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Myometrium in the upper segment uterine relaxation to return to its original length
after contraction; but being relatively settled on a shorter length. However, the voltage
remains the same as before kontaksi. The top of the uterus, or active segment berkontaksi
down even when it is reduced, so that the pressure remains konatan myometrium. The end
effect is to tighten the slack, by maintaining favorable conditions obtained from the expulsion
of the fetus and maintain uterine muscles still clung to the contents of the uterus. As a
consequence retraction, each kontaksi next start in the space left by the previous contraction,
so that the top of the uterine cavity be slightly smaller on each subsequent contraction. Due to
the shortening of the muscle fibers are continuous at each contraction, the upper segment of
the uterus becomes progressively more active along the first and second stage of labor and
becomes very thick right after delivery of the fetus.
The phenomenon of retraction of the upper segment of the uterus depends on the
reduced volume of the contents of the uterus, especially in early labor when the entire uterus
is really a sealed bag with only a small hole in the cervical os. This allows more isis
intrauterine fill the lower segment, and the segment above only in so far as the expansion
beretraksi lower segment and cervical dilation.
Relaxation of the lower uterine segment is not a perfect relaxation, but rather a
retraction opponent. Fibers become stretched in the lower segment of each segment kontaksi
above, and thereafter did not return to the previous long but relatively retaining a longer
length; but the voltage remains essentially the same as before. The muscles are still showing
tone, still hold the stretch, and still contracting slightly during the last stimulus. When the
delivery of advanced, pemanjangn successively lower uterine segment followed by
shortening, normally only a few millimeters at the thinnest part. As a result of the depletion of
the lower uterine segment and together with thickening the upper segment of the boundary
between the two is marked by a circle on the surface of the uterus, called the physiologic
retraction ring. If the shortening of the lower uterine segment is too thin, as in obstructed, this
ring is very prominent so forming pathological retraction ring. This is an abnormal condition
is also referred to as ring Bandl. The existence of a gradient of the physiological activity of
the shrinking of the fundus to the cervix can be seen from the measurement of the top and
bottom of the uterus in normal labor.
Figure 1: uterine vaginal deliveries. Segments on the active beretraksi uterus around the
fetus because the fetus down through the birth canal. In the lower segment of the passive tone
of myometrium much smaller
Each contraction produces ovoid shaped uterus elongation accompanied by a
reduction in horizontal diameter. With this shape change, no important effects on labor. First,
the reduction of the horizontal diameter cause fetal vetebralis rectification column,
emphasizing the pole it tightly against the fundus, while the lower pole is pushed further
down and toward the pelvis. Ovoid-shaped elongation of the resulting fetus is estimated to
have reached between 5 to 10 cm: the pressure exerted in this way is known as fetal stress
axis. Second, with prolonged uterus, longitudinal fibers pulled taut and because of the lower
segment and cervix is the only portion of the uterus flexible, this section is pulled up in the
lower pole of the fetus. This effect is an important factor for cervical dilatation in the muscles
of the lower segment and cervix.
ADDITIONAL FORCES IN LABOR
Once fully dilated cervix, the most important force in the process of expulsion of the
fetus is the force generated by the intra-abdominal pressure rises mother. This style is formed
by the contraction of the muscles of the abdomen simultaneously through efforts pernapasa
forced to closed glottis. This force is called push.
The nature of the force created in the same style that happens to defikasi, but the
intensity is usually larger. The importance of intra-abdominal pressure on the expulsion of the
fetus is most clearly seen in patients with paraplegia labor. Women like this do not suffer
pain, although it may contract the uterus strong. Cervical dilatation which largely is the result
of uterine contractions acting on the cervix to soften proceeds normally, but ekpulsi baby can
be accomplished more easily if she was asked to push, and can perform the command during
a uterine contraction.
Despite the high intra-abdominal pressure required to complete spontaneous labor,
this labor would be in vain until the full opening of the cervix. Specifically, this power is the
additional assistance needed by contractions of the uterus in the second stage of labor, but
pushing it only helped slightly in the first stage besides causing sheer exhaustion.
Intaabdominal pressure may also be important in the third stage of labor, especially when the
mother who gave birth unsupervised. After the placenta separated, spontaneous expulsion of
the placenta may be assisted by the mother increased intra-abdominal pressure.
CHANGES IN CERVICAL
Power effective in the first stage of labor are uterine contractions, which in turn will
generate a hydrostatic pressure to the rest of the membranes of the cervix and lower uterine
segment. When the membranes have ruptured, the presenting part is forced directly urged the
cervix and lower uterine segment. As a result of the thrust of this activity, there are two
fundamental changes-effacement and dilation of the cervix-which already softened. For the
passage of an average head aterem fetus through the cervix, cervical canal to be widened to
about 10 cm in diameter; at this time the cervix is said to have a complete open. Perhaps there
is no impairment of the fetus during cervical effacement, but most often the presenting part
tururn sediki start when it comes to the second stage of labor. Decrease the presenting part be
typically a little slow on the nulliparous. But in multiparas, especially those of high parity, a
decline usually takes place very rapidly.
