First stage of labour process and its management

1. Subject – obstetrics and gynecological nursing
Topic – 1st stage of labour and its management

2. Introduction

3. KEY WORDS
•Labour - A series of events take place in the genital organs in an effort to expel the
viable products of conception out of the womb through the vagina into the outer
world is called labour.
•First stage – It starts from the onset of labour pains to the full dilatation of the cervix
•Second stage – it starts from the full dilatation of the cervix to the expulsion of foetus
from birth canal.
•Third stage – It starts after the birth of the baby and ends with expulsion of the
placenta, umbilical cord and membranes.
•Fourth stage – This is the stage of observation.
•Mechanism of labour – It is the series of movements that occur on the head and the
fetal trunk in the process of adaptation, during its journey through the pelvis.
•Lightening – It is a welcome sign, occurs due to the active pulling of the lower pole of
the uterus and widening of the symphysis pubis.
•Partograph – graphic representation used to assess the progress of labour .
•Active phase – the cervix under goes rapid dilatation. It begins when cervix is dilated
3 -4 cm and complete when cervix is fully dilated 10cm.
•Latent phase – it occurs prior to active phase .last for 6 -8 hours in da.The cervix
dilates 0cm – 3 -4 cm.

4. Physiology of normal labour
Primary forces
Engagement
Contractions
Rhythm
Fundal dominance
Duration and frequency

5. Main movements in mechanism of labour
Engagement of head
↓
Flexion of head
↓
Internal rotation of head
↓
Crowning
↓
Extension and birth of head
↓
Restitution
↓
Internal rotation of shoulders and external rotation
of head
↓
Birth of shoulders and trunk by lateral
flexion.

6. First stage of labour
phases -
Latent phase
Active phase
Transition phase

7. Signs and symptoms of onset of labour
Labour pain
Show
Abdominal signs
Fundal dominance
Contractin and retraction of the uterus
Dilatation of the cervix
Effacement of the cervix
Formation of the upper and lower uterine
segment

8. Upper Uterine
Segment
Lower Uterine
Segment
Peritoneum Firmly-attached. Loosely-attached.
Myometriu
m
3 layers; outer longitudinal, middle
oblique and inner circular. The
middle layer forms 8-shaped fibres
around the blood vessels to control
postpartum haemorrhage (living
ligatures).
2 layers; outer longitudinal and
inner circular.
Decidua Well-developed. Poorly-developed.
Membranes Firmly-attached. Loosely- attached.
Activity Active, contracts, retracts and
becomes thicker during labour.
Passive, dilates, stretches and
becomes thinner during labour.

9. True Labour Pain False Labour Pain
Regular. Irregular.
Increase progressively in
frequency, duration and intensity.
Do not.
Pain is felt in the abdomen and
radiating to the back.
Pain is felt mainly in the abdomen.
Progressive dilatation and
effacement of the cervix.
No effect on the cervix.
Membranes are bulging during
contractions.
No bulging of the membranes.
Not relieved by antispasmodics
or sedatives.
Can be relieved by antispasmodics
and sedatives.

10. PREPARATION OF LABOUR ROOM AND WOMAN –
Preparation of labour room –
•Effective cleaning it reduces the transfer of air bone
organisms and spread of infection.
•Visitors are not allowed to enter in the labour room
•Cleanliness should be maintained
•Good sources of light should be made.
•All the necessary articles, drugs, equipments and
machines have to be made ready prior. Delivery kit
should be ready and cleanliness and sterility of the
articles should be taken care of.

11. PREPARATION OF WOMAN –
•When woman is admitted in hospital she should bring
all the records of her previous antenatal checkups.
•A general and vaginal examination is done to diagnose
the onset of true labour.
•Perineal area is shaved and washed. A sterile pad is put
on the vulva.
•If bowel movement is absent enema should be given to
the women.

12. THECONCEPTOFPARTOGRAPH:
- It is a record of all observations made on a
woman in labour
- Decision making tool
- Implies a functioning referral system with
essential Obstetric service
- It improves Efficiency and Effectiveness of
Maternity Services

13. DEFINITION:
* A Partograph is a tool to help in the management of labour for
the identification of women who are not likely to have a normal
delivery and who need medical assistance.
•Partograph is a chart in which the salient features of labour are
entered in a graphic form and it provides the opportunity for early
identification of deviations from normal.
* A Partograph is a graphical record of progress during labour.
Progress measured by cervical dilatation against time in hours & it
provides a record of the important conditions of the mother & fetus
that may arise during the process of labour.

14. PURPOSE OF THE PARTOGRAPH:
1) To detect abnormal progress of labour as early as
possible
2) To prevent prolonged labour
3) To recognize CPD long before obstructed labour
4)To assist in early decision on transfer, augmentation or
termination of labour
5) To increase the quality and regularity of all
observations of mother and fetus
6) To recognize maternal or fetal problems as early as
possible

15. OBJECTIVE OF INTRODUCTION OF PARTOGRAPH:
Partograph facilitates the providers in
a) Differentiating between latent and active phase of
labour and its deviation from normal
b) Monitoring the progress of labour and well being of
mother and fetus
c) Recognizing the need for action at the appropriate time
FUNCTIONS OF PARTOGRAPH:
- Give early warning in prolonged labour.
- Moving to the right of the alert line serves as a WARNING
for extra vigilance and specific management decisions must
be made.
- Other observations on the progress of labour also recorded.

16. COMPONENTS OF THE PARTOGRAPH:
Part I Assessment of fetal condition
Part II Progress of labour
Part III Assessment of maternal condition
Part IV Outcome of labour

17. INDUCTION OF LABOUR –
This is deliberate initiation of labour before
spontaneous onset after 28weeks of pregnancy.
Types of induction –
•Elective induction – It is the induction of labour
for the convenience of woman, the physician or
the hospital.
•Indicated induction – It is the induction of labour
for the high risk pregnancies.

18. Methods of induction –
There are mainly three methods of induction:
•Medical
•Surgical
•Combined
Medical induction – two drugs are used
•Oxytocin induction
•Prostaglandins
Surgical induction –
it consist of the following methods.
Artificial rupture of membranes.
Stripping of the membrane.

19. Management of 1st stage of labour

20. ROLE OF NURSE

21. SUMMARY AND
CONCLUSION