The document discusses the stages of normal labour and delivery. It is divided into four stages: 1) First stage from onset of contractions until full cervical dilation. It has latent and active phases of dilation. 2) Second stage from full dilation until delivery of the baby. It has propulsive and expulsive phases. 3) Third stage from delivery of baby until delivery of placenta, which has separation and expulsion phases. 4) Fourth stage is the period of stabilization for the fetus and mother for 3-4 hours after delivery of the placenta.

1. NORMAL LABOUR
AND
DELIVERY
By
Dr.shatha sami
FICOG
CABCOG

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

4. WHAT FACTORS INFLUENCE
PROGRESS OF LABOUR ?

5. LABOUR AND DELIVERY
FACTORS THAT INFLUENCE
PROGRESS OF LABOUR
Passenger Passage
Power

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

10. LABOUR AND DELIVERY
WHAT INITIATE LABOUR
“ONSET OF LABOUR”

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:

12. LABOUR AND DELIVERY
DIAGNOSIS OF LABOUR

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

14. LABOUR AND DELIVERY
THE STAGES OF
LABOUR

15. FIRST STAGE 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:

21. SECOND STAGE OF
LABOUR

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

23. APRIL 2005
THIRD STAGE OF
LABOUR

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