the fetal head

This can lead to diagnostic errors; the caput can reach This can lead to diagnostic errors; the caput can reach almost to the pelvic floor while the head is still not engagedalmost to the pelvic floor while the head is still not engaged

An inexperienced physician may make premature and An inexperienced physician may make premature and unwise attempts at forceps deliveryunwise attempts at forceps delivery


Fetal Head Molding:Fetal Head Molding: Under the pressure of the strong uterine Under the pressure of the strong uterine

contractions, cranial plates overlap one another at contractions, cranial plates overlap one another at the major sutures,a process referred to as moldingthe major sutures,a process referred to as molding


In nearly 97% of pregnancies, at the time of delivery, In nearly 97% of pregnancies, at the time of delivery, the fetus is entering the pelvis as a cephalic the fetus is entering the pelvis as a cephalic presentationpresentation

Compound presentation: an extremity prolapses Compound presentation: an extremity prolapses alongside the presenting par, with both presenting in alongside the presenting par, with both presenting in the pelvis simultaneously (1/700)the pelvis simultaneously (1/700)

Persistent occiput posterior position: most often Persistent occiput posterior position: most often undergoes spontaneous rotation to anterior rotation undergoes spontaneous rotation to anterior rotation followed by NVDfollowed by NVD

Cesarean sectionCesarean section

proceed with c/s with:proceed with c/s with: Transverse lieTransverse lie Placenta previaPlacenta previa Non-reassuring fetal heart rate when an operative delivery Non-reassuring fetal heart rate when an operative delivery

is not attainableis not attainable Nonvertex presenting twinNonvertex presenting twin BreechBreech Many more indications, including repeat s( decline TOL) Many more indications, including repeat s( decline TOL)

ands elective cesarean sectionands elective cesarean section

Cesarean SectionCesarean Section

Indications for Vacuum-Indications for Vacuum-Assisted DeliveryAssisted Delivery

Maternal indicationsMaternal indications • Need to avoid voluntary Need to avoid voluntary

maternal expulsive efforts maternal expulsive efforts (e.g., the mother has (e.g., the mother has cardiac or cerebrovascular cardiac or cerebrovascular disease) disease)

• Inadequate maternal Inadequate maternal expulsive effortsexpulsive efforts

• Maternal exhaustion or Maternal exhaustion or lack of cooperationlack of cooperation

Fetal indicationsFetal indications • Nonreassuring fetal Nonreassuring fetal

heart tracing heart tracing • Prolonged second Prolonged second

stage of laborstage of labor • Failure to progress in Failure to progress in

second stage of laborsecond stage of labor

Comparative Advantages of Vacuum Comparative Advantages of Vacuum

Extractors and ForcepsExtractors and Forceps

Vacuum extractorsVacuum extractors • Easier to learnEasier to learn • Quicker deliveryQuicker delivery • Less maternal genital Less maternal genital

trauma trauma • Less maternal discomfortLess maternal discomfort • Fewer neonatal Fewer neonatal

craniofacial injuries craniofacial injuries • Less anesthesia neededLess anesthesia needed

Forceps Forceps • Fewer neonatal Fewer neonatal

injuries, including injuries, including cephalohematoma, cephalohematoma, retinal hemorrhage retinal hemorrhage and transient lateral and transient lateral rectus palsyrectus palsy

• Higher rate of Higher rate of successful vaginal successful vaginal deliverydelivery

VacuumVacuum

Procedure Using Soft-Cup Vacuum Procedure Using Soft-Cup Vacuum

ExtractionExtraction

Empty bladder Empty bladder Ensure complete dilationEnsure complete dilation Adequate anesthesia Adequate anesthesia fetal presentation, position and station are fetal presentation, position and station are

then confirmedthen confirmed

How to Apply a VacuumHow to Apply a Vacuum apply the soft cup by spreading the patient's labia, apply the soft cup by spreading the patient's labia,

compressing the cup and inserting it gently by pressing compressing the cup and inserting it gently by pressing inward and downward with the inferior edge over the inward and downward with the inferior edge over the

posterior fourchetteposterior fourchette.. When contact is made with the fetal scalp, the When contact is made with the fetal scalp, the

center of the cup should be over the sagittal center of the cup should be over the sagittal suture and about 3 cm (1.2 in) in front of the suture and about 3 cm (1.2 in) in front of the posterior fontanelle. As a practical guide, the cup posterior fontanelle. As a practical guide, the cup is generally placed as far posteriorly as possible is generally placed as far posteriorly as possible

