National Institute Of Traumatolog&Orthopaedic Rehabilitation. 3rd Year 22nd Batch Group-B Subject:Physiotherapy In Surgical Condition. Topic:LABOUR

2. Topic:
Labor

3. PRESENTED TO
Dr.Md.Moslam Patwary
Ph.D Fellow,MPT(Ortho),BPT(NITOR,DU),MSc(RehabilitationScience,DU)
LecturerOf Physiotherapy,NITOR,Dhaka
Date Of Performance
19.12.2019

4. PRESENted By
Group-B
ROLL NAME
10 KONIKA AKTER
11 HASAN ALI
12 AFSANA KOLY
13 ARIFUL ISLAM
14 MST.SAJIDA IBNAT

5. Contents……
 What is labor?
 What is normal labor and abnormal labor ?
 Stages of labor
 Duration of normal labor
 Changes during different stages of labor
 Intervention of labor
 Normal mechanism of labor
 Differences of true and false labor
 Complication of labor
 Management of labor

6. WHAT IS LABOR?
 Series of events take place in genital organs of a pregnant women, to
an effort to expel viable product of contraction from the womb to the
exterior through vagina is called labor.
 Labor is the process of baby birth at the termination of pregnancy.

7. What IS
Normal labor & Abnormal labor?
• Normal labor
It is the expulsion of a matured foetus through vagina,cervix,with
placenta,membrane & liquor amni without of any undue delay,without
any artificial aid and with any injury to mother and foetus.
• Abnormal labor
Any deviation from the definition of normal labor is called abnormal
labor.

8. Stages of labor
• Labor Is divided into three stages-
a) 1st Stage :
Stage of dilatation last from the onset of true labor pain until the
cervix is fully dilated.
b) 2nd Stage:
Stage of expulsion of the foetus, last from full dilatation of the
cervix until the foetus is born.
c) 3rd Stage:
Lasts from the birth of foetus until the placenta and membrane are
delivered and uterus has retracted firmly to compress the uterine blood
sinuses.

9. Duration of normal labor
Duration Primi Multi
1st Stage 8-12 hours 6-8 hours
2nd Stage 1-2 hours ½-1 hour
3rd Stage 15-30 minutes 15-30 minutes
Total 12-18 hours 6-8 hours

11. Changes during different stages of labor
A. 1st Stage-
1.Contraction & retraction of uterine muscle.
2.Formation of upper active & lower passive uterine
segment(LUSCS).Upper segment contraction, lower segment
relaxation..
3.Dilatation of the cervical OS
4.Taken up of the cervical ring(Effacement)
5.Formation of fore water bag
6.Formation of the membrane.(Artificial rupture membrane)

12. Changes during different stages of labor
B. 2nd Stage-
1.Increased pain, intensity and strength of contraction and
retraction.
2.Activation of the secondary powers.
3.Displacement of pelvic floor by the foetal head.
4.Expulsion of foetus
C. 3rd Stage-
1.Like 2nd stage-contraction and retraction and bearing down
affects after delivery of foetus.expulsion of placenta and membrane

13. Intervention of Labor
 1st Stage: To initiate labor in the first stage-
a)Prostaglandins: Prostaglandin pessaries or gel applied to the cervix may produce required
effect.
b)Oxytocin:Synthetic oxytocin are applied in IV route causes uterine contraction.
Relaxin hormone in IV route to enhance delivery.
c)Amniotomy:Amniotomy or artificial rupture of membrane(ARM) is sometimes called
surgical induction.
A amniohook or forceps are used to nick the amniotic SAC.
 If failure 1st stage than continue 2nd stage.
 2nd Stage: To assist delivery in the second stage-
a)Episiotomy: It is the incision of perineum to enlarge the vaginal opening. Local anesthetics
should be used.

14. b)Forceps delivery:
-Where progress is nil or slow.
-For fetal distress to speed delivery.
-For maternal distress;exhausation or where minimum maternal effort is
desirable.eg-Cardiac failure,cystic fibrosis or raised blood pressure.
c)Vacuum extraction:
The indication for vacuum extraction are similar to forceps delivery. A suction
cup of an appropriate size is introduce into vagina and applied fetal scalp posteriorly.
 3rd Stage or Caesarean section:
Procedure for lower segment incision.An incision is made through skin and
subcuteneous tissue in the natural fold just above the pubic hair.
A transverse incision are made in the anterior part of rectus sheath.

