MediLog Bio Health

Events in First Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Sun, 12 Oct 2025 08:55:00 +0000

Events in First Stage of Labor

Event of 1st stage of labor start with true labour pain and full dilatation of cervix.

1. Dilatation and effacement of cervix

2. Full formation of lower uterine segment

First Stage of Labor Events

1. Latent phase

(0-3 cm)

Begin with regular contraction (true labour pain)

Every 5 minutes (25-35 second )

2. Active phase

(4-7cm)

More active contraction

Contraction frequent

Every 3-5 minutes (60 second)

Moderate to strong intensity

Cervical dilatation

In primi; 1 cm/hr

In multi; 1.5cm/hr

Phase of Active labour

Acceleration phase
Maximum slope
Deaccleration phase

3. Transitional phase

(7-10cm)

Intense phase of labour

Strong contraction

More frequent

More intensity

Every 2 to 3 minutes ( 60-90 seconds)

Rectal pressure

Bearing down efforts

Increase bloody show

Spontaneous repture of membrane

1. Fetal Axis Pressure

In longitudinal lie of fetus, due to mechanical stretching, fundal contraction, straightening of fetal vertebral column pressure created on cervix hence dilate.

But in transverse lie absent.

2. Dilatation of Cervix

Softening of cervix

Fibro-musculo-glandular hypertrophy

Increase vascularity

Accumulation of fluid in between collagen fibres

Breakdown of collagen fibrils by enzyme collagenase and elastase

Change in various glycosaminoglycans (for examples; increase in hyaluronic acid, decrease in dermatan sulphate)

These action due to action of hormones; oestrogen, progesterone and relaxin.

Relaxin hormone loosens and relax the muscles, joints and ligaments during pregnancy to help body stretch.

3. Uterine Contraction and Retraction

Uterine contraction; tightening of uterine muscles

Retraction; shortening muscles fibres

4. Bag of Membrane

Hind water

Fore water

5. Effacement of Cervix

Thinning of cervix and taking up of cervix.

6. Expulsion of Muscus Plug Caused by Effacement

7. Vis-a-Tergo

Downward push of presenting part of fetus. Upward pull of cervix over lower segment.

8. Formation of Upper and Lower Segment

Retraction ring; line between upper and lower uterine segment present during normal labour.

9. Cervical Dilatation or Cervical Ripening

Refers thinning of cervix.

1. Cervix is not effaced or dilated

2. Cervix is 50% effaced or dilated

3. Cervix is 100% effeced and dilated to 3cm

4. Cervix is fully dilated to 10cm

Fetal Lies Inside Uterus

noreply@blogger.com (Medilog Bio Health) — Thu, 07 Dec 2023 11:30:00 +0000

Fetus in Utero

Fetal lies inside uterus in closed-sac filled with liquor amnii.

Terminology

1. Lie

2. Presentation

3. Presenting part

4. Attitude

5. Denominator

6. Position

1. Lie

Fetus lies inside uterus in-

1. Longitudinal lie

2. Transverse lie

3. Oblique lie

Refers to the relationship between long axis of fetus with respect to long axis of mother.

2. Presentation

Part of fetus which occupies at lower pole of uterus (pelvic brim) called presentation may be-

1. Cephalic

2. Breech

3. Shoulder

When more than one part of fetus present called compound presentation.

3. Presentating Part

Part of presentation which overlies the internal OS and felt by examining finger through cervical opening.

1. Cephalic (vertex)

2. Face and brow

4. Attitude

Relation of different part of fetus to one other.

Relationship of fetal head of fetal back or extremities.

Posture of fetus;

1. Flexion (vertex)

2. Deflexion (vertex)

3. Extension

4. Brow

5. Face

5. Denominator

Bony fixed point (bony landmark) on presentating part which comes in relation with various

quadrants of maternal pelvis.

Denominator of Different Presentation

1. In vertex; Occiput

2. Face; Mentum (chin)

3. Breech; sacrum

4. Brow; Frontal eminence

5. Shoulder; acromion/scapula

6. Position

Relation of the denominator to the different quadrants of pelvis.

8 positions with each presenting part-

Anterior, posterior, right and left is referred in relation to maternal pelvis.

