Series of events that take place in the genital
organs in an effort to expel the viable products of
conception out of the womb through the vagina
into the outer world is called labour.
It is the process where by painful , regular uterine
activity (contraction) with progressive cervical
effacement and dilatation accompanied by decent
of the presenting part leads to expelled of the
fetus from the uterus at or beyond 24 (or 28)
completed weeks of pregnancy.
Term
Labour
PTL prolonged
24 W 28 W 37 W 40W 42W
1 LNMP
Spontaneous in onset
single
term
live fetus
vertex presentation
without undue prolongation
natural termination with minimal aids
without fetal or maternal
complications.
Onset of labour
Mechanism not definitely known however there
are several theories
Mechanical theories: uterine distension
Hormonal theories:
fetal hypothalamic pituitary adrenal axis
increased CRH
increased cortisol production
accelerate estrogen and PG production
from placenta
Premonitory stage
Lightening welcoming sign
Cervical changes
Prelabour
Appearance of false pain
False labour pain
Primigravida
Prior to true pain
Dull in nature
Continous and unrelated to hardening
of uterus
No effect on cervical dilatation
Relived by enema and sedation
True labour pain
Regular
Increasing intensity and duration
Show
Progressive effacement and dilatation
of cervix
Formation of bag of water
character True labour pain False labour pain
contractions regular Irregular
Interval between Progressive (increase in Short duration, not
contractions and frequency and progressive
intensity intensity)
Changes in the cervix Associated with Not associated with
effacement and effacement and
dilation of the cervix dilation of the cervix
Membranes Associated with bulging Not associated with
of membranes bulging of
membranes
Response to analgesia Not relieved by Relieved by sedation
sedation
Labour Followed by labour Not followed by labour
STAGES OF LABOUR:
I-First stage: cervical stage
Definition:
the period from the onset of true
uterine contractions to the fully
dilation of the cervix, when the
diameter of the cervical os measures
10cm.
Duration:
o primigravida = 12 h
o multigravida = 6 h
Phases of the first stage:
Latent phase:
started when the cervix dilatated slowly and
reached to about 3cm.
primigravida = 8h
multigravida = 4h
Active phase:
rapid dilatation of the cervix to reach 10cm
primigravda = 4h
multigravida =2h
The active phase is divided into:
1. Accelerative phase
2. Slopping phase
3. Deceleration
partograph
II-Second stage of labour: stage of
delivery of the fetus.
Def:
Starts from complete cervical dilatation
to the birth of the fetus.
Duration:
primigravida =2 h
multigravida = h
however the timing of the second stage
is very different to determine and
controversial and can be extended as
much as there is progress in descent
and no harm to the mother or fetus
The second stage of labour had two
phases:
1. Propulsive phase starts with full
dilatation upto the descent of the
presenting part to the pelvic floor.
2. Expulsive phase stage of maternal
bearing down due to contraction
and retraction of the uterine muscle
and voluntary efforts by diaphragm
and abdominal muscles and ends
with delivery of the baby
III-Third stage of labour: the
stage of expulsion of the
placenta and membranes ( after
birth).
Duration: up to 30 minutes,
however the length of the third
stage of labour is reduced to
5mins in active management.
IV Fourth
stage
Stage of observation for at least one
hour after expulsion of the after birth
Events in first
stage
Pain
Dilatation and effacement of cervix
Formation of lower uterine segment
Factors affecting cervical
dilatation:
1. Contraction and retraction of the
uterus.
2. The bag of fore-water.
3. Fitting of the presenting part to
the lower segment and the cervix.
4. Pre-labour changes in the cervix
(eg, softening)
Dilation and effacement of
cervix
Lower uterine
segment
Events in second stage of
labour
This stage is concerned with the descent and
delivery of the fetus through canal
Pain
Bearing down efforts
Descent of the fetus
abdominal assessed in relation to the brim
rotation of the anterior shoulder to the
midline and change in position of fetal heart
rate
vaginal assessed in relation to ischial
spines and gradual rotation of head
Fifth formula
Events in third stage
Placental separation, its descent and
expulsion with its membranes.
[Link] first phase:
Phase of placental separation occurs
through the spongiosa layer of the
decidua at the time of expulsion of the
baby or very soon afterwards. The
shearing force responsible for the
separation is the contraction and
retraction of the uterus, reducing the
uterine volume and the area of the
placental site, as the fetus is expelled.
[Link] second phase: The separated
placenta descends from the upper
segment into lower uterine segment,
cervix, and vagina by two
mechanisms:
[Link] mechanism:(80%)
The placenta delivered as an inverted
umbrella with its fetal surface
presenting first followed by the
membranes with retro-placental
haematoma.
[Link] Duncan mechanism: (20%)
The placenta delivered side way and it
Signs of separation and decent of the
placenta:
1. The body of the uterus becomes smaller,
harder, and globular.
2. Suprapubic bulge may appear due to
presence of the placenta in the lower
segment.
3. Elongation of the cord out side the vulva.
4. Sudden gush of blood from the vagina.
Control of bleeding