In the conference room on the 18th floor of Shengjing Maternal and Child Health Hospital, a unique fantasy journey of pregnancy and baby is taking place here.

Shengjing Maternity and Child Health Hospital will hold a knowledge lecture on time every month, involving pregnant women in 8~9 months.

Molly, Wen Jing, and Ji Xiaohe were all invited inside.

On the large projection screen in front of the conference room, Cui Dandan, director of the obstetrics department of Shengjing Maternal and Child Health Hospital, is teaching all the pregnant women present the basic knowledge of the labor process.

Cui Dandan took the laser pointer and said to the PPT of the projection screen.

"Labor refers to the whole process of childbirth, that is, from the beginning of regular contractions to the delivery of the fetus and placenta, which is called the total labor process.

It usually takes more than ten hours. Clinically, the total labor stage is divided into three stages, that is, the three stages of labor in medicine.

That is, the first, second, and third stages of labor.

Labor and labor

Labor: The period from the beginning of regular uterine contractions to the delivery of the fetal placenta is called "total labor".

The total stage of labor is clinically divided into three stages, i.e., three stages of labor.

The first stage of labor is the period from the onset of labor to the opening of the cervix, with an average of 11-12 hours for primiparous women and 6-8 hours for multiparous women.

The second stage of labor is a period of time from the opening of the uterus to the birth of the fetus, which takes 1-2 hours for primiparous women and a few minutes for multiparous women.

The third stage of labor is the period from the birth of the fetus to the discharge of the placenta, which is similar to that of multiparous women in primiparous women and generally takes 5-15 minutes.

If the placenta does not pass 30 minutes after the baby is born, the placenta needs to be removed by hand by the doctor after careful sterilization.

Childbirth is a physiological process that progresses naturally, and it is also a process of dynamic changes in the four factors of labor (labor force, birth canal, fetal position, and maternal mental psychology).

Throughout the delivery process, it is necessary to observe not only the changes in the labor process, but also the safety of the mother and child.

Detect abnormalities in time and deal with them as soon as possible.

According to the characteristics of labor, in addition to multiparous women, for first-time mothers, there is generally enough time to give birth in the hospital, no need to be nervous and panicked, and in different stages of labor, the mother learns to cooperate and will give birth quickly.

In order to closely observe the labor process, the examination results should be recorded in time, and if there is any abnormality, it should be dealt with as soon as possible.

The abscissa of the partogram is the time of onset of labor (hours), the left side of the ordinate is the degree of uterine ostium dilation (cm), and the right side is the degree of presentation descent (cm).

The degree of uterine orifice dilation and the position of fetal presentation descent are plotted as uterine orifice dilation curves and fetal presentation descent curves, which can understand the progress of labor at a glance.

First stage of labor

1. Definitions:

The first stage of labor is also known as cervical dilation: it begins with regular contractions of 5-6 minutes intermittently and ends with the cervix opening widely.

It takes about 11-12 hours for primiparous women and 6-8 hours for multiparous women.

2. Clinical manifestations:

The clinical manifestations of the first stage of labor are regular contractions, dilated uterine ostium, fetal head descent, and rupture of membranes.

(1) Contraction regularity

At the beginning of the first stage of labor, the uterine contractility is weak, and the intermittent period is about 5-6 minutes and lasts for 20-30 seconds.

As labor progresses, there are intervals of 2-3 minutes lasting 50-60 seconds, increasing in intensity.

When the uterine opening is fully opened, the contractions can last for more than 1 minute, with intervals of only 1 minute or a little longer.

(2) Dilation of the uterine opening

During this time, the cervical canal softens, shortens, disappears, and the cervix flattens and gradually expands.

Uterine dilation can be divided into two phases: latent and active.

The dilation rate of the latent period is slow, and the speed accelerates after entering the active phase, and after the uterine opening is fully opened, the edge of the uterine opening gradually disappears, forming the birth canal with the lower uterine segment and **.

(3) The fetal head is down

Generally, the fetal head of primiparous women has been put into the pelvis before labor, and the fetal head is connected after the onset of labor.

As labor progresses, the presentation gradually decreases, and generally during the maximum acceleration of cervical dilation, the fetal head descends at the highest level and remains unchanged until the presentation reaches the vulva and the ** orifice.

