The document outlines the normal labor and delivery process, detailing the stages of labor, including the first stage of cervical dilation, the second stage involving the expulsion of the fetus, and the third stage with the expulsion of the placenta. Key characteristics, causes, and mechanisms of labor are discussed, along with factors affecting the labor process. Management strategies for each stage, including active and expectant management of the third stage, are also highlighted.

1. NORMAL LABOR AND
DELIVERY
PRESENTER:ABDULAHMAN AHMED
SUPERVISOR:DR. NEEMA

2. PRESENTATION OUTLINE
• Introduction
• Causes
• Pathophysiology
• Mechanism of labor
• Stages of labor
• discussions

3. INTRODUCTION
• Labour (also known as parturition) is the physiological
process by which a fetus is expelled from the uterus to the
outside world. There are three separate stages,
characterised by specific physiological changes in the uterus
which eventually result in expulsion of the fetus. At this
point, the fetus becomes known as a neonate.

4. NORMAL LABOUR CRITERIA
Spontaneous in onset and at term
With vertex presentation
Without undue prolongation
Natural termination with minimal aids
Without having any complications affecting the health of the
mother and/or the baby.

5. Characteristics of normal labour
Painful uterine contractions at regular intervals,
frequency of contractions increase gradually,
intensity and duration of contractions increase progressively,
associated with “show”,
progressive effacement and dilatation of the cervix,
descent of the presenting part,
formation of the “bag of forewaters” and
not relieved by enema or sedatives.

6. CAUSES OF LABOUR
Uterine distension
fetoplacental contribution
Estrogen
Progesterone
Prostaglandins
Oxytocin and myometrial oxytocin receptors
Neurological factor

7. PATHOPHYSIOLOGY

8. CONT…

9. MECHANISM OF
NORMAL LABOUR
The series of
movements
that occur on
the head in
the process of
adaptation
during its
journey
through the
pelvis

10. CONT..
• the head enters the brim more commonly through the available
transverse diameter (70%) and to a lesser extent through one of the
oblique diameters.
• the position is either occipitolateral or oblique occipitoanterior.
• Left occipitoanterior is little more common than right occipitoanterior
as the left oblique diameter is encroached by the rectum.
• The engaging anteroposterior diameter of the head is either
suboccipitobregmatic 9.5 cm or in slight deflexion—the
suboccipitofrontal 10 cm. The engaging transverse diameter is
biparietal 9.5 cm

11. CARDINAL MOVEMENTS
engagement
flexion
internal rotation
extension
external rotation and
expulsion of the trunk.

12. ENGAGEMENT
• The widest diameter of the presenting part (with a well-
flexed head, where the largest transverse diameter of the
fetal occiput is the biparietal diameter) enters the maternal
pelvis to a level below the plane of the pelvic inlet.
• On the pelvic examination, the presenting part is at 0 station,
or at the level of the maternal ischial spines

13. DESCENT
• The downward passage of the presenting part through
the pelvis. This occurs intermittently with
contractions. The rate is greatest during the second
stage of labor

14. FLEXION
• As the fetal vertex descents, it encounters resistance from
the bony pelvis or the soft tissues of the pelvic floor,
resulting in passive flexion of the fetal occiput. The chin is
brought into contact with the fetal thorax, and the
presenting diameter changes from occipitofrontal (11.0 cm)
to suboccipitobregmatic (9.5 cm) for optimal passage
through the pelvis

15. INTERNAL ROTATION
• As the head descends, the presenting part, usually in the
transverse position, is rotated about 45° to anteroposterior
(AP) position under the symphysis. Internal rotation brings
the AP diameter of the head in line with the AP diameter of
the pelvic outlet.

16. EXTENSION
• With further descent and full flexion of the head, the base of
the occiput comes in contact with the inferior margin of the
pubic symphysis. Upward resistance from the pelvic floor
and the downward forces from the uterine contractions
cause the occiput to extend and rotate around the
symphysis. This is followed by the delivery of the fetus' head.

17. Restitution and external rotation
•When the fetus' head is free of resistance, it
untwists about 45° left or right, returning to its
original anatomic position in relation to the
body.

18. EXPULSION
•After the fetus' head is delivered, further
descent brings the anterior shoulder to the level
of the pubic symphysis. The anterior shoulder is
then rotated under the symphysis, followed by
the posterior shoulder and the rest of the fetus.

19. • .

21. STAGES OF LABOR

22. FACTORS AFFECTING LABOUR PROCESS
• Passageway( birth canal)
• Passenger( fetus and placenta)
• Power( contractions) and
• Psychological response(maternal psychology/ anxiety)

23. STAGES OF LABOR
• First stage (cervical stage)
It starts from the onset of true labor pain and ends
with full dilatation of the cervix
Its average duration is 12 hours in primigravidae and
6 hours in multiparae.

24. • Phases of first stage of labour
Latent phase( 0-3cm dilatation)
Active phase (4-10cm dilatation)

25. • The latent phase begins with mild, irregular uterine
contractions that soften and shorten the cervix. The
contractions become progressively more rhythmic and
stronger

26. • This is followed by the active phase of labor, which
usually begins at about 3-4 cm of cervical dilation and
is characterized by rapid cervical dilation and descent
of the presenting fetal part.

27. Friedman curve

28. Cont..
• Second stage
It starts from the full dilatation of the cervix (not from the rupture of
the membranes) and ends with expulsion of the fetus from the birth
canal.
two phases
propulsive phase—starts from full dilatation up to the descent of the
presenting part to the pelvic floor.
expulsive phase is distinguished by maternal bearing down efforts
and ends with delivery of the baby.
Its average duration is 2 hours in primigravidae and 30 minutes in
multiparae

29. Prolonged second stage of labor
• Risk factors associated with a prolonged second stage
include nulliparity, increasing maternal weight and/or
weight gain, use of regional anesthesia, fetal occiput
in a posterior or transverse position, and increased
birth weight

30. Cont..
• Third stage
It begins after expulsion of the fetus and ends with expulsion of
the placenta and membranes (afterbirths)
Its average duration is about 15 minutes in both primigravidae
and multiparae
the duration is, however, reduced to 5 minutes in active
management.

31. Management of third stage of labor
Aims at;
• Shortening of the third stage
• Minimize blood loss
Expectant/passive management of the third stage of labor
involves spontaneous delivery of the placenta

32. Active management
• Involves prophylactic administration of oxytocin or other
uterotonics (prostaglandins or ergot alkaloids), early cord
clamping/cutting, and controlled cord traction of the
umbilical cord.
• A systematic review of the literature reveals that that active
management shortens the duration of the third stage and is
superior to expectant management with respect to blood
loss/risk of postpartum hemorrhage

33. Cont..
• Fourth stage
It is the stage of observation for at least 1 hour after
expulsion of the afterbirths
 During this period maternal vitals, uterine retraction and
any vaginal bleeding are monitored
Baby is examined
 these are done to ensure that both the mother and baby
are well.

34. REFERENCES
• Dutta textbook of obstetrics 8th editions
• Williams obstetric 24th and 25th editions

35. DISCUSSIONS

36. Assumption of the patient
 demographics
age 27, primigravida, married university student, eight antenatal visits
 Complaints
Amenorrhea for nine months
LAP for hours
Back ache
Leopard maneuver ???

37. Cont..
 Investigations??
 Post delivery care

38. THANKS