How to Apply a VacuumHow to Apply a Vacuum

Avoid anterior fontanelleAvoid anterior fontanelle Do not attempt for more than 20 minutes. Do not attempt for more than 20 minutes. The procedure should be abandoned if delivery The procedure should be abandoned if delivery

is not achieved or the labor does not progress. is not achieved or the labor does not progress. Under ordinary circumstances, the procedure Under ordinary circumstances, the procedure

should be abandoned after three cup should be abandoned after three cup detachments.detachments.

What are some complications of What are some complications of the Vacuum?the Vacuum?

Fetal complications:Fetal complications: Subgaleal hemorrhage:Subgaleal hemorrhage:

occurred in 1.0 to 3.8 percent of vacuum occurred in 1.0 to 3.8 percent of vacuum extractions in one series but has been much less extractions in one series but has been much less common in more recent studies.common in more recent studies.

Infants with subgaleal hemorrhage present with a Infants with subgaleal hemorrhage present with a boggy scalp, swelling crossing the suture lines and boggy scalp, swelling crossing the suture lines and an expanding head circumference.an expanding head circumference.

may also have signs of hypovolemia, pallor, may also have signs of hypovolemia, pallor, tachycardia and a falling hematocrit.tachycardia and a falling hematocrit.


Fetal ComplicationsFetal Complications CephalohematomaCephalohematoma

incidence of 6 percent (range: 1 to 26 percent) in vacuum-assisted incidence of 6 percent (range: 1 to 26 percent) in vacuum-assisted deliveries.deliveries.

Intracranial hemorrhage Intracranial hemorrhage one of every 860 vacuum-assisted deliveries compared with one one of every 860 vacuum-assisted deliveries compared with one

of every 1,900 spontaneous deliveries (a statistically significant of every 1,900 spontaneous deliveries (a statistically significant difference).difference).

the comparative rate of intracranial hemorrhage is not the comparative rate of intracranial hemorrhage is not statistically different when vacuum extraction, forceps delivery statistically different when vacuum extraction, forceps delivery and cesarean section during labor are compared. and cesarean section during labor are compared.

Perhaps the abnormal labor that necessitated the assisted Perhaps the abnormal labor that necessitated the assisted delivery may be an underlying cause for a portion of the delivery may be an underlying cause for a portion of the morbidity attributed to operative deliveries.morbidity attributed to operative deliveries.66


Retinal hemorrhages Retinal hemorrhages may be more common in vacuum-assisted deliveries but are may be more common in vacuum-assisted deliveries but are

most often associated with duration of labormost often associated with duration of labor resolve within several weeks and are to be associated with long-resolve within several weeks and are to be associated with long-

term morbidity.term morbidity.

Transient neonatal lateral rectus paralysis found to occur in:Transient neonatal lateral rectus paralysis found to occur in:* 3.2% of vacuum-assisted deliveries * 3.2% of vacuum-assisted deliveries ** 2.4 percent of forceps assisted deliveries2.4 percent of forceps assisted deliveries * 0.1 percent normal spontaneous vaginal deliveries * 0.1 percent normal spontaneous vaginal deliveries * 0% cesarean sections (0 percent* 0% cesarean sections (0 percent * the paralysis resolves spontaneously and is unlikely to be of * the paralysis resolves spontaneously and is unlikely to be of

clinical importanceclinical importance

(0.1 percent)

VacuumVacuum

Vacuum extraction has not been found to Vacuum extraction has not been found to result in significant intellectual or result in significant intellectual or neurologic disability!neurologic disability!