1. Occipito posterior (OP)

2. Right occipito posterior (ROP)

3. Left occipito posterior (LOP)

4. Right occipito transverse (ROT)

5. Left occipito transverse (LOT)

6. Right occipito anterior (ROA)

7. Left occipito posterior (LOA)

8. Occipito anterior (OA)

Cardinal Movements of Labour

noreply@blogger.com (Medilog Bio Health) — Wed, 06 Dec 2023 11:30:00 +0000

Mechanism of Labour

A series of changes in position and attitude the fetus undergo during its passage through the birth canal.

Vertex presentation fetus in gynecoid pelvis

Terminology

1. Lie

Longitudinal lie

Transverse lie

Oblique lie

2. Attitude

Posture of fetus

1. Head flexed over chest

2. Arms/Hands flexed over chest

3. Thigh/ legs flexed over abdomen

3. Presentation

Portion of the body of fetus.

Vertex, breech, face, eyebrow, shoulder

4. Position

Fetal presenting part right to left side of maternal birth canal.

5. Denominator

Bony landmark of presenting part, used to describe postion of presentation.

1. In vertex; occiput

2. In face; mentum(chin)

3. In breech; sacrum

4. In shoulder; scapula

Cardinal Movements of Labour

Mechanism of labour (9 movements)-

1. Engagement

2. Descent

3. Flexion

4. Internal rotation of head

5. Crowning

6. Extension

7. Restitution

8. External rotation of head/ internal rotation of shoulder

9. Lateral flexion of body and shoulder through birth canal

1. Engagement

Biparietal diameter of fetal head passed through pelvic inlet.

In primigrivida; usually occurs 12 hours

In multigravidae; occurs within 6 hours

2. Descent

Contraction, maternal pushing effort with contraction of her abdominal muscles.

Baby descents through pelvic inlet towards the pelvic floor.

3. Flexion

Increase flexion of head.

Fetal head come contact with pelvic floor. Allow presenting part of fetus to be sub- occipital bregmatic.

In this position, fetal skull has smallest diameter which assists passage through pelvis.

4. Internal Rotation of Head

Internal rotation of occiput anteriorly.

5. Crowning

After internal rotation of head descent occur, maximum diameter of head (biparietal diameter) stretches the vulval outlet.

6. Extension

Fetal head (sinciput, face and chin) sweep over perineum.

Delivery of fetal head by extension.

7. Restitution

Head externally rotates to face of right or left medial thigh of mother.

8. External Rotation of Head/ Internal Rotation of Shoulder

Head rotates and anterior shoulder reaches pelvic floor and rotate anteriorly. Shoulder lie in anterio- posterio diameter of pelvic outlet.

9. Lateral Flexion of Body and Shoulder Through Birth Canal

After by hook method delivered the anterior shoulder and posterior and delivery of shoulder and trunk by lateral flexion.

Mechanism of Labour

noreply@blogger.com (Medilog Bio Health) — Tue, 05 Dec 2023 11:30:00 +0000

Mechanism of Labour

A series of changes in position and attitude the fetus undergo during its passage through the birth canal.

Vertex presentation fetus in gynecoid pelvis

Terminology

1. Lie

Longitudinal lie

Transverse lie

Oblique lie

2. Attitude

Posture of fetus

Head flexed over chest

Arms/Hands flexed over chest

Thigh/ legs flexed over abdomen

3. Presentation

Portion of the body of fetus.

Vertex, breech, face, eyebrow, shoulder

4. Position

Fetal presenting part right to left side of maternal birth canal.

5. Denominator

Bony landmark of presenting part, used to describe postion of presentation.

In vertex; occiput

In face; mentum(chin)

In breech; sacrum

In shoulder; scapula

Cardinal movements of labour

Mechanism of Labour (9 movements)-

1. Engagement

2. Descent

3. Flexion

4. Internal rotation of head

5. Crowning

6. Extension

7. Restitution

8. External rotation of head/ internal rotation of shoulder

9. Lateral flexion of body and shoulder through birth canal

1. Engagement

Biparietal diameter of fetal head passed through pelvic inlet.

In primigrivida; usually occurs 12 hours

In multigravidae; occurs within 6 hours

2. Descent

Contraction, maternal pushing effort with contraction of her abdominal muscles.

Baby descents through pelvic inlet towards the pelvic floor.

3. Flexion

Increase flexion of head.

Fetal head come contact with pelvic floor. Allow presenting part of fetus to be sub- occipital bregmatic.

In this position, fetal skull has smallest diameter which assists passage through pelvis.

4. Internal Rotation of Head

Internal rotation of occiput anteriorly.

5. Crowning

After internal rotation of head descent occur, maximum diameter of head (biparietal diameter) stretches the vulval outlet.