Cervical effacement
Obliteration or effacement of the cervix is shortening of the cervical canal along
approximately 2 cm into the estuary just a nearly circular with a paper-thin edge. This process
is referred to as a flattening (effacement) and going from top to bottom. Muscle fibers as high
as cervical os internum is pulled up, or shortened, to the lower uterine segment, while the
condition os eksternum temporarily remain unchanged. The edge of the os internum ditaraik
to the top few centimeters to be a part (both anatomic and functional) of bawaj uterine
segment. Shortening can be compared with a bunch of a tunneling process that changes the
whole length of a narrow tube into a funnel that is very blunt and expands with small circular
exit holes. As a result of the myometrium activity increased throughout the preparation of the
uterus for childbirth, perfect effacement of the cervix that sometimes software has been
completed before the start of active labor. Leveling cause expulsion of mucus plugs when the
cervical canal shortened.
Cervical dilatation
When compared with the uterine corpus, cervix and lower uterine segment is an area
of resistance is smaller. Therefore, during the contraction of these structures in the process to
stretch the cervix undergoes a centrifugal pull. When the contractions of the uterus puts
pressure on the amniotic membrane, amniotic bag hydrostatic pressure will dilate the cervix.
When the membranes have ruptured, the pressure at the bottom of the fetus against the cervix
and lower uterine segment as well as effective. Premature rupture of the membranes that do
not reduce cervical dilation during the presenting part is in a position to continue the pressure
on the cervix and lower uterine segment. The process effacement and dilation of the cervix
this causes the formation of pockets of amniotic fluid in the front of the head.
pregnancy, and no treated with heavy sedation, analgesia conduction, oxytocin, or operative
intervention. All had normal pelvis, term pregnancies with vertex presentation, and averagesized babies. From this research, friedman develop the concept of three functional parts,
namely childbirth preparation, dilatation, and pelvik- to find that part of the preparation for
labor might be sensitive to sedation and analgesia conduction. Despite the little cervical
dilation at this time, a big change in the extracellular matrix (collagen and components of
other connective tissue) in the cervix. Part dilatation childbirth, when dilatation with the most
rapid pace, in principle, not affected by sedation or analgesia conduction. Part of the pelvic
labor begins simultaneously with cervical deselarasi phase. Classic delivery mechanisms,
involving the major movements of the fetus, especially so during the pelvic part of this labor.
The early part of this quaint clinically rarely be separated from the dilatation of labor. In
addition, the speed of cervical dilation is not always reduced when it has reached full
dilatation; perhaps even sooner.
Spontaneous rupture of membranes most often occur at any time in active labor.
Rupture of membranes typical secra apparent as the liquid jet that is normally clear or slightly
cloudy, virtually colorless varying amounts. The membranes intact until after the baby is born
is more rare. If by chance the membranes intact until delivery is completed, the fetus is born
is wrapped by membranes, and the part that wraps a newborn baby's head is sometimes
referred to as caul. Rupture of membranes before labor begins at any stage of pregnancy is
referred to as membrane rupture.
Disposal Placenta
Third stage labor begins after the birth of the fetus and involve the release of and
expulsion of the placenta. After delivery of the placenta and fetal membranes, active labor
was completed. Because the baby is born, spontaneously contracting uterine hard to fill the
empty. Normally, when the baby has been born almost obliterated the uterine cavity and
Reviews These organs form an almost solid mass of muscle, with some thick lower segment
above sentimerer thinner. Fundus now under the height limit of the umbilicus.
The sudden depreciation uterine size is always accompanied by a reduction in the
field of placental implantation site. So that the placenta can accommodate themselves to the
surface of this shrinking, this organ enlarges its thickness, but the limited elasticity of the
placenta, the placenta was forced to bend. The resulting voltage causes the decidua weakest
layer of spongy layer, or decidua spongiosa relented, and separation occurred at this place.
Therefore, the release of the placenta and shrinking beneath the implantation site. In cesarean
section this phenomenon may be observed directly when the placenta implants in the
posterior.
The separation of the placenta is very easy by the structural properties of the decidua
spongiosa loose. When the separation took place, formed a hematoma between separate
placenta and decidua were tersisisa. Hematoma formation is usually a consequence and not
the cause of the separation. However hematoma can accelerate the process of separation.
Due to the separation of the placenta through the spongy layer of the decidua, part of
the decidua disposed of with the placenta, while the rest remain attached to the myometrium.
Number of decidua tissue left in the placenta varies. Placental separation usually occurs
within a few minutes after delivery. Because the peripheral part of the placenta is the most
attached, separation usually begin anywhere. Sometimes a few degrees of separation initiated
before the third stage of labor, which may explain the occurrence of cases of fetal heart rate
decelerations just before the expulsion of the fetus.
