For GNM 3rd & B. Sc(N) 4th .... OBG....

1. NORMAL LABOR &
IT’S MANAGEMENT
MS. BEENA VAZA

2. DEFINITION
• Series of event that take place in the genital organs in an
effort to expel the viable products of conception out of
womb through the vagina into outer world is called labour.
• Labour or parturition is the process whereby the products
of conception are expelled from the uterine cavity after the
24th week of gestation.

3. TERMINOLOGY
• PARTURIENT: A mother in labour is called parturient.
• PRETERM : Labour may occur before 37 weeks
• FULL TERM : Labour may occur between 39 weeks and
0 days through 40 weeks and 6 days
• POSTTERM : Labour may occur greater than or equal to
42 weeks and 0 days

4. CONT…
• NORMAL LABOUR/EUTOCIA: The criteria of normal labour are
spontaneous expulsion of a single, mature fetus, presented by vertex,
through the birth canal, within a reasonable time( not less than 3 hours or
more than 18 hour) and without complications to the mother or the fetus.
• ABNORMAL LABOUR/DYSTOCIA: Dystocia is defined as abnormal
labour that result from what have been categorized classically as
abnormalities of power (uterine contractions or maternal expulsive forces),
the passenger (position, size or presentation of the fetus) or passage (pelvis
soft tissues)

5. CAUSES OF ONSET OF LABOUR
1. HORMONAL FACTORS:
• Maternal hormones: Estrogen, progesterone,
prostaglandins, oxytocin
• Fetal hormones: Cortisol

6. ESTROGEN THEORY
• During pregnancy, most of the estrogen are present in a
binding form. During the last trimester, more free estrogen
appears increasing the excitability of the myometrium and
prostaglandins synthesis. It stimulates the synthesis of
myometrial contraction protein – actomysin. It increase
the release of oxytocin from the maternal pituitary gland.

7. PROGESTERONE WITHDRAWAL
THEORY
• The major sites of synthesis of prostaglanding are placenta. Fetal
membrane, decidual cells and myometrium. It is thought that the
decidua at term releases prostaglandins from the uterus in
response to the release of estrogen. They act on the uterine
muscles and causes it to contract. Prostaglandins E2 and F2 alpha
are powerful stimulators of uterine muscle activity. PGF2 alpha
was found to be increased in maternal and fetal blood as well as
the amniotic fluid late in pregnancy and during labour.

8. OXYTOCIN THEORY
• Oxytocin is a powerful stimulator of uterine contraction. This
hormone is released by the posterior pituitary gland of the
mother. It has a stimulating action on the pregnant uterus. At
the end of pregnancy there is an increase in the oxytocin
receptors in the decidua vera. The oxytocin released acts directly
on the myometrium and causes the uterus to contract. It acts on
the endometrial tissue and causes the release of prostaglandin.

9. FETAL CORTISOL THEORY/
FETOPLACENTAL CONTRIBUTION
• Increased cortisol production from the fetal
adrenal gland before labour may influence its onset
by increasing estrogen production from the
placenta.

10. TRUE LABOUR PAIN
• UTERINE CONTRACTIONS
• Always present
• Regular
• Increased progressively in frequency, duration and
intensity.
• Duration exceeds 60 seconds.

11. CONT…
• Abdominal tightening (hardening of uterus),
discomfort or pain.
• Discomfort / pain begins in the back then radiates
to the abdomen.
• Intensity of contraction is increased by walking

12. CONT…
• Pain can not be relieved by enema, antispasmodics
or sedatives.
• CERVIX
• Progressive dilatation and effacement of the cervix
• Cervix is shortened

13. CONT…
• MEMBRANES
• Membranes are bulging /tense during contractions
• Formation of the bag of forewater
• SHOW
• Bloody show is usually present
• FETUS
• Progressive fetal descent

14. FALSE LABOUR PAIN
• UTERINE CONTRACTION
• Not always present
• Irregular
• Do not
• Duration for three to four minutes

15. CONT…
• No hardening of uterus, not always painful
• Discomfort / pain is primarily in the abdomen.
• Intensity of contraction may be relieved by walking
• Pain can be relieved by enema, antispasmodics and
sedatives.

16. CONT…
• CERVIX
• Not effect on the cervix
• Not shortened
• MEMBRANE
• No bulging/ tense of the membranes
• No formation of bag of forewater

17. CONT…
• SHOW
• Not present
• FETUS
• Not fetal descent