Normal vaginal labor refers to the process of childbirth where the baby is delivered through the vagina without the need for surgical intervention such as a cesarean section. During normal vaginal labor, the cervix dilates and effaces, allowing the baby to pass through the birth canal. Cesarean sections, often referred to as C- sections, are surgical procedures used to deliver a baby when vaginal delivery is not possible or not safe for the mother or the baby.

1. Dr / Ahmed Salah Ashour(Ph.D.)
Associate professor of human anatomy
Dr.Ahmedashour@gmu.ac.ae
USMLE Clinical Anatomy

2. Case report

3. We present a case report of a 26-year-old primigravida woman with a low-risk
pregnancy who successfully underwent normal vaginal delivery (NVD). The patient
had an uneventful antenatal period with regular prenatal check-ups and appropriate
prenatal care. Labor progressed smoothly, and the patient achieved complete
cervical dilation without complications.

4. The second stage of labor was actively managed, and the patient delivered a healthy
baby boy weighing 3.2 kg. Both mother and baby had favorable postpartum
outcomes with no immediate complications. This case highlights the importance of
antenatal care, appropriate management during labor, and the successful outcome of
NVD in low-risk pregnancies.

5. ANATOMICAL
BASIS OF
DELIVERY

6. ILOs
• Normal labor is a complex physiological process involving coordinated
interactions between the maternal uterus, cervix, hormones, fetal
positioning, and the maternal pelvis.
• These anatomical and physiological factors work together to facilitate the
safe passage of the baby from the uterus through the birth canal during
childbirth.

7. Normal vaginal labor refers to the process of
childbirth where the baby is delivered through
the vagina without the need for surgical
intervention such as a cesarean section.
During normal vaginal labor, the cervix dilates
and effaces, allowing the baby to pass through
the birth canal.
Cesarean sections, often referred to as C-
sections, are surgical procedures used to deliver
a baby when vaginal delivery is not possible or
not safe for the mother or the baby.

9. ANATOMICAL BASIS OF
NORMAL VAGINAL
DELIVERY

10. MATERNALAND
FETAL ENGAGING
BONES

11. The ideal female pelvis:
• The brim is slightly oval
transversely.
• The sacral promontory is not
prominent.
• The transverse diameter is
slightly longer than the
anteroposterior.
• The ischial spines are not
prominent.
• The sacrum has a good curve.
• The pubic arch angle are
wide, i.e. more than 90 degree
• Inter tuberous diameter is
wide
sacral promontory
sacrum
ischial spine
Ischial tuberosity
pubic arch angle

12. 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.

13. SYMPTOMS AND
SIGNS OF LABOUR

14. • 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
Regular uterine contractions

15. STAGES OF
LABOUR

16. FIRST STAGE

17. Uterine contractions
• Regular
• Increasing in frequency
• Stronger

18. Cervical dilatation and effacement
The cervix shortens (effaces) and widens (dilates), effectively disappearing.
Associated with stretched lower part of uterus.

19. Intrapartum hemorrhage
In the context of placenta previa, where the
placenta covers part or all of the cervix, cervical
dilatation and effacement can pose significant
risks. As the cervix dilates and effaces, it can
disrupt the placenta, leading to bleeding.
This bleeding can be severe and potentially life-
threatening for both the mother and the baby.
Monitoring cervical dilatation and effacement is
an essential part of labor management, especially
in cases of placenta previa, to minimize
complications and ensure a safe delivery.
Clinical Insight

20. SECOND STAGE

21. It have two Phases
• Propulsive phase – from full dilatation
until baby head has descended to the
pelvic floor
• Expulsive phase which ends with the
delivery of the baby

22. Once the baby is delivered, the umbilical cord is clamped and cut.

23. THIRD STAGE

24. As the uterine contractions continue, the
placenta detaches from the uterine wall.
Once the placenta is delivered, the healthcare
provider will examine it to ensure that it is intact
and that no pieces are left behind in the uterus,
which could lead to complications.
After the placenta is delivered, the healthcare
provider may massage the mother's abdomen to
help the uterus contract and prevent excessive
bleeding.

25. Clinical Insight
Retained placental tissues
occur when some or all of the placenta or
membranes remain in the uterus after
delivery. This condition can lead to
complications such as postpartum
hemorrhage (excessive bleeding), infection,
and uterine perforation.
Retained placental tissues are usually
diagnosed when the healthcare provider
notices that the placenta has not been
delivered within a certain timeframe after the
baby's birth, or if there are signs of excessive
bleeding or infection after delivery.

26. FOURTH STAGE

27. Its 3-4 hours after delivery of placenta & mebrane, period of stabilization of fetus &
mother.

28. ANATOMICAL BASIS OF
CESAREAN SECTION

29. A Cesarean section, often abbreviated as C-section, is a surgical procedure used to
deliver a baby when a vaginal delivery isn't safe or possible. It involves making an
incision in the mother's abdomen and uterus to remove the baby.

30. INDICATIONS

31. 1. Fetal distress: When monitoring shows that the baby is not tolerating labor well,
indicating potential problems with oxygen supply.

32. 2. Placental abnormalities: Such as placenta previa (placenta covering the cervix) or
placental abruption (premature separation of the placenta from the uterine wall),
which can lead to dangerous bleeding during vaginal delivery.

33. 3. Abnormal fetal presentation: If the baby is not positioned head-down (breech),
transverse, or in any other position that makes vaginal delivery unsafe.