EXTRUSION PLACENTA
After the placenta separates from the implantation, the pressure exerted on it by the
wall of the uterus causing this organ was sliding down the slope to the lower uterine segment
or the top of the vagina. In some cases, the placenta can be pushed out as a result of
heightened abdominal pressure. Artificial methods are used to complete the delivery plasneta
is alternately pressing and raising the fundus, while doing a light traction on the center.
MECHANISM OF LABOR
Ongoing Normal Delivery
Parturition is divided into 4 time
1. Kala I, called kala opening.
2. Kala II, called kala expenditure.
3. Kala III, or when the placenta.
His is the power of the mother that cause cervical opening and push the fetus down.
At the presentation of his head when strong enough, will head down and started to get into
the pelvic cavity.
The entry of the head across the pelvic inlet can be in a state of sinklitismus is when
the fetal head axis direction perpendicular to the plane of the pelvic. Can also head into the
state asinklitismus, ie towards the axis of the fetal head tilted to the field of the pelvic inlet.
Asinklitismus anterior according to Naegele is when the head axis direction to make acute
angle to the front with the door on pnggul. Can also asinklitismus posterior according to
Litzman; the situation is the opposite of the anterior asinklitismus.
Asinklitismus anterior circumstances more favorable than the decline in the head with
a mechanism for asinklitismus posterior pelvic space in the posterior region wider than the
space pelvs in daerh anterior. It is important asinklitismus pelvis when the power of
accommodation is rather limited.
As a result of the eccentric axis of the fetal head or not symmetrical with the axis
closer subocciput, then the detainee in the underlying tissue of the head that will decrease
mengakibatkn head held flexion in the pelvic cavity. With flexion of the fetal head into the
pelvic cavity with the smallest size, the diameter suboccipito-bregmatica (9.5 cm) and with
sirkumferensia suboccipito-bregmatica (32 cm). reached the pelvic floor fetal head in a state
of maximum flexion. Head from the fall meet pelvic diaphragm that runs from top to bottom
rear forward. As a result of the elasticity combination pelvic diaphragm and intrauterine
pressure caused by his repeated, holding the head of the rotation, called the rotation axis
inside. In the case of holding round occiput axis will rotate towards the front so that the
pelvic floor occiput under the symphysis. After the fetal head to the bottom of the pelvis and
occiput under the symphysis, then by subocciput as hipomoklion, head deflection maneuver
to be born. In each of his vulva is more open and more visible fetal head. Perineum becomes
increasingly wide, thin wall rectum anus opening. With his strength along with strength
straining, successively appear bregma, forehead, face and finally the chin. After the head is
born, the head immediately entered rotation, called the pivot round the outside.
Pivot round the outside this is a movement back before the rotation axis in the case, to adjust
the position of the head with the back of the child.
Shoulder across the inlet in an oblique. In the pelvic cavity shoulder will conform to
the shape of the pelvis in its path, resulting in pelvic floor, when the head has been born, the
shoulder will be in a position behind the front. Similarly, the front trochanter was born first,
then trochanter behind. Then the baby is born entirely.
When the baby was born, soon airway cleared. The umbilical cord is clamped
between the two pliers at a distance of 5 and 10 cm. then cut between the two pliers, and then
tied up. Umbilical cord stump given antiseptic. Generally, when it has a complete birthday,
baby soon draw breath and cry. Resuscitation with street cleaning and sucking lenders in the
airway should be promptly undertaken. Similarly liquid in the bubble about to inhaled to
prevent aspiration into the lungs when the baby vomits.
If the baby is born, the uterus shrink. Parturition are in the third stage. Although the
baby was born, when uri is no less important than the first stage and second stage. Maternal
death due to bleeding when the placenta is not uncommon because the leadership of the third
stage less carefully done. As has been stated, immediately after the baby is born, his having
amplitude that is approximately the same height reduced frequency only. As a result of this
his, the uterus will shrink so that the attachment of the placenta to the uterus wall of
separation. Remove the placenta from the uterine wall can be started from 1). Central (central
according to Schultze); 2). The edge (marginal according to Mathews-Duncan); 3). A
combination of 1 and 2. The most is according to Schultze. Uri kala generally lasts for 6-15
minutes. High fundus after the third stage of approximately two fingers below the center.
REFERENCES
Garry Cunningham F, Leveno, K J et al. Normal labor and delivery;. Williams Obstetrics 21st
Edition. Book Medical Publishers EGC. It 272-318, 2006
Keman K. Physiology and mechanisms of normal deliveries in the book of Obstetrics. Bina
Library Sarwono Prawiwohardjo, Jakarta. The third mold fourth edition, p 296-314, 2010
W. Power Hanifa labor and delivery mechanisms, in the book of obstetrics surgery. Bina
Library Sarwono Prawiwohardjo, Jakarta. The eighth edition of the mold first, p 19-29,
2010