Normal Labor Essential Factors Elements of Uterine Contractions & Physiology of 1 Stage of Labor
Normal Labor Essential Factors Elements of Uterine Contractions & Physiology of 1 Stage of Labor
Normal Labor Essential Factors Elements of Uterine Contractions & Physiology of 1 Stage of Labor
FACTORS;ELEMENTS OF UTERINE
CONTRACTIONS & PHYSIOLOGY OF
1ST STAGE OF LABOR
SUBMITTED TO, SUBMITTED BY,
Dr. Sharda Rastogi Mrs. Aswathy M U
Assistant professor MN 1 st year
INTRODUCTION
• Normal labor
• Signs of normal labor
• True and false labor
• Causes of onset of labor
• Stages of labor
• Factors affecting normal labor
• Elements of uterine contractions
• Physiology of first stage of labor
LABOUR
Series of events that takes place in the
genital organs in an effort to expel the viable
products of conception (fetus, placenta and
the membranes) out of the womb through
the vagina into the outer world is called
LABOUR ( D C Dutta’s)
LABOUR
• Normal labor is called EUTOCIA
• Abnormal labor is called DYSTOCIA
CRITERIA OF NORMAL LABOUR
• Spontaneous expulsion, of a single, mature
foetus, presented by vertex, through the
birth canal, within a reasonable time (not
less than 3 hours or more than 18
hours),natural termination with minimal
aids, without complications to the mother, or
the foetus
NORMAL LABOUR
• The period begins with the onset of regular
uterine contractions(UCs) and lasts until the
expulsion of the placenta; we called the
Intrapartum.
• Delivery is the birth of baby itself.
• Delivery can occur in two ways, vaginally or
by a cesarean delivery.
Normal Labor Signs/Premonitary signs of
Labor
• 1.Pre-labor(1-4 weeks before labor ):
• Lightening
• Braxton Hick’s contractions
• Sudden burst of maternal energy/activity
• Increased back pain and cramps
• Abdominal pain
• Joints feel looser
• Diarrhea
• Cervix effacement and dilation
Signs of lightening
• Increased frequency of voiding
• Increased amount of vaginal discharge
• Increased lordosis as the fetus enters the
pelvis and falls further forward
• Increased varicosities
• Shooting pains down the legs because of
pressure on the sciatic nerve
Cervix effacement and dilation
Normal Labor Signs/Premonitary signs of
Labor
• 2.Early labor (Hours before labor):
• Bloody show
• Rupture of membranes
• Uterine contractions
Phases of uterine contractions
• Increment/Crescendo –intensity of the
contraction increases
• Apex/Acme –the height or peak of the
contraction
• Decrement/Decrescendo–intensity of the
contraction decreases
Characteristics of contractions
• Frequency of contraction
• Duration of contraction
• Intensity of contraction
Mild contraction
Moderate contraction
Strong contraction
True vs False Labor
• Parameters for comparison:
1.Regularity
2.Location
3.Changes in contractions
4.Absence/presence of contractions during
activity.
5.Cervical Changes
CAUSE OF ONSET OF LABOUR
•Hormonal factors
•Mechanical factors
HORMONAL FACTORS
1. Oestrogen theory:
• During pregnancy, most of the oestrogens are
present in a binding form. During the last trimester,
more free oestrogen appears increasing the
excitability of the myometrium and prostaglandins
synthesis.
2. Progesterone withdrawal theory:
• Before labour, there is a drop in progesterone
synthesis leading to predominance of the excitatory
action of oestrogens
HORMONAL FACTORS
3. Prostaglandins theory:
• PGF2α was found to be increased in maternal
and foetal blood as well as the amniotic fluid
late in pregnancy and during labour.
4. Oxytocin theory:
• The secretion of oxytocinase enzyme from the
placenta is decreased near term due to
placental ischemia leading to predominance of
oxytocin’s action.
MECHANICAL FACTORS
1. Uterine distension theory:
• Like any hollow organ in the body, when the
uterus in distended to a certain limit, it starts
to contract to evacuate its contents. This
explains the preterm labour in case of
multiple pregnancy and polyhydramnios.
Stretch of the lower uterine segment: by the
presenting part near term
STAGES OF LABOR
a).1st stage (cervix dilation): begins with onset of
labor and ends with complete cervical dilation.
b).2nd stage (baby delivery): begins with complete
dilation of cervix and ends with delivery of baby.
c).3rd stage (placenta delivery): begins after delivery
of baby and ends with delivery of placenta.
d).4th stage (post partum): begins after delivery of
the placenta and is completed 4hours later.
Approximate time taken for each stage of
labour
Primigravidae Multigravidae
FIRST STAGE
• THE LATENT PHASE : Last 6-8 hours in the first time
mothers; cervix dilates from 0cm to 3-4 cm
dilated;cervical canal shortens from 3cm long to less
than 0.5 cm long.
• THE ACTIVE PHASE :This begins when the cervix is 3-
4 cm dilated; in the presence of rhythmic
contractions, is complete when the cervix is fully
dilated.
• THE TRANSITIONAL PHASE : It is the stage of labor
when the cervix from around 8 cm dilated until it is
fully dilated
FIRST STAGE
SECOND STAGE
• It starts when the cervix is completely
opened and ends with the delivery of the
baby.
• Often referred to as the "pushing" stage.
• When the baby's head is visible at the
opening of the vagina, it is called "crowning."