6. Extension

Fetal head (sinciput, face and chin) sweep over perineum.

Delivery of fetal head by extension.

7. Restitution

Head externally rotates to face of right or left medial thigh of mother.

8. External Rotation of Head/ Internal Rotation of Shoulder

Head rotates and anterior shoulder reaches pelvic floor and rotate anteriorly. Shoulder lie in anterio- posterio diameter of pelvic outlet.

9. Lateral Flexion of Body and Shoulder Through Birth Canal

After by hook method delivered the anterior shoulder and posterior and delivery of shoulder and trunk by lateral flexion.

Assisted Expulsion of Placenta

noreply@blogger.com (Medilog Bio Health) — Mon, 04 Dec 2023 11:30:00 +0000

Assisted Expulsion of Placenta

1. Controlled Cord Traction

(Modified brandt-andrews method)

Palmer surface place on above symphsis pubis

(Abdomen gently pushing uterus over uterus, upward and backward).

At same time traction is applied on umbilical cord (secure with haemostat or kocher's forceps) in direction downward and backward and then apply downwards till placenta and membrane are expelled completely.

Procedure is to be attempted only when uterus is hard and contracted.

Examination of placenta, membrane and cord done.

2. Fundal Pressure

Fundus is pushed downwards and backwards after placing four finger behind the fundus and thumb infront of uterus or gently rubbing.

Pressure must give only when uteus become hard.

Uterine massage to make it hard.

Facilitates expulsion of retained clots.

Oxtocin (5-10units) or methergin (0.2mg) given IM.

Method of Placental Separation

noreply@blogger.com (Medilog Bio Health) — Sun, 03 Dec 2023 11:30:00 +0000

Method of Placental Separation

Bierer forceps used to grapse and slowly detach placenta from uterine wall. Instruments also used for placemental removal.

1. Schultze Method

Central separation, placenta separate from centre.

2. Matthews Duncan

Placenta seprate from peripheral (marginal separation more common).

3. Crede manoeuvre

Method to separate the placenta after delivery, by placing the hand on uterine fundus in order to squeeze between the fingers the fundus to make the placenta separate and expel the placenta through vagina.

If failure of placental delivery within 30 minutes after delivery of fetus.

Immediate Care of Newborn

noreply@blogger.com (Medilog Bio Health) — Sat, 02 Dec 2023 11:30:00 +0000

Immediate Care of New Born

1. Soon after Delivery of Baby

Placed on tray covered with dry linen.

Head slightly downward (15degree)

Facilitated drainage of mucus accumulatd in tracheo-bronchial tree by gravity.

Baby placed between legs of mother and at lower level the uterus to facilitates gravitation of blood from placenta to infant.

2. Suctioning

Cleared mucus and liquor

3. APGAR Rating

Within one minutes and 5 minutes recorded.

4. Clamping and Ligature of the Cord

Cord clamp with two kocher's forceps to prevent fetal blood loss.

Delay clamping code for 2-3 minutes (80-100ml) blood from compressed placenta to baby when placed between the level of uterus.

Compress placenta to baby when placed below the level of uterus.

Beneficial to baby but not to prebirth baby due to hypervolaemia.

Early clamping done in case of Rh negative compatibility.

Detect any abnormality.

Essential Care of Newborn

noreply@blogger.com (Medilog Bio Health) — Fri, 01 Dec 2023 11:30:00 +0000

Immediate Care of New Born

1. Soon after Delivery of Baby

Placed on tray covered with dry linen.

Head slightly downward (15degree)

Facilitated drainage of mucus accumulatd in tracheo-bronchial tree by gravity.

Baby placed between legs of mother and at lower level the uterus to facilitates gravitation of blood from placenta to infant.

2. Suctioning

Cleared mucus and liquor

3. APGAR Rating

Within one minutes and 5 minutes recorded.

4. Clamping and Ligature of the Cord

Cord clamp with two kocher's forceps to prevent fetal blood loss.

Delay clamping code for 2-3 minutes (80-100ml) blood from compressed placenta to baby when placed between the level of uterus.

Compress placenta to baby when placed below the level of uterus.

Beneficial to baby but not to prebirth baby due to hypervolaemia.

Early clamping done in case of Rh negative compatibility.

Detect any abnormality.