15. Normal mechanism of Labor
• Engagement-
pressure on stomach, lung
Foetus engaged in uterus
• Decent with flexion
• Internal rotation at the level of ischial spine(when the occiput touch the pelvic floor)
• Crowing
• Extension & birth of the head
• Restitution(untwisting)
• External rotation of head (due to internal rotation of the shoulder)
• Lateral flexion & birth of the baby.

17. Differences of True Labor & False Labor
Traits True Labor False Labor
1 Onset At the onset of labor Onset of labor by 1 or 2 weeks
in primi & few weeks in multi
2 Nature Severe Dull
3 Site Back & front of the
abdomen
Lower abdomen & groin area
4 Radiation Back & front of the
abdomen
Localized
5 Duration Intermittent Persistent
6 Pattern Regular contraction Irregular contraction

18. Differences of True Labor & False Labor
Traits True Labor False Labor
7 Progression Intensity increased
& interval
decreased
Non-progressive
8 Rhythm Rhythmic Non-rhythmic
9 Relieving factor Nothing Sedative analgesic
10 Cervical dilatation Present Absent
11 Show Present Absent
12 Formation of water bag Occur Do not occur

19. Complication of Labor
1st Stage
 Failure to dilate the cervix.
 Early ruptures of membrane with or without cord prolapsed.
 Hypotonic uterine contraction or Inco-ordinate uterine
contraction.
 Cervical dystocia
 Prolonged 1st stage.
 Fetal distress.
 Intra-partum eclampsia.

20. Complication of Labor
2nd Stage
• Maternal:
Perineal tear
Sepsis
Haemorrhage
Maternal distress :
DM
Hypertension
Eclampsia
• Foetal:
Asphyxia
Foetal part damage
Foetal distress

21. Complication of Labor
3rd Stage
 PPH(Post Partum Haemorrhage).
 Acute inversion of uterus.
 Rupture of uterus.
 Retained placenta.
 Sepsis of birth canal .
 Embolism-Pulmonary by blood ,thrombus,air,amniotic fluid.

22. Management of Labor
 Pain control-
a)Non-pharmaceutical:
-Counter pressure
-Environmental condition
-Breathing technique
-water
-Birthing aids
-Vocalization
-Visualization
-Emotional support
b)Pharmaceutical :
1)Analgesic-Pathedine
Antidote must be used if the baby is affected.
2)Nitrous oxide & oxygen
70% N2O & 30% O2 is administrated at the 2nd stage

23. 3) Epidulral analgesia:
Analgesic agent into the dural space between the dura mater and the periosteum.
4)Perineal infiltration:
Anaesthetizes the perineum.
 Labor induction & elective cesarean:
Following condition may be on indication for induction-
*Abruptio placenta
*Chorioamnitis
*Gastational hypertension
*Pre-eclampsia or eclampsia
*Pre-mature rupture of membrane
*Post-term pregnancy

24. Management of Labor
 Aim of physiotherapy:
Relaxation
Breathing exercise
Positioning
Pain relief
Massage
Maintain muscle power
Improve circulatory function
Maintain posture
Counseling
Other coping strategies(hypnosis, warm water bath,accupuncture)
Home advice-ADL

25. Methods of physiotherapy treatment
• All joint passive movement upper & lower extremities.
• Isometrics exercise of pelvic floor muscles.
• Maintain lung fuction by breathing exercise.
• Prevent back pain by positioning of the patients,pillow support.
• Improve circulatory function by elevation of leg,banding of
leg,efflurage massage.
• To promote relaxation-cold & hot compression.
• Pain relief by electrotherapy modalities.
• Home advices-
-Aerobic exercise like-four point kneeling,
-Wall push(anteriorly,posteriorly)
-Squatting
-Isometric exercise of abdomen,perineal & back muscle.

28. References
 “Class lecture”-By Dr.Md.Moslam Patwary.
 “Tidy’s Physiotherapy”-Ann Thomson,Alison Skinner,Joan
Piercy.
 “Physiotherapy in Obstetrics & Gynaecology”-Jill
Mantle,Margaret Polden.
 “Rosen’s Management of Labor”-Ralph Hale.M.D
 “Management of Labor & Delivery”-Wiley Blackwell
 “Care in normal birth”-Technical working group, WHO
 “Labor”-Wikipedia

30. THANK YOU FOR YOUR ATTENTION