Lecture of prognostic factors for childbirth

2021-03-21 12:00 AM

Mother had a number of medical problems from the past such as Heart, Lung, Kidney, Liver, Anemia or some new diseases that arise during labor.

Prognostic factors are signs detected when asking pregnant women, during the examination, and during labor monitoring, that help physicians evaluate the prediction of labor and delivery. Those signs, if within the normal range are good signs. On the contrary, if there are signs and indicators that are not normal, childbirth will have difficulty with possible complications.

Labor

Labor is the final stage of pregnancy that causes the fetus and placenta to be removed out of the uterus through the vagina.

Labor usually occurs after a gestation period from 37 weeks (259 days) to 41 weeks (287 days), with an average of 40 weeks (280 days).

Labor diagnosis

Labor is determined by the following 4 main symptoms:

Uterus contractions with progressive abdominal pain with features ranging from mild to strong, from short to long, from thin to rapid with a frequency of 3 contractions in 10 minutes, each lasting more than 20 seconds.

Pregnant women notice mucus (banana resin) in the vagina.

The cervix is ​​completely or almost completely erased and has opened from 2 cm or more.

Forming of the amniotic bottom: During labor, the poles under the amniotic sac will gradually dilate as uterine contractions push the amniotic fluid down to form the amniotic bottom.

Distinguish real labor and fake labor

Before entering real labor to end the pregnancy for a few weeks, the pregnant woman also had some changes in pre-labor, such as:

There is a phenomenon of the abdominal slump because the fetus begins to bend over the subframe, the woman sees the belly smaller, easier to breath, the uterus height decreases.

Women often have urination, increased vaginal discharge.

There is a very mild contraction, very short, very sparse. It is a physiological contraction before labor.

The cervix may be partially erased or sometimes completely erased, even in this pre-labor period of the first child women, the cervix is ​​sometimes opened to allow the finger to slip easily.

Stages of labor

Labor is divided into three stages

Stage I

Also known as cervical opening, is calculated from when the cervix is ​​open from 0 to 10 cm (fully opened). The cervical opening phase is divided into 2 phases:

The potential phase (1a) of the cervix opens from 0 to 3 cm, this phase of the cervix progresses slowly, the time is 8 hours.

The active phase (1b) of the cervix opens from 3 cm to 10cm, this phase of the cervix develops rapidly, the time is about 7 hours, each hour the cervix opens 1 cm more.

Stage II

Also known as the expulsion of the foetus period, from the time the cervix is ​​fully opened, the throne falls to the time the fetus passes out. Average time from 30 minutes to 1 hour.

Stage III

Also known as the placenta delivery stage, following the expulsion of the foetus till the placenta and membranes are delivered. Average time from 15 minutes to 30 minutes.

The concept of a normal labor

It includes many factors:

Women give birth naturally through the vagina after normal labor.

During labor, there is no need to interfere with any drugs or procedures, or surgery.

Some specific criteria have been identified for the evaluation of a normal delivery:

Healthy mother: no disease (acute, chronic), no malformations and sequelae of disease (whole body, genitals), no history of a difficult delivery, haemorrhage.

No accident during this pregnancy.

Gestational age 38 - 41 weeks.

One fetus - cephalic presentation.

Natural labor.

Normal uterine contractions follow the progression of labor.

The fetal heart rate is stable during labor.

Amniotic fluid status is normal (no poly amniotic fluid, minimal amniotic fluid, premature and premature rupture of the amniotic fluid, the amniotic fluid has no stool, no blood)

The normal time of labor, on average 16-18 hours.

Ephalic presentation is going well.

Stripping time for less than 60 minutes.

Natural pregnancy without intervention.

Not having to take any drugs, including giving oxygen.

The fetus weighed more than 2,500g, Apgar must have 8 points or more after the first minute.

The normal placenta delivery (less than 30 minutes) during and after the placenta delivery is not bleeding, no placenta left.

Factors that predict abnormal labor

These are signs, unusual symptoms detected during pregnancy, and monitoring of labor detected through history, physical examination, and subclinical.

Mother factor

Bleeding during pregnancy and heavy bleeding during labor.

Mother had some previous medical diseases such as Heart, Lung, Kidney, Liver, Anemia, or some new diseases arising during labor such as high blood pressure, pre-eclampsia, eclampsia, infections.

Mother's age: before 18 or after 35 years if it is a pig, after 40 years if it is the first pregnancy.

Giving birth too thick or too much (interval between 2 births less than 2 years, laying more than 4 times).

Severe obstetric history: infertility treatment, recurrent miscarriage.

Pregnant women are worried, afraid, tired due to reasons of personal health, family, and society.

History of difficult delivery: old cesarean section, forceps, haemorrhage during delivery

Pregnancy factors and fetal appendages

Amniotic fluid

The amniotic fluid is swollen or pear-shaped, with a thick amniotic membrane.

Premature rupture of membranes, premature rupture of amniotic fluid.

Amniotic fluid with meconium and blood.

Poly amniotic fluid or minimal amniotic fluid.

Placenta condition

Placental presentation,  abruptio placentae

The placental cord is too short, too long, the placental rope is tied up

Factors encountered during labor

Abnormal uterine contractions

Increased contraction: strong contractions, rapid contractions, or both (strong and rapid contractions).

Decreased contraction: weak contractions, sparse contractions, or total reduction in contractions (weak and sparse contractions).

Seizure disorder: asynchronous uterine contractions.

Due to cervical opening is not good

Normally, during labor, the cervix will be cleared under the effect of contractions:

The cervix is ​​thick, stiff, swollen, slowly opening, or not opening.

Prolonged labor compared to the labor pattern, latent phase lasting more than 8 hours.

Birth of the fetus: The fetus's head is protected. The fetus is not progressing, the head does not bow, there is a superposition of the skull or not leaking.

Thus, the accurate prognosis of labor is not difficult, but it is imperative that every obstetrician have to perform close follow-up, detect referral abnormalities or promptly manage to avoid complications. can happen to mother and child. Using the labor chart is essential in the process of labor monitoring to detect abnormal labor early and reduce fatal obstetric complications for mother and baby.

Basic principles of care during labor

Ideally, the mother should be monitored for labor at the commune health station.

Midwives must explain the benefits of giving birth in a health facility for good care

Must have comprehensive systematic labor monitoring, must be proficient in specialized procedures, must know how to record and analyze a labor chart to detect abnormal factors in labor monitoring, in time sent to the hospital to ensure the safety of mother and child

If a woman decides to give birth at a medical facility, the midwife needs to prepare the minimum necessary tools and ensure sterility with tools for immediate postpartum care. If pregnant women deliver at home, use a clean delivery package.

When giving birth, placenta delivery stage, checking placenta, making the umbilical cord, the newborn must manipulate the correct process. In some cases, artificial placenta peeling, uterine control, episiotomy must also be manipulated properly and ensure sterility to contribute to reducing the rate of five obstetric complications.

Labor charts must be used for all women during labor at all levels.