Fourth Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Thu, 30 Nov 2023 11:30:00 +0000

Fourth Stage of Labor

1. Pulse

2. Blood pressure

3. Behaviour of uterus

4. Abnormal vaginal bleeding watch at least 1 hours after delivery

5. Uterus is contracted or not

Fully satisfied general condition-

Uterus well contracted.

No abnormal vaginal bleeding.

Patient sent to ward.

Management of Third Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Wed, 29 Nov 2023 11:30:00 +0000

Management of Third Stage of Labour

1. Expectant management (traditional method)

2. Active management (preferred)

1. Traditional Method

1. Delivery of baby

2. Clamp, divide and ligate the cord.

3. Wait and watch

4. Catherized bladder (if needed)

5. Uterus hard and contact

6. Wait spontaneous Separation of Placenta.

7. Placenta separated

8. Wait of spontaneous expulsion with aid of gravity.

| Fails

Assisted Expulsion

Injection oxtocin 5-10units intravenous infusion with RL

Or methergin 0.2mg IM

To examine placenta and membrane

To inspect vulva, vagina, perineum

2. Active management (Preferred)

Injection oxtocin 10 units IM or methergin 0.2mg IM within one minute of delivery of baby.

According to WHO within one minute of delivery oxytocin given (IM) to mother.

Produce effective contraction to uterus or methergin 0.2mg IM

Clamp divide and ligate the cord, cut the cord.

Deliver the placenta by controllcord traction after uterine contraction

If placental membrane tear use sponge holding forceps and twisting movement rest membrane delivered.

| Fails

Repeat after 2-3minutes

| Fails

Wait for 10 minutes, repeat the procedure

| Fails

Mannual removal of Placenta

Injection oxtocin 5-10units IV infusion or methergin 0.2mg IM

To examine placenta and membrane

To inspect, vulva, vagina, perineum

Examination of the placental membrane and cord and vulva, vagina and perineum.

1. Examine Maternal Surface

Cotyledons; absence of cotyledons

2. Chorion and Amnion Membrane

3. Blood Vessels Abnormality

4. Placental Attachment of Umbilical Cord

5. Vulva, Vagina, Perineum Inspected; Injury Repaired

Episiotomy wound sutured.

Clean the area with cotton swab soaked with antiseptic solution.

Clinical Features of Third Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Tue, 28 Nov 2023 11:30:00 +0000

Clinical Features of 3rd Stage of Labor

1. Separation of Placenta

2. Descent of Placenta

3. Expulsion of Placenta with its Membrane

1. Pain

Patient experience no pain.

Disappear discomfort in lower abdomen.

Uterine contraction

2. Sign of Placenta Separation

Per Abdominal;

Before separation of placenta, fundal height reaches slightly below umbilicus.

Firm to feel

Per Vaginal;

Fade colour of umbilical cord

Lengthening of cord

Trickling (gush) of blood

Uterus start shrinking

Method of Placental Separation

Bierer forceps used to grapse and slowly detach placenta from uterine wall. Instruments also used for placemental removal.

1. Schultze Method

Central separation, placenta separate from centre.

2. Matthews Duncan

Placenta seprate from peripheral (marginal separation more common).

3. Crede Manoeuvre

If failure of placental delivery within 30 minutes after delivery of fetus.

After Separation of Placenta

1. Per Abdomen

Uterus shrinking within minutes of giving birth.

(Involution of uterus)

2. Per Vaginal

Slight gush of vaginal bleeding

Lengthening of cord

Expulsion of Placenta and membrane.

Maternal sign

May be chills, slight transient hypotension.

Assisted Expulsion of Placenta

1. Controlled Cord Traction

(Modified brandt-andrews method)

Palmer surface place on above symphsis pubis

(Abdomen gently pushing uterus over uterus, upward and backward).

Procedure is to be attempted only when uterus is hard and contracted.

Examination of placenta, membrane and cord done.

2. Fundal Pressure

Fundus is pushed downwards and backwards after placing four finger behind the fundus and thumb infront of uterus or gently rubbing.

Pressure must give only when uteus become hard.

Uterine massage to make it hard.

Facilitates expulsion of retained clots.

Oxtocin (5-10units) or methergin (0.2mg) given IM.