Relative Contraindications for Relative Contraindications for Vacuum ExtractionVacuum Extraction

Fetal prematurity (<34 weeks of gestation) Fetal prematurity (<34 weeks of gestation) Fetal scalp trauma Fetal scalp trauma Unengaged head Unengaged head Incomplete cervical dilatationIncomplete cervical dilatationActive bleeding or suspected fetal coagulation defects Active bleeding or suspected fetal coagulation defects Suspected macrosomia Suspected macrosomia

Nonvertex presentation or other malpresentation Nonvertex presentation or other malpresentation Cephalopelvic disproportion Cephalopelvic disproportion Delivery requiring rotation or excessive traction Delivery requiring rotation or excessive traction Inadequate anesthesia Inadequate anesthesia

ForcepsForceps

Forceps are metal surgical instruments, Forceps are metal surgical instruments, similar to tongs, with rounded edges similar to tongs, with rounded edges that fit around the fetus's head. that fit around the fetus's head.

Forceps DeliveryForceps Delivery

Forceps Forceps

Technique of Applying low and Technique of Applying low and outlet forcepsoutlet forceps

Identify blades and their applicationIdentify blades and their application The instrument should be placed in front of the The instrument should be placed in front of the

pelvis with the tip pointing upward and pelvic pelvis with the tip pointing upward and pelvic curve forwardscurve forwards

First the left blade should be applied guided by the First the left blade should be applied guided by the right hand and then the right blade with the left right hand and then the right blade with the left handhand

Locking of blades: the blades should articulate Locking of blades: the blades should articulate with easewith ease

Technique of Applying low and Technique of Applying low and outlet forcepsoutlet forceps

Clinical checks for correct forceps Clinical checks for correct forceps applications:applications: Sagital suture lies in the midline of the shanksSagital suture lies in the midline of the shanks The operator is unable to place more than a The operator is unable to place more than a

fingertip between the fenestration of the blade and fingertip between the fenestration of the blade and the fetal head on either sidethe posterior fontanelle the fetal head on either sidethe posterior fontanelle is not more than one finger breathe above the plane is not more than one finger breathe above the plane of the shanks of the forcepsof the shanks of the forceps

Complications of ForcepsComplications of Forceps

Mostly due to poor applicationMostly due to poor application Maternal: Maternal:

Extension of episiotomy or cervical tearsExtension of episiotomy or cervical tears PP hemorrhage due to traumaPP hemorrhage due to trauma Anesthesia hazardsAnesthesia hazards

Complications of ForcepsComplications of Forceps

Fetal:Fetal: Poor oxygenationPoor oxygenation TraumaTrauma

Intracranial hemorrhageIntracranial hemorrhage CephalohematomaCephalohematoma Facial palsyFacial palsy Skull fractureSkull fracture Injury to soft tissue of faceInjury to soft tissue of face

BreastfeedingBreastfeeding

Infant feeding practices have changed Infant feeding practices have changed dramatically during this centurydramatically during this century

In the early 1900s, nearly 100% of the In the early 1900s, nearly 100% of the newborns in the U.S. were breastfednewborns in the U.S. were breastfed

By the 1970s, only 30% of the newborn were By the 1970s, only 30% of the newborn were breastfed at one week and less than 5% at 6 breastfed at one week and less than 5% at 6 monthsmonths


Breastfeeding is recognized as the best method Breastfeeding is recognized as the best method for promoting healthy growth and for promoting healthy growth and development and successful bonding between development and successful bonding between mother and childmother and child

the decline in breastfeeding has been the decline in breastfeeding has been particularly problematic in developing particularly problematic in developing countriescountries

formula is expensiveformula is expensive


As of 1992 about 50% of all US infants were As of 1992 about 50% of all US infants were breastfed initially and nearly 20% continued to breastfed initially and nearly 20% continued to breastfeed at 6 mobreastfeed at 6 mo

BENEFITS OF BREASTFEEDING:BENEFITS OF BREASTFEEDING: Many moms find it a wonderful and challenging Many moms find it a wonderful and challenging

experienceexperience Mothers who breastfeed often frequently establish a Mothers who breastfeed often frequently establish a

stronger and faster let-down response and may ensure stronger and faster let-down response and may ensure healthy uterine involution due to oxytocin releasehealthy uterine involution due to oxytocin release

