The delivery includes all the physiological phenomena leading to the separation of the fetus from the maternal organismIts course is complicated by its physiology and mechanics: -the fetus must initially pass three hurdles: -the neck of the cervix -the hipbone -the perineum -this complex transit can not occur without uterine contractions, the real "engine" of childbirth -three main phases of work are to be noted : -Phase 1: Modification of cervix-Phase 2: Growth in fetal mobility divided into 3 stages: -engagement-the descent and rotation in the pelvis -release, corresponding to the expulsion of the fetus -Phase 3: the delivery
Vocabulary around childbirth: :
-Presentation :Part of the body of the fetus comes into contact with the brim of the maternal pelvis.-Episiotomy :perineal incision made at the time of delivery, aiming to enlarge the vaginal opening, to prevent damage to the perineum.-Labour: :involuntary uterine contractions , painful,which come quicker and more regular and changes of the cervix.-Pelvic expulsion: :anatomical region in which the presentation makes its descent and rotation. Some simple anatomical explanations: The die bone and soft tissue in question
Some simple anatomical explanations: The pelvic girdle and soft tissue in question
To exit the womb, during childbirth, the fetus will have to overcome two obstacles: :-The The bony pelvis,, which is a narrow channel fixed and inextensible: Often compared to a bent cylinder open at the front the pelvis bone is limited at the front by the symphysis pubis, posteriorly by the sacrum and coccyx, and laterally by the iliac bone . The brim or orifice of the die is the engagement plan of the presentation- A muscular portion,, corresponding to the pelvic floor muscles, firm the pelvic cavity. These elements are fibromuscular influenced by hormones, and distended, forming an open tube at the front
Uterine contractions, "key driver" »
The uterus although gradually distended with advancing pregnancy, maintains its functional structure in which the cervix is closed belowWith the onset of labour, initially, the cervix will change by clearing the cervical canal. Gradually the cervix dilates to allow passage to the presentation. This expansion is progressing at a rate of 1cm per hour of labour to reach a diameter of 10cm. Uterine contractions of labor are characterized as being: :-painful -Involuntary -close,together, regular - and the frequency and duration increase gradually
Foetal mobility
The mechanical factor is important in the dynamics of the birth. In fact the fetal head,which is an incompressible element, in order to descend into the pelvis, will have to undergo at first a rotation and flexion. The portion of the inferior strait, the final step called "disengagement" corresponds to the combined effect of uterine contractions and expulsive efforts, with a movement of deflection of the head. To finish
Delivery
It is the third stage of labour, and is defined as all the events leading to the expulsion of the placenta and membranes. The 3 phases of the delivery are respectively: -:detachment: after the expulsion of the fetus, the resumption of normal uterine contractions will help to detach the placenta.-Under the action of the same uterine contractions and maternal expulsive efforts, the expulsion of the placenta will take place. -Then the uterus will shrink to allow the closure of the uterine vessels, corresponding to the physiological hemostasis.
Close surveillance
The process of delivery is done under continuous fetal monitoring to monitor the "welfare" of the fetal heart rate . The work is performed by the analgesic anesthetic team, who increasingly suggest that epidural analgesia reduces or eliminates the sensation of pain.The serving team will consist of the patient, nurses / nurse assistants, midwives and doctors that work in the best conditions for both mother and child.
presentation .
In most cases, in 57% of cases, the fetus presents head down, though bent, with the posterior fontanelle (fontanel posterior) oriented toward the front and left. (Next to the eminence iliopectineal left). This presentation called LOA (left occiput anterior iliac) is the most common and the most favorable, since the bending will reduce by a huge amount the diameter of the moving fetus, and make it much less than the dimensions of the pelvis. The descent is easier then!
Special case of breech presentation
The breech presentation corresponds to a fetus whose buttocks are towards the brim while the head is located high in the uterus. There is a nuance with the breech where the legs are raised in front of the trunk. When the breech is discovered before the 8th month, the obstetrician may try to turn the presentation by external manipulation.
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Victor Hugo