Management of Second Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Mon, 27 Nov 2023 11:30:00 +0000

Management of Second Stage of Labour

Principles-

1. To assess in natural expulsion of fetus slowly and steadily

2. To prevent perineal injury

Transition From First Stage of Labor To Second Stage of Labor

1. Increase intensity of uterine contraction

2. Appearance of bearing down efforts

3. Urge to defecate with descent part presenting part

4. Complete dilatation of cervix, evidence by PV

General Measures

1. Patient should be in bed

2. FHR recorded every five minutes

3. If required O2 support

4. Vaginal experiment

Detect any accidental cord prolapse

Position and station of head

Progressive descent of head

Preparation For Delivery

1. Position

Lateral or partial sitting position

2. Bladder and Bowel

Catherized bladder, if full.

Toileting external genitalia

3. Assess the Contraction and Pain

Conduction of Delivery

1. Delivery of head

2. Delivery of shoulder

3. Delivery of trunk

1. Delivery of Head

Crowning of head

Increase flexion of head.

Su- occipito frontal diameter (10cm)

Extension of head, distending valval outlet.

Delivery of head between contraction.

Head grapse by both hands.

2. Delivery of Shoulder

Delivery of Anterior shoulder

Delivery of Posterior shoulder

Avoid stretching of neck

3. Delivery of Trunk

After delivers shoulder, by lateral flexion delivery of trunk.

Prevention of Perineal Laceration

Support perineum

Perform timely episiotomy, If required.

Immediate Care of New Born

1. Soon after Delivery of Baby

Placed on tray covered with dry linen.

Head slightly downward (15degree)

Facilitated drainage of mucus accumulatd in tracheo-bronchial tree by gravity.

Baby placed between legs of mother and at lower level the uterus to facilitates gravitation of blood from placenta to infant.

2. Suctioning

Cleared mucus and liquor

3. APGAR Rating

Within one minutes and 5 minutes recorded.

4. Clamping and Ligature of the Cord

Cord clamp with two kocher's forceps to prevent fetal blood loss.

Delay clamping code for 2-3 minutes (80-100ml) blood from compressed placenta to baby when placed between the level of uterus.

Compress placenta to baby when placed below the level of uterus.

Beneficial to baby but not to prebirth baby due to hypervolaemia.

Early clamping done in case of Rh negative compatibility.

Detect any abnormality.

Clinical Features of Second Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Sun, 26 Nov 2023 13:40:00 +0000

Clinical Features of 2nd Stage of Labour

Start with full dilatation of cervix and ends with expulsion of fetus from birth canal.

2nd stage of labor has two phase -

1. Propulsive Phase

It starts from full dilatation of cervix upto descent of presenting part of the pelvic floor.

2. Expulsive Phase

Maternal bearing down efforts and ends with delivery of baby.

1. Pain

Increase intensity of pain

In every 2-3 minutes, 60-90 seconds.

2. Show

Increase bloody show

3. Bearing Down Efforts

Expulsive phase (voluntary efforts)

May slowing FHR during pushing; normal once contraction over.

4. Membrane Status

Membrane may rupture, liquor.

5. Descent of Fetus

Abdominal and vaginal examination;

Descent of head in relation to ischial spine.

Rotation of head by position of sagittal suture and occiput in relation to quadrants of pelvis.

Observe progressive descent of head.

Sinciput felt

Change in position of FHR shifted down word medially.

6. Bulging of Perineum

Vulval opening become circular (expulsive phase)

7. Pressure on Rectum

8. Crowning of Head

Biparietal stretched vulval outlet.

9. Head delivered by Extension, Expel Shoulder and Trunk

10. Vaginal Sign

Gush of liquid (hind water; tinged with blood)

11. Station of Head

-5; head floating over brim

0; ischial spine (deeply engaged)

+5;

Maternal Sign

Features of exhaustion

Increase perspiration

During bearing down effort face congested with neck vein prominent.

Irritability

After expulsion of fetus, relief occur.

Fetal Efforts

Slowing of FHR during contraction

Observe liquor (meconium stained or clean)

Observe fetal distress

Events of Second of Labour

noreply@blogger.com (Medilog Bio Health) — Sat, 28 Oct 2023 15:34:00 +0000

Events of 2nd Stage of Labour

Starts from full dilatation of cervix and ends with delivery (expulsion of fetus from birth canal).

In primigrivida; 1-2hrs

In multigravidae; 30 minutes

Events in 2nd stage

1. Propulsive Phase

Start from full dilation of cervix upto descent of presenting part to pelvic floor.

2. Expulsive Phase

Maternal bearing down efforts and ends with delivery of baby.

