Most of the basic stuff you need to know about the 1st stage of labor.

4. • Cervix fully EFFACED
• Mild, irregular contractions become more
rhythmic and stronger
• Cervical dilatation starts
• Can last even up to 12-16 hours

6. • Cervix dilates rapidly up to 10cm
• At a rate of 1cm/hour or more
• Foetal descent begins
• Lasts for 2 – 6 hours

7. • Duration shorter in multi
• Considered as prolonged if,
– >12hrs in primi
– >8hrs in multi

9. • Maternal well-being
• Foetal well-being
• Progression of labour
• Adequate hydration
• Pain relief

11. • Graphical presentation of the progress of
labour
• Monitor active phase of 1st stage
• Instant visual assessment of maternal & fetal
well being & progression of labour

13. – Vital signs
– Urine
– Hydration
– FHR
– Character of liquor
– Moulding

14. – Cervical dilatation
– Station
– Uterine contractions
– Oxytocin
– Pain relief

17. • Heart rate auscultation

18. • Intact membranes
• Ruptured membranes
• Liquor colour
• Meconium stained

19. 2 main components
Abdominal examination
PV examination

20. – Can be felt by palpation
– Maximum expected is
• 3 in 10min
• One lasting >40 sec
• 2min relaxation in between

21. • Palpate the number of contractions in 10 minutes
and calculate the duration of one contraction
Less than 20sec
Between 20 and 40sec
More than 40sec

22. Recording of uterine contractions

23. • If contractions are not satisfactory,
Oxytocin
infusion
5U for primi
2U for multi
Starting
15drops/min
Can increase by
15drops/min
every ½ hour
Up to max. of
60drops/min

24. • Palpation of foetus
– To detect progressive descent of head
– Expressed in 1/5th

25. • Routinely done every 4 hourly
• Important to determine progression
• 4 main things to check
– Cervical dilatation
– Effacement
– Descent
– Moulding

26. • 2 important indicator lines are marked in
Partogram
Alert line - A line drawn at the end of the latent
phase demonstrating progress of 1cm
dilatation per hour
Action line - A line drawn parallel and 4 hrs to the
right of alert line

29. • Overlapping of skull bones
0 - bones are separated
+ - bones touching , can be separated
++ - bones overlapping
+++ - bones overlapping severely

30. • Types in 1st stage
1. Prolonged latent phase
2. Primary dysfunctional labour
3. Secondary arrest

31. • Latent phase > 14-16hrs in primi
> 8-10 hrs in multi
• Poor uterine contractions
• Possibilities
– Occipito posterior position of foetus
– Cephalopelvic disproportion
– Cervical dystocia
– Uterine dysfunction

33. • Slow progression in active phase
• Falls to right of action line
• Possibilities
–Uterine Inertia (ineffective uterine contraction)
– Malposition (2nd commenest)
– Cephalopelvic disproportion

35. • Progression normal in latent and early active
phase and arrest of cervical dilatation during
late active phase.
• No cervical dilatation > 2hrs at any point
beyond 6cm dilatation
• Possibilities
–CPD
–OP position
–Inadequate uterine contraction

37. • Non pharmacological
 Psychoprophylaxis
 Psycotherapy
 Physical methods

38. • Pharmacological
Pethidine
1mg/kg
Primi – 1st when cx is 3cm, 2nd after 4hrs of 1st dose
Multi – single dose when cx is 3cm
Morphine
10mg SC or IM
Preferred in heart disease
Nitrous oxide gas (Entonox)
Mixed with oxygen 1:1
Given via face mask