Whether the fetal head can be lowered smoothly is an important observation item to determine whether the fetal head can be delivered through **.

(4) Rupture of membranes

When the pressure in the amniotic cavity increases to a certain extent, the fetal membranes will rupture naturally, and they will rupture before the uterine opening of the uterine opening, and the amniotic fluid will flow out, and the fetal membranes will rupture, referred to as rupture of membranes.

3. Observation and treatment of labor:

(1) Uterine contractions: There are two commonly used methods to observe uterine contractions: hand sensation and instrument monitoring.

Feel: The midwife will defend the palm of the hand against the abdominal wall of the mother, and the uterine body can be felt to bulge and harden during contractions, and the intermittent period of relaxation and softness.

The time, intensity, regularity, and intermittent duration of contractions must be continuously observed, and recorded in time.

Instrument monitoring: The contraction curve traced by the fetal monitor can show the intensity, frequency and duration of each contraction, which is an objective indicator that reflects the contractions more comprehensively.

There are two types of monitors: external monitoring and internal monitoring.

External monitoring is most commonly used in clinical practice.

(2) Uterine dilation and fetal head descent: The changes in uterine dilation divide the first stage of labor into latent and active phases.

First stage of labour latency:

Regular contractions begin after labor until the uterine opening is dilated to 3 cm.

During this phase, the cervix dilates slowly, with an average of 2-3 hours dilating 1 cm, about 8 hours, and a maximum duration of 16 hours.

The fetal head does not drop significantly during the incubation period.

Active phase of the first stage of labor:

Dilation of 3 cm from the cervical opening until the uterine opening is fully open.

During this phase, the rate of cervical dilation is significantly accelerated, taking about 4 hours, with a maximum duration of 8 hours.

The head of the body and the active period decreased significantly, with an average decrease of 0.86 cm per hour.

Anal examination or ** examination can be used to understand the dilation of the uterine ostium and the lowering of the head of the head.

Anal examination:

It should be performed at the time of contractions, so as to understand the firmness and thickness of the cervix, the degree of uterine opening dilation, whether the membranes are broken, the size of the pelvic cavity, and determine the fetal position and the degree of head lifting.

**Examine:

It is carried out after strict disinfection.

It can directly touch the sagittal suture and fontanelle to determine the fetal position and the degree of uterine ostium dilation.

It is suitable for patients with unclear anal examination, unclear degree of uterine opening dilation and head uplift, suspected umbilical cord presentation or umbilical cord prolapse, mild cephalopelvic asymmetry, and slow labor progression.

(3) Rupture of membranes

Once the fetal membranes are ruptured, the fetal heart rate should be listened to immediately, and the shape, color, and outflow of amniotic fluid should be observed, and the time of rupture of the membrane should be recorded.

If the head is presented first, the amniotic fluid is yellow-green and mixed with meconium, and the ** examination should be performed immediately to pay attention to the presence of umbilical cord prolapse.

4. Fetal heartbeat and maternal observation and treatment

(1) Fetal heartbeat

Latent period of the first stage of labor: Listen to the fetal heartbeat every 1-2 hours between contractions.

The first active stage of labor: listen to the fetal heartbeat every 15-30min. , 1min each auscultation.

In the second half of the first stage of labor, the fetus is temporarily hypoxic during contractions, and the fetal heart rate slows down, but it should not be less than 100 beats per minute, and the fetal heart rate quickly returns to the original level after the contractions.

(2) Observation of maternal conditions

Vital signs: including measurement of the mother's blood pressure, temperature, pulse, and respiratory rate.

Blood pressure usually rises by 5 to 10 mmHg during contractions during the first birth, and returns to its original state intermittently.

Intrapartum diet: Women should eat small amounts of food often. Eat high-calorie, easy-to-digest foods and drink plenty of fluids to keep your energy and stamina high.

Activity and rest: contractions are not strong and the membranes are not ruptured, and women can move appropriately indoors to help labor progress.

When the uterine ostium of primiparous women is nearly fully open or the uterine ostium of multiparous women is dilated to 4 cm, the left side should be decubitus in bed.

Urination and defecation: Women do not urinate once every 2-4 hours to avoid bladder fullness affecting contractions and fetal head dropping.

