2. Labour is defined as the onset of regular painful contractions
with progressive cervical effacement and dilatation of the
cervix accompanied by descent of the presenting part.End
By delivery of fetus, placenta, membranes
DEFINITIONS
3. NORMAL LABOUR
Spontaneous expulsion,
of a single,
mature fetus (37 completed weeks – 42 weeks),
presented by vertex,
through the birth canal (i.e. vaginal delivery),
within a reasonable time (not less than 3 hours or more than 18
hours),
without complications to the mother,
or the fetus
The following criteria should be present to call it normal labour
6. THE NORMAL FEMALE PELVIS
1. The brim is slightly oval transversely.
2. The sacral promontory is not prominent.
3. The transverse diameter is slightly longer
than the anteroposterior.
4. The sidewalls are parallel and straight.
5. The ischial spines are not prominent.
6. The sacrosciatic notches are wide.
7. The sacrum has a good curve.
8. The pubic arch angle are wide, i.e. more than
90
9. Inter tuberous diameter is wide
The ideal normal female gynaecoid pelvis:
7. THE FETAL SKULL
MOULDING’ is the ability
of the fetal head to
change its shape and so
to adapt itself to the
maternal pelvis during
the progress of labour
8. POWER ► Contractions + Maternal
pushing
Uterine contractions:
Shortening of muscle fibres
Retractions
intra uterine pressure
EXPULSION OF THE FETUS
Additional force
“maternal pushing”
Intra abdominal pressure
9. UTERINE CONTRACTION
NORMAL CONTRACTION
1. Frequency ~ one in every 2 – 3 min with at least 1 minute interval
2. Intensity ~ strong (> 50 mmHg)
3. Duration ~ 45 – 60 sec
Uterine contractions
11. NORMAL LABOUR
Hormonal factors
1) Estrogen theory
2) Progesterone withdrawal theory
3) Prostaglandins theory
4) Oxytocin theory
5) Fetal cortisol theory
Mechanical factors
1) Uterine distension theory
2) Stretch of the lower uterine segment by the presenting near
term
Causes of Onset of Labour:
- It is unknown but the following theories were postulated:
13. NORMAL LABOUR AND DELIVERY
Painful regular uterine contractions – as evidence
by contraction at least one in ten minutes
Show – as evidence by mucus mixed with blood
Rupture of membranes – as evidence by leaking
liquor
Progressive shortening and dilatation of the
cervix
SYMPTOMS AND SIGNS OF LABOUR
16. NORMAL LABOUR AND DELIVERY
First stage: from onset of labour till fully effacement and
dilitation
Divided into:
Latent phase – begins with onset of contracts and ends when cervix is
3 cm dilated and effaced
Active phase – begins after the cervix is 3 cm dilated
17. NORMAL LABOUR AND DELIVERY
WHAT HAPPEN DURING
THE FIRST STAGE OF LABOUR
18. NORMAL LABOUR AND DELIVERY
WHAT HAPPEN DURING THE FIRST STAGE
1. Contractions:
CONTRACTIONS
1: Regular
2: Increasing in frequency
3: Stronger
19. WHAT HAPPEN DURING THE FIRST STAGE OF LABOUR
2. Cervical dilatation and effacement:
Phases of cervical dilatation
Latent phase – the first 3 cm of dilatation; a slow
process (8 hours in nulliparous and 3 hours
in multiparous
Active phase – this is active process of cervical
dilatation; the normal rate is 1 cm/hour
20. NORMAL LABOUR AND DELIVERY
WHAT HAPPEN DURING THE FIRST STAGE
3. Engagement of the presenting part:
22. NORMAL LABOUR AND DELIVERY
SECOND STAGE OF LABOUR
1. Begins with FULL DILATATION and ends with DELIVERY OF THE BABY.
2. It have TWO Phases
a) Propulsive phase – from full dilatation until presenting part has descended
to the pelvic floor
b) Expulsive phase which ends with the delivery of the baby
3. Average length
a) Primigravidae – 40 minutes
b) Multigravidae – 20 minutes
24. NORMAL LABOUR AND DELIVERY
THIRD STAGE OF LABOUR
1. Begins after DELIVERY of the baby and ends with DELIVERY OF THE
PLACENTA / MEMBRANES.
2. It have TWO Phases
a) Separation phase
b) Expulsion phase
3. Duration – usually 15 minutes or less (if actively managed).
.
25. Fourth stage
Its 3-4 hours after delivery of placenta & mebrane
,period of stabilization of fetus & mother