• It may take between 30 minutes to 1 hour for
a woman's first pregnancy
SECOND STAGE
THIRD STAGE
• It is the delivery of the placenta
• Once the baby has been delivered, it may be
left for two to three minutes before cut the
umbilical cord.
• The mother may experience some bleeding.
• This stage usually lasts just a few minutes
upto a half-hour
THIRD STAGE
FOURTH STAGE
• The hour to four hours after delivery,and
sometimes for about six weeks, or with the
stabilization of the mother.
• The baby should be assessed and the mother
should have regular assessments for uterine
contraction,vaginal bleeding, heart rate and
blood pressure, and temperature, for the first
24 hours after birth.
FACTORS AFFECTING LABOR (5 P’S)
1.Passenger:the fetus
2.Passage way:the pelvis and birth canal
3.Powers:the uterine contractions
4.Position:maternal postures and physical
positions
5.Psyche:the response of the mother
1.PASSENGER (THE FETUS)
• Presentation of the fetus (breech,
transverse).
• Position of the fetus (ROP, LOP).
• Size of the fetus
• Number of fetus
1.PASSENGER (THE FETUS)
• FETAL LIE : It is the relationship between the
long axis of the fetus and the long axis of the
uterus. It may be longitudinal, oblique or
transverse lie. In the majority of cases the lie
is longitudinal owing to the ovoid shape of
the uterus.
1.PASSENGER (THE FETUS)
• FETAL PRESENTATION : It refers to the part of
the fetus that lies at the pelvic brim or in the
lower pole of the uterus. Presentation can be
vertex, breech, shoulder, face or brow.
Vertex, face and brow are called cephalic
presentation. When the head is flexed the
vertex presents.
1.PASSENGER (THE FETUS)
1.PASSENGER (THE FETUS)
• FETAL ATTITUDE : Attitude is the relationship
of the fetal head and limbs to its trunk. It
may be flexion (normal) or extension
(abnormal). The attitude should be one of
flexion. The fetus is curled up with chin on
chest, arms and legs flexed, compact mass,
which utilises the space in the uterine cavity
most effectively.
1.PASSENGER (THE FETUS)
1.PASSENGER (THE FETUS)
• Denominator : It is an arbitrary bony fixed
point on the presenting part which comes in
relation with the various quadrant of the
maternal pelvis
Eg :-occiput in vertex, mentum(chin) in
face,sacrum in breech and acromian in
shoulder
1.PASSENGER (THE FETUS)
• FETAL POSITION : The position is the
relationship between the denominator of the
presentation and six points on the pelvic
brim. Anterior positions are more favourable
than posterior positions
1.PASSENGER (THE FETUS)
1.PASSENGER (THE FETUS)
• FETAL STATION: Position of the baby's head
relative to the lower bone of pelvis called the
ischial spines.
1.PASSENGER (THE FETUS)
2.PASSAGE WAY (THE PELVIS)
• Parity of the woman, if she has ever
delivered before.
• Resistance of the soft tissues as the fetus
passes through the birth canal.
• Fetopelvic diameters.
2.PASSAGE WAY (THE PELVIS)
2.PASSAGE WAY (THE PELVIS)
•The passage includes the bony pelvis,the soft
tissues of the cervix, and the vagina.
•The maternal pelvis is the greatest determinant
in the vaginal delivery of the fetus.
•During the first stage of labor, the cervix opens
(dilates) and thins out (effaces) to allow the
baby to move into the birth canal.
•The cervix must be 100 percent effaced and 10
centimeters dilated before a vaginal delivery.
2.PASSAGE WAY (THE PELVIS)
3.POWERS
• Powers refer to the involuntary Uterine
Contractions (UCs) and voluntary pushing of fetus.
• Contractions are a tightening and relaxing of the
muscles in the abdomen and the back.
• Uterine Contractions have two major goals:
1.To dilate the cervix
2.To push the fetus through the birth canal
• After each contraction there is a uterine
relaxation that allows blood flow to the uterus.
4.POSITION
5.PSYCHE
• Patient may be
anxious. We should
give her the support
and health care, and
allow the family to give
her the support
ELEMENTS OF UTERINE CONTRACTIONS
a. actin
b. myosin
c. adenosine triphosphate (ATP)
d. The enzyme myosin light chain kinase
(MLCK)
e. Ca++
ELEMENTS OF UTERINE CONTRACTIONS
ANS:B
2.State True/False
True labor is associated with regular
uterine contractions
• Ans: TRUE
3.Second stage of labor refers to
A) cervix dilates from 0cm to 3-4 cm dilated
B) cervix from around 8 cm dilated until it is
fully dilated
C) cervix is completely opened and ends with
the delivery of the baby.
ANS: C
4.The relationship between the long axis
of the fetus and the long axis of the uterus
is called
A) FETAL LIE
B) FETAL ATTITUDE
C) FETAL PRESENTATION
ANS: A
5.The term used to describe the
neuromuscular harmony that prevails
between the two poles or segment of the
uterus throughout labor
A) RESTING TONE
B) POLARITY
C) RETRACTION
ANS : B
6. A ridge forms between the upper and
lower uterine segment
ANS: RETRACTION
RING OR BANDL’S
RING
7. Occasionally the membranes do
not rupture even in the second
stage and appear at the vulva as a
bulging sac covering the fetal head
as it is born; this is known as
ANS : CAUL
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