When the uterine ostium is dilated < 4cm in primiparous

However, premature rupture of membranes, ** bleeding, fetal head is not connected, abnormal fetal position, history of cesarean section, uterine contractions are estimated to be delivered within 1 hour, and severe heart disease is not suitable for enema.

Others: Pregnant women should prepare skin, and primiparous women and multiparous women with a history of dystocia need to do an extrapelvic measurement again.

Second stage of labor

1. Definitions:

The second stage of labor is also known as the fetal delivery period: from the complete dilation of the uterine opening to 10 cm to the delivery of the fetus.

It takes about 1-2 hours for primiparous mothers; Multiparous women usually complete it in a few minutes, but some can take up to 1 hour.

The timing of the second stage of labor varies from person to person, and it is still necessary to take into account the individual's cooperation and exertion skills.

2. Clinical manifestations:

(1) Perforation. After the uterine opening is fully opened, most of the membranes have ruptured spontaneously. If there is no rupture, it will affect the head-up drop, and the membrane should be broken artificially.

(2) Contractions. After the membrane is ruptured, the contractions tend to stop, and the mother feels slightly comfortable, and then the contractions are strengthened, lasting 1 minute or more each time, with intervals of 1-2 minutes.

(3) Feeling of defecation. When the head is lowered to compress the pelvic floor tissues, the mother has a feeling of defecation and involuntarily produces a downward force to hold her breath.

(4) The fetal head is exposed. Between contractions, the fetal head is either exposed and then retracted, or it is not retracted after it is exposed.

(5) The fetus is delivered. As labor progresses, the fetal head is delivered, followed by the baby.

3. Observation and treatment of labor

(1) Closely monitor the fetal heartbeat

Because contractions are frequent and strong at this time, the fetus needs to be closely monitored for acute hypoxia.

Listen to the fetal heartbeat every 5-10 minutes, preferably with a fetal monitor.

If a slowed fetal heart rate is found, a ** examination should be performed immediately to end labor as soon as possible.

(2) Instruct the mother to hold her breath

Instruct the woman to use abdominal pressure appropriately by having the woman put her feet on the delivery bed, holding the delivery bed handle in both hands, inhaling deeply during contractions and holding it, and then holding it downward as if she were having a bowel movement to increase abdominal pressure.

During intervals of contractions, the woman exhales and relaxes the muscles of the whole body.

Continue to hold your breath during contractions to speed up labor.

(3) Preparation for midwifery

When the uterine opening of the primiparous woman is fully opened, the uterine opening of the multiparous woman is dilated by 4 cm, and the uterine contractions are regular and strong, preparations for delivery should be made.

Let the mother lie on her back on the delivery bed, and adjust the lying position into a semi-sitting position, which is very good for the mother to make the mother feel more comfortable and more forceful.

Then, the nurse in the delivery room disinfects the perineum and prepares supplies.

(4) Delivery

The key is to let the fetal head pass slowly through the ** opening during the interval of contractions with the smallest diameter, and at the same time pay attention to protecting the perineum.

If the perineum is too tight or the fetus is too large, it is estimated that a perineal tear is inevitable during childbirth, or if the mother and child have pathological conditions that urgently need to end the delivery, the midwife will recommend an episiotomy.

Third stage of labor

1. Definitions:

The third stage of labor is the delivery of the placenta, which takes about 5-15 minutes from the delivery of the fetus to the delivery of the placenta, and the time required for primiparous and multiparous women will not exceed 30 minutes.

2. Clinical manifestations

Delivery after placental ablation: After the fetus is delivered, the uterus suddenly becomes smaller, and the placenta cannot shrink accordingly and dislocates with the uterine wall.

Bleeding from the peeling surface, formation of postplacental hemorrhage; The uterus continues to contract, increasing the area of the detachment so that the placenta is completely detached and delivered.

Other manifestations of placental detachment include a lengthening of the umbilical cord exposed to the outside of **, the rise of the uterine fundus to the abdomen, and the rounding and spherical shape of the uterus.

3. Processing

(1) Neonatal treatment: After the newborn is delivered, the respiratory tract must be cleaned first, and then the umbilical cord should be treated.