34. 4. Previous C-section: In some cases, women who have had a previous Cesarean
may need another one for subsequent deliveries due to concerns about uterine
rupture during vaginal birth.

35. 5. Maternal health issues: Certain medical conditions in the mother, such as active
genital herpes, severe heart disease, or certain types of cancer, may make vaginal
delivery risky.

36. 6. Multiple pregnancies: Such as twins or triplets,
where the babies may not be positioned optimally for
a safe vaginal birth.

37. 7. Labor complications: Prolonged labor, failure to progress, or other complications
that make vaginal delivery unlikely to be successful or safe.

38. 8. Umbilical cord prolapse: Where the umbilical cord slips into the birth canal ahead
of the baby, cutting off oxygen flow.

39. STEPS

40. 1. Preparation: The patient is prepped for surgery, which includes cleaning the
surgical site and administering anesthesia (usually regional anesthesia like an
epidural or spinal block, or in some cases, general anesthesia).

41. 2. Incision: A horizontal (Bikini) or vertical incision is made through the skin and
abdominal wall, usually just above the pubic hairline (lower uterine segment). This
incision extends through the uterus, allowing access to the baby.

42. The bikini incision, also known as a low transverse incision, is a common approach
for cesarean sections. It's called a "bikini" incision because it's typically made
horizontally just above the pubic hairline, resembling the lower edge of a bikini.
Surgeons do consider the natural lines and creases of the body, including the "bikini
line" or "fashion lines," to make incisions that are both functional and aesthetically
pleasing. This approach helps to minimize visible scarring and promotes better
healing and patient satisfaction.

43. 3. Uterine incision: The uterus is opened with a separate incision, typically in a
horizontal or transverse fashion (known as a low transverse incision or occasionally
a vertical incision), to minimize bleeding and facilitate healing.

44. 4. Delivery of the baby: The baby is gently
delivered through the uterine incision.
The obstetrician or surgeon carefully
maneuvers the baby out of the uterus while
ensuring the umbilical cord is not
compressed.

45. 5. Clamping and cutting the umbilical cord: Once the baby is delivered, the
umbilical cord is clamped and cut.

46. 6. Placental removal: The placenta is then removed from the uterus.

47. 7. Uterine repair: The uterus is carefully sutured to close the incision. The number
of layers and type of sutures used may vary depending on the circumstances and
surgeon preference.

48. 8. Closure: The abdominal incision is closed in layers, typically including the
muscle and subcutaneous tissue, followed by the skin. The skin incision may be
closed with stitches, staples, or adhesive strips.

49. Formative Quiz

50. Q1 During the first stage of labor, which anatomical structure undergoes significant
changes to facilitate cervical dilation?
a) Uterus
b) Cervix
c) Vagina
d) Fallopian tubes

51. Q2 What is the primary function of the amniotic sac during normal vaginal
delivery?
a) To provide a protective barrier against infections
b) To cushion the fetus from external pressure
c) To regulate the temperature of the fetus
d) To contain amniotic fluid, aiding in fetal movement and development

52. Q3 Which pelvic structure forms the bony passage through which the fetus passes
during childbirth?
a) Coccyx
b) Sacrum
c) Ischium
d) Pubic symphysis

53. Q4 What is the role of the perineum during the second stage of labor?
a) To protect the fetus from compression
b) To dilate and allow passage of the fetus through the birth canal
c) To provide structural support to the pelvic floor muscles
d) To prevent excessive bleeding during delivery

54. Q5 Which hormone, released during labor, stimulates uterine contractions and helps
initiate and maintain the process of childbirth?
a) Estrogen
b) Progesterone
c) Oxytocin
d) Prolactin

55. Q1 Cervix
Q2 To contain amniotic fluid, aiding in fetal movement and development
Q3 Sacrum
Q4 To provide structural support to the pelvic floor muscles
Q5 Oxytocin

56. List of Texts and Recommended Readings
• Last's Anatomy, Regional and Applied. Chummy S. Sinnatamby. 12th edition 2011, ISBN:13 - 978 0 7020
3394 0 (Available in ClinicalKey: https://www.clinicalkey.com/#!/browse/book/3-s2.0- C2009060533X)
• Estomih Mtui, Gregory Gruener and Peter Dockery. Fitzgerald's Clinical Neuroanatomy and
Neuroscience. 7th edition; 2016, ISBN: 13 - 978-0-7020- 6727-3 (Available in ClinicalKey:
https://www.clinicalkey.com/#!/browse/book/3-s2.0- C20130134113
• Drake, Richard L. Gray's Anatomy for Students, Third Edition, Elsevier Saunders 2015. ISBN-13: 978-
0702051319 (Available in ClinicalKey: https://www.clinicalkey.com/#!/browse/book/3- s2.0-
C20110061707).
• Sobotta Atlas of Human Anatomy. F. Paulsen. Vol.1, 15th Edition; 2013, ISBN: 9780702052514 (Available in
ClinicalKey: https://www.clinicalkey.com/#!/content/book/3- s2.0-B9780702052514500067)
• Sobotta Atlas of Human Anatomy. F. Paulsen. Vol.2, 15th Edition; 2013, ISBN:13 - 978-0-7020-5252-1

57. https://www.slideshare.net/ahmedsahm
edtanta
USMLE FULL SOURCES

58. Recap