2.  PROCESS BY WHICH FETUS OF VIABLE
AGE IS EXPELLED FROM THE UTERUS
 NORMAL LABOUR: FETUS PRESENTS BY
VERTEX, BEGINS SPONTANEOUSLY AT
TERM, TERMINATES NATURALLY
WITHOUT ARTIFICIAL AID & WITHOUT
COMPLICATIONS
 ABNORMAL: ANY DEVIATION FROM
ABOVE

3.  PREMONITORY STAGE
 PRIMI:BEGINS 2-3 WKS BEFORE ONSET OF TRUE LABOUR
 MULTI:FEW DAYS BEFORE ONSET
FEATURES:
 LIGHTENING:PRESENTING PART SINKS INTO TRUE
PELVIS,DECREASE IN FUNDAL HEIGHT,RELIEF FROM
CARDIO-RESP EMBARRASMENT,WELCOME SIGN-RULE
OUT CPD
 CERVICAL CHANGES:SOFT&DILATABLE
 FALSE LABOUR PAINS:DUE TO STRETCHING OF
CERVIX&LUS. DULL,CONTINOUS,CONFINED TO LOWER
ABDOMEN,NOT ASSOCIATED WITH HARDENING OF
UTERUS OR DILATATION OF OS,RELIEVED BY ENEMA OR
SEDATION

4.  PAINFUL UTERINE CONTRECTIONS:
INTERMITTENT CONTRACTIONS
RECOGNISABLE ON PALPATION
INITIALLY FOR 30 SEC AT 15-30 MIN
GRADUALLY INCREASE IN
FREQUENCY,SEVERITY&DURATION
 SHOW:
DISCHARGE OF CERVICAL MUCUS PLUG
&SLIGHT HEMORRHAGE
 DILATATION &EFFACEMENT OF INT OS:
 FORMATION OF BAG OF WATERS:

5. First Stage
 Interval between the onset of labor and full
cervical dilation
 Duration is 8-16 hours in primis &4-8 hours in
multis
Second stage:
 Starts with full dilation of cervix &ends with
expulsion of fetus from birth canal.
 Duration:1-2 hours in primis.
30 mins in multis.

6. Third Stage:
Begins after expulsion of fetus &ends with
expulsion of placenta and membranes.
Duration:15 mins in both primis &multis.
Fourth Stage:
Stage of observation.
One hour after expulsion of placenta and
membrane.

8. FIRST STAGE
PRELIMINARIES - H/o duration of
amenorrhoea
-time of onset of labor
pains/leaking
-general examination
-vital parameters
-obstetric examination p/a p/v
-review of antenatal records

9. ASSESSMENT OF PROGRESS OF LABOR
Per-abdominal-uterine contractions-
frequency,intensity&duration.
-descent of head
-FHS -110-160/min.
-rhythm & intensity
-every half hour
With progress of labor &descent of head maximum
impulse of FHS shifts downwards & medially.
All high risk women to be put on CTG monitor.

10. Per vaginal-dilation &effacement of cervix.
-descent of head-station of head in
relation to ischeal spine
-rotation of head
-if membrane absent-colour of liquor
-if cx 4 cm or more –ARM
-any caput or moulding

11. MATERNAL CONDITION:
Every 2 hourly
Hydration
Pulse
B.P.
Temperature
Urine output

12. SECOND STAGE:
The transition from 1st to 2nd stage is evidenced
by-increasing intensity of uterine cont.
-bearing down effort
-urge to defecate
Per vaginal –full dilation of cervix

13. CONDUCT OF DELIVERY
DELIVERY OF HEAD
Maintain flexion
Prevent early extension
Regulate slow escape out of vulva
Bearing down encouraged during
contraction&deep breathing in between
contractions
When the perineum is stretched &threatening to
tear,an episiotomy should be performed.

16. EPISIOTOMY