Anterior cervical lip
A story: A mother GI P0 A0 40 weeks gestation comes to a BPS want maternity everything goes smoothly, when the mother started to push along with the contractions felt. After some time when sibidan try to check in to 'see what happens' turns midwife found the anterior cervical lip. Finally I asked the mother to stop pushing first because he did not fully experience the complete opening and told the mother that if the mother is still pushing it will hamper the process of opening and slowing the delivery process. The mother had become confused and frightened. He can not stop to push out of a desire to push very strong, but his body was not ready to give birth to her body eventually create more pain than usual. But after a motivated and taught breathing and relaxation techniques eventually the mother is able to resist the urge to mengejannya, and after a while when done checking in, finally the cervix has opened fully and finally the mother can give birth normally.
In the story of the birth process as above is very general. And if this happens in the hospital normally would end the labor action (vacuum, forceps) or the mother at the recommended for epidural or even this condition is diagnosed as a failure of labor progress, malls posterior position with the position of the baby who finally done SC.
Messages in this capital case is that his body failed, and should the mother not to push until the cervix has fully opened.
Anatomy and Physiology
Birth is a very complex physiological process but is there are 3 main things that happened:
1. Cervical dilatation
2. Rotation of the baby through the pelvis
3. The fall in the baby through the pelvis
But this is not the process step-by-step - it's all happening at the same time, and at different levels. So while the cervix is dilated and the baby also turned down.
1. Cervical dilatation
In the picture, do not open or the cervix dilated to form a perfect circle neat (Sutton 2001). However, open from back to front like an ellipse. opening started from the back toward the front when at the beginning of the opening. In some cases of childbirth almost every woman will have an anterior lip as this is the last part of the cervix is pulled over by the baby's head. Is this lip detected depending on when or whether vaginal examination. While the posterior lip almost unheard of for this part of the cervix shortens, widens and disappears the first time. Or rather lip is also difficult to reach with your fingers.
The cervix is dilated because of muscle fibers in the fundus (top of uterus) interesting and cervical shortening with contraction (Coad 2005). This does not require pressure from the lowest part of the fetus. However, the head can affect the shape for the dilated cervix. For example, infants with OA presentations and flexi or infants (see figure A) will create a more dilated form a neat circle, while the baby's head with a presentation of OP and / or baby deflexi (see figure B) will make cervical dilation less than perfect.
2. Rotation
Babies enter the pelvis through the edge of the pelvic bone. As you can see from the picture above this will be easier to head into the pelvis with his head in a transverse position. baby's head down into the cavity will asynclitic - with the parietal bone is due to angle the pelvis requires a baby to get in on a corner - see picture on the right. Once in the cavity of the baby has room to rotate into the best position of OA. Rotation is assisted by the pelvic floor and are often aided by contraction and movement pangul.
3. Descent - the urge to push
The urge to push was triggered when the lowest fetal down into the vagina and put pressure on the rectum and pelvic floor. This is called 'Ferguson reflex'. This reflex does not depend on what the cervix do, but where and what do the baby's head.
Straining before Opening Complete
Because we did not tell the mother when she had to push it they will push when they need to push your body. If we lead when he must push means that we intervene in the physiology of labor and risk can actually create problems. Spontaneously pushing before full dilation of the cervix were normal and the physiological and it is helpful when:
1. Baby's head down into the vagina before the cervix has opened. In this case the extra pressure helps push the baby to move beyond temporary cervical cervical pull out of the road.
2. Infants in the position of the OP (Occiput Posterior) and occiput (back of the head) push on the anus. Infants in the OA position where the head can not go past the pubic symphysis so that the baby's head should be down deeper meaning the baby's head should be lowered so that the front of the head (forehead) is pressing on the rectum and that creates a feeling of want to push. In the case of OP position, spontaneous pushing to help the baby's head to rotate to the position of OA.
During this time I often encounter the cervix become edema / swelling when the mother has repeatedly pushing when the cervix has not opened fully. But when we look at the condition of the patient with the baby's head is already pressing the anus so that the Ferguson reflex took over control. We often can not instruct the mother to do something that can not be done that is to stop pushing.