BreastfeedingBreastfeeding Practical Benefits:Practical Benefits:

Low costLow cost Convenient and readily available in the correct quantity, at the right Convenient and readily available in the correct quantity, at the right

temperature, and without the need for complicated sterilizing and temperature, and without the need for complicated sterilizing and preparation procedurespreparation procedures

Benefits to Infant’s Health:Benefits to Infant’s Health: Provides nourishment in a form that is easier for babies to digest Provides nourishment in a form that is easier for babies to digest

than formulathan formula Provides exactly the the right combination of nutrients:Provides exactly the the right combination of nutrients:

Lactose as primary source of carbohydrates provides energy and Lactose as primary source of carbohydrates provides energy and correct balance of intestinal acidscorrect balance of intestinal acids

Fat levels in breast milk are better digested and cholesterol levels in Fat levels in breast milk are better digested and cholesterol levels in breast milk may protect infant from excessively high cholesterol laterbreast milk may protect infant from excessively high cholesterol later


Benefits to Infant’s Health:Benefits to Infant’s Health: Protein levels in early breast milk, especially colostrum, Protein levels in early breast milk, especially colostrum,

are vital to infant’s nutritional needs and more easily are vital to infant’s nutritional needs and more easily used than proteins in formulaused than proteins in formula

High water content and low salt levels in breast milk High water content and low salt levels in breast milk ensure that infant does not need supplementary water to ensure that infant does not need supplementary water to prevent dehydration and excrete saltprevent dehydration and excrete salt

Vitamin supplements: except, occasionally vit D, are Vitamin supplements: except, occasionally vit D, are unnecessary for breastfed infantsunnecessary for breastfed infants

Mineral content of breast milk is perfectly balanced and Mineral content of breast milk is perfectly balanced and more easily absorbed more easily absorbed


Benefits to Mother’s Health:Benefits to Mother’s Health: Lactation helps the mother get back in shape Lactation helps the mother get back in shape

following pregnancy in part because milk following pregnancy in part because milk production consumes fat reserves built up during production consumes fat reserves built up during pregnancypregnancy

Breastfeeding-induced release of oxytocin helps Breastfeeding-induced release of oxytocin helps the uterus to contract normally postpartumthe uterus to contract normally postpartum


Emotional benefits:Emotional benefits: Breastfeeding facilitates physical and emotional bonding Breastfeeding facilitates physical and emotional bonding

between mother and child, partly because:between mother and child, partly because: It stimulates maternal release of prolactin-related to increase in It stimulates maternal release of prolactin-related to increase in

maternal caretaking behaviormaternal caretaking behavior It stimulates maternal release of beta-endorphin-associated with It stimulates maternal release of beta-endorphin-associated with

increased sense of well beingincreased sense of well being Periods of close contact with mother combined with the Periods of close contact with mother combined with the

opportunity to suckle enhances the infant;s sense of securityopportunity to suckle enhances the infant;s sense of security


Inhibited Let-Down:Inhibited Let-Down: Starting a week or two after delivery, the mother Starting a week or two after delivery, the mother

experiences the let-down reflex as a tingling and a experiences the let-down reflex as a tingling and a feeling of fullness in the breastfeeling of fullness in the breast

It results from the release of oxytocin in the It results from the release of oxytocin in the posterior pituitaryposterior pituitary

General Postpartum CareGeneral Postpartum Care

After a Vaginal Delivery:After a Vaginal Delivery: Greet the patient and congratulate her and the Greet the patient and congratulate her and the

familyfamily Check vitals– temp, pulse, BPCheck vitals– temp, pulse, BP

Can detect endometritis, PE. PreeclampsiaCan detect endometritis, PE. Preeclampsia Evaluate fundus and lochiaEvaluate fundus and lochia

The abdomen should be palpated/massaged every 15 The abdomen should be palpated/massaged every 15 minutes or so during the first hour post delivery and the minutes or so during the first hour post delivery and the fundus is at around the umbilicus at this stagefundus is at around the umbilicus at this stage

Abnormal Labor and Distosia

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