Clear the respiratory tract: After the fetus is delivered, place the fetus on the platform, and use the neonatal sputum suction tube to remove the mucus and amniotic fluid from the newborn's mouth and nasal cavity in time to avoid inhalation and neonatal pneumonia.

When the mucus and amniotic fluid in the respiratory tract have been sucked away and there is still no crying, the newborn's soles can be gently patted with the hand to stimulate the cry.

A newborn cries loudly, indicating that the airway is clear.

Handle the umbilical cord: Clamp the umbilical cord with two hemostats and cut between the two forceps. After cutting, iodine alcohol sterilization, and finally bandage the umbilical cord.

Neonatal Apgar Score: The Neonatal Apgar Score is used to determine the presence and severity of neonatal asphyxia, which is based on five signs of heart rate, respiration, muscle tone, laryngeal reflex, and skin color at one minute after birth, each with a score of 0-2.

With a full score of 10, it is a normal newborn.

Other treatments: wipe the heels of the newborn, make footprints and fingerprints on the neonatal medical record, and attach the wristband and wrap that has indicated the gender, weight, time of birth, mother's name and bed number of the newborn.

Bring the newborn to the nursery and do a physical examination:

(1) Measure weight, length and head diameter, and pay attention to whether the newborn is mature and consistent with the number of gestational weeks.

(2) Check the head: the fetal head with occipital exposure is often deformed in order to adapt to the shape of the birth canal.

If the fetal head is compressed in the pelvis for a long time, local edema or tumor may occur in the soft tissues of the scalp, which usually resolves naturally within 1-2 days. Check the size and tension of the chimney.

(3) Check the activities of the heart, lungs, liver, spleen and limbs, and pay attention to whether there is any injury.

(4) Pay attention to whether there are deformities, such as cleft lip, polydactyly (toe), spina bifida, foot varus, etc.

(2) Check the placental fetal membranes

The placenta is first checked for size, shape, weight, and integrity, followed by calcifications and vascular abnormalities.

Finally, the length of the umbilical cord should be measured, and the umbilical cord blood vessels should be checked for abnormalities and whether the fetal membranes are intact.

Clinically, after delivery of the placenta, uterotonic agents are given to help the uterus contract.

(3) Examine the soft birth canal

After the placenta is delivered, carefully check the perineum, **, cervix and other parts for lacerations.

If there is a laceration, it should be sutured immediately.

(4) Prevention of postpartum hemorrhage

The amount of bleeding in normal labor does not exceed 300ml. If the amount of bleeding is excessive, it should be treated immediately.

Labor is prolonged

Commonly referred to as prolonged labor, it means that strong contractions do not reach the expected state of the pelvic.

The doctor carefully monitors the timing of each stage of labor, and if it is found that the woman is taking longer than normal, a diagnosis of dystocia is made, and it is dealt with quickly: with forceps or by caesarean section.

Modern medicine can diagnose possible abnormalities at an early stage and take appropriate treatment measures, many of which can be prevented before childbirth begins.

There are 7 common situations, which can exist alone or together.

(1) Extended incubation period: refers to the incubation period of more than 16 hours.

(2) Extension of the active period: refers to the active period of more than 8 hours. When the rate of uterine ostium dilation in the active phase is < 1.2 cm/h in primiparous women and 1.5 cm/h

(3) Active phase stagnation: refers to the cessation of uterine opening for more than 2 hours during the active phase.

(4) Extension of the second stage of labor: refers to the second stage of labor of primiparous women exceeding 2 hours (more than 3 hours for painless delivery under epidural anesthesia) and more than 1 hour of second stage of labor for multiparous women.

(5) Delayed fetal head descent: In the deceleration period of cervical dilation and the second stage of labor, the fetal head descends the fastest.

At this stage, the rate of fetal head descent is < 1.0 cm/h for primiparous women and 2.0 cm/h

(6) Fetal head descent stagnation: refers to the descent and stagnation of the fetal head for more than 1 hour after the deceleration period.

(7) Delayed labor: the total duration of labor exceeds 24 hours. ”

When Cui Dandan finished talking about this, he found that below, there were already many pregnant women sleeping with their chin on their crutches.

Cui Dandan also felt that he was talking a little too academically, as if he was talking about it to the doctor, so he slapped his hands and woke up those pregnant women.