Sometimes the mother will complain of pain associated with cervical lips are 'sandwiched' between the baby's head and pubic symphysis them as long as there is a sense of contraction and straining. In this case for reducing the pressure on the anus thus avoiding the desire to push, the mother can be helped to change to a position that will reduce pressure on the lip of the cervix (eg, lean). usually the mother will make the changes this position instinctively.
Suggestion
Avoid checks in (vaginal examination) that is too often at the time of delivery.
Try not to lead the mother to push during labor according to our commands. This means that by asking questions or give direction when to push, this will interfere with a woman's instinct. For example, when we (midwives) asks her clients to push, usually by giving a count 1,2,3 and so on and this often makes mothers think should I push? But I do not want to push, in the delivery process so the mother thinks and feels tense, it will decrease its production of oxytocin. And this would make the delivery process has become longer. It would be better if we (midwives) to control the peak contraction, just direct the mother to push with just how to use positive suggestions, of course, for example, "straining under the mother, like she was wasting water" instead of just saying "do not push on the neck!" When the mother is wrong to push for mother during delivery was not able to distinguish between the neck, so when the mother began pushing just point with a soft or silent, as he gave a positive suggestion.
And do not say anything when she stopped pushing, just his eyes and take a deep breath and a long pull. allow the mother to the rhythm of her body (Bergstrom 1997).
If a mother spontaneously pushing for a while with excessive pain (usually on top of the pubic bone), he may encounter the anterior cervical lip which is sandwiched between the head and the symphysis pubis. You do not need a vaginal examination to confirm this unless he wants you to do it.
If you suspect or know he's probably anterior cervical lip:
1. Reassure him that he has made fantastic progress and soon it was over, and she will give birth to the current. Provide support and positive suggestions, ask for relaxation as much as possible and get the baby to help her mother's communication facilitate the birth process.
2. Ask him to follow the rhythm of his body, but not to force him to push.
3. Help her to take a position that can reduce the pressure from the lips of the cervix and feel most comfortable - usually lying down or leaning half an sit.
4. If this situation continues and causes problems during contraction pressure means more pain at the symphysis, give a warm compress or lift and prop her ass a little part of this as an attempt to 'lift' of the cervix to the top.
5. If the mother was asked for further assistance tepiskan cervical lip can manually into the internals of the baby's head. But this is very uncomfortable for the mother!
Note: This situation is rare and usually only be passed without a problem.
Summary
Anterior cervical lip is a normal part of the birth process. Does not require special management. Complications associated with cervical lip due to how midwives identify, and manage the situation as if it is a problem.
In the story of the birth process as above is very general. And if this happens in the hospital normally would end the labor action (vacuum, forceps) or the mother at the recommended for epidural or even this condition is diagnosed as a failure of labor progress, malls posterior position with the position of the baby who finally done SC.
Messages in this capital case is that his body failed, and should the mother not to push until the cervix has fully opened.
Anatomy and Physiology
Birth is a very complex physiological process but is there are 3 main things that happened:
1. Cervical dilatation
2. Rotation of the baby through the pelvis
3. The fall in the baby through the pelvis
But this is not the process step-by-step - it's all happening at the same time, and at different levels. So while the cervix is dilated and the baby also turned down.
1. Cervical dilatation
In the picture, do not open or the cervix dilated to form a perfect circle neat (Sutton 2001). However, open from back to front like an ellipse. opening started from the back toward the front when at the beginning of the opening. In some cases of childbirth almost every woman will have an anterior lip as this is the last part of the cervix is pulled over by the baby's head. Is this lip detected depending on when or whether vaginal examination. While the posterior lip almost unheard of for this part of the cervix shortens, widens and disappears the first time. Or rather lip is also difficult to reach with your fingers.
The cervix is dilated because of muscle fibers in the fundus (top of uterus) interesting and cervical shortening with contraction (Coad 2005). This does not require pressure from the lowest part of the fetus. However, the head can affect the shape for the dilated cervix. For example, infants with OA presentations and flexi or infants (see figure A) will create a more dilated form a neat circle, while the baby's head with a presentation of OP and / or baby deflexi (see figure B) will make cervical dilation less than perfect.