Management of First Stage of Labor

noreply@blogger.com (Medilog Bio Health) — Sat, 28 Oct 2023 15:31:00 +0000

Management of 1st Stage of Labor

Principle;

1. Non-interference with watchful expectancy

2. Prepare patient for natural birth

Actual Management

1. Maternal Condition

Monitor progress of;

Labor

Maternal condition

Fetal behaviour

2. General and Obstetrical Examination, Vaginal Examination

3. Records of -

Antenatal visits

Investigation reports

If specific treatment given (reviewed)

4. Detect Intrapartum Complication

5. Bowel and Bladder Care; if required give suppository/enema

6. Rest and Ambulation

If membrane intact allow to walk.

Ambulation can reduce duration of labour.

7. Relief of Pain

Need of analgesics and improve maternal comfort.

Pain in active labour;

Pethidine 50-100; IM; opioid; analgesics

Metoclopramide 10mg ; IM; vomiting

Drug not given if delivery is anticipated within 24 hours.

8. Diet

Food not taken during active labour because of delayed emptying of stomach in labor.

Take fluid; plain water, ice chips, fruit juice/ intravenous RL.

10. Access of Progress of Labour and Partograph Recording

Start partograph in active phase first stage of labor, cervix dilatation; 4cm or above

Pulse; every 30 minutes (.)

Blood pressure; every 4 hours

Temperature; every 2 hours

Urine output; recorded for; volume, protein, acetone or glucose

Any drug (oxytocin or other); recorded in partograph

11. Abdominal Palpation

(For decent of fetal head)

1. Assess Frequency, Intensity, Duration of Pain

Number of contraction in 10 minutes and duration of each contraction in second recorded.

Contraction duration;

<20 seconds

20-40 seconds

>40 seconds

2. Pelvic Grip

12. Observe tongue for dehydration

13. Fetal Well-being

1. Fetal Heart Rate (FHR)

Normal FHR; 110-160 b/minutes

In every 30 minutes in first stage, every 5 minutes in second stage.

2. Evidence of Fetal Distress

Fetal heart by Doppler ultrasonic cardiotocography

Uterine contraction by tomography

3. Vaginal Examination

Dilatation of cervix in cm.

Position of head and degree of flexion

Station of head in relation to ischial spine

Color of liquor (clear meconium stained), if membrane is rupture.

Degree of moulding of head; moulding first at junction of occipito-parietal bone and then between parietal bone.

Caput formation

4. Evidence of Maternal Distress

1. Anxious look with sunken eyes

2. Dehydration , dry tongue

3. Rising pulse rate >100 b/m

4. Hot and dry vagina

5. Scanty (small amoun) dark colour urine with presence of acetone

6. Acetone smell breath

Clinical Features of First Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Sat, 28 Oct 2023 15:26:00 +0000

Clinical Course of 1st Stage of Labor

Before start first stage of labor-

1. Prodromal Labour/ Pre Labour

Type of False Labour Contractions

1. Don't lead to cervical dilatation or effacement

2. Shelf formation; shelfing of uterus

Forward of uterus fundus making the upper abdomen look like shelf during standing position

3. Lightening

Descending of fetus

Relief of upper abdominal pressure symptoms as dyspnoea, papitation, dyspepsia.

4. Pelvic pressure symptoms

Rectal pressure

Difficulty in walking

Increase vaginal discharge

False labour pain

Constipation, micturition frequency increase

5. False labour pain

First stage of labour (established labour) clinical features-

1. True labour pain

Every 3-5 minutes for 45 seconds.

Pain felt shortly after uterine contraction begin and before complete relaxation of uterus.

Passive phase;

dilate 1-3cm (4-6 hours)

Contraction of uterus slowly

Active phase;

dilate 4-8cm (4-8 hours)

Contraction get stronger

Hence, cervix fully dilated.

2. Dilatation of cervix and effacement of cervix (rim); ripening of cervix

Cervix is 8-10 cm dilated.

Cervix dilatation expressed by;

1 finger insert; 2cm

2 finger insert; 4cm

5 finger insert; 10cm

And cervix effacement occur; 25%, 50% and 100%

Cervix stretched go upper.

3. The show

Expulsion of bloody mucus plug

4. Formation of bag of fore-water

5. Polarity of uterus

Co-ordination between fundal contraction and cervical dilatation

Upper uterine segment contracts while lower uterine segment dilates pushes the fetus.

Following each contraction; uterine muscle fibres undergo retraction.

6. Partograph

Latent phase over cervix 3cm dilated.

Active phase starts with 3 cm cervix dilatation.

There are three component of active phase-

1. Acceleration phase

3-5cm in