2. Rotation
Babies enter the pelvis through the edge of the pelvic bone. As you can see from the picture above this will be easier to head into the pelvis with his head in a transverse position. baby's head down into the cavity will asynclitic - with the parietal bone is due to angle the pelvis requires a baby to get in on a corner - see picture on the right. Once in the cavity of the baby has room to rotate into the best position of OA. Rotation is assisted by the pelvic floor and are often aided by contraction and movement pangul.
3. Descent - the urge to push
The urge to push was triggered when the lowest fetal down into the vagina and put pressure on the rectum and pelvic floor. This is called 'Ferguson reflex'. This reflex does not depend on what the cervix do, but where and what do the baby's head.
Straining before Opening Complete
Because we did not tell the mother when she had to push it they will push when they need to push your body. If we lead when he must push means that we intervene in the physiology of labor and risk can actually create problems. Spontaneously pushing before full dilation of the cervix were normal and the physiological and it is helpful when:
1. Baby's head down into the vagina before the cervix has opened. In this case the extra pressure helps push the baby to move beyond temporary cervical cervical pull out of the road.
2. Infants in the position of the OP (Occiput Posterior) and occiput (back of the head) push on the anus. Infants in the OA position where the head can not go past the pubic symphysis so that the baby's head should be down deeper meaning the baby's head should be lowered so that the front of the head (forehead) is pressing on the rectum and that creates a feeling of want to push. In the case of OP position, spontaneous pushing to help the baby's head to rotate to the position of OA.
During this time I often encounter the cervix become edema / swelling when the mother has repeatedly pushing when the cervix has not opened fully. But when we look at the condition of the patient with the baby's head is already pressing the anus so that the Ferguson reflex took over control. We often can not instruct the mother to do something that can not be done that is to stop pushing.
Sometimes the mother will complain of pain associated with cervical lips are 'sandwiched' between the baby's head and pubic symphysis them as long as there is a sense of contraction and straining. In this case for reducing the pressure on the anus thus avoiding the desire to push, the mother can be helped to change to a position that will reduce pressure on the lip of the cervix (eg, lean). usually the mother will make the changes this position instinctively.
Suggestion
Avoid checks in (vaginal examination) that is too often at the time of delivery.
Try not to lead the mother to push during labor according to our commands. This means that by asking questions or give direction when to push, this will interfere with a woman's instinct. For example, when we (midwives) asks her clients to push, usually by giving a count 1,2,3 and so on and this often makes mothers think should I push? But I do not want to push, in the delivery process so the mother thinks and feels tense, it will decrease its production of oxytocin. And this would make the delivery process has become longer. It would be better if we (midwives) to control the peak contraction, just direct the mother to push with just how to use positive suggestions, of course, for example, "straining under the mother, like she was wasting water" instead of just saying "do not push on the neck!" When the mother is wrong to push for mother during delivery was not able to distinguish between the neck, so when the mother began pushing just point with a soft or silent, as he gave a positive suggestion.
And do not say anything when she stopped pushing, just his eyes and take a deep breath and a long pull. allow the mother to the rhythm of her body (Bergstrom 1997).
If a mother spontaneously pushing for a while with excessive pain (usually on top of the pubic bone), he may encounter the anterior cervical lip which is sandwiched between the head and the symphysis pubis. You do not need a vaginal examination to confirm this unless he wants you to do it.
If you suspect or know he's probably anterior cervical lip:
1. Reassure him that he has made fantastic progress and soon it was over, and she will give birth to the current. Provide support and positive suggestions, ask for relaxation as much as possible and get the baby to help her mother's communication facilitate the birth process.
2. Ask him to follow the rhythm of his body, but not to force him to push.
3. Help her to take a position that can reduce the pressure from the lips of the cervix and feel most comfortable - usually lying down or leaning half an sit.
4. If this situation continues and causes problems during contraction pressure means more pain at the symphysis, give a warm compress or lift and prop her ass a little part of this as an attempt to 'lift' of the cervix to the top.
5. If the mother was asked for further assistance tepiskan cervical lip can manually into the internals of the baby's head. But this is very uncomfortable for the mother!
Note: This situation is rare and usually only be passed without a problem.
Summary
Anterior cervical lip is a normal part of the birth process. Does not require special management. Complications associated with cervical lip due to how midwives identify, and manage the situation as if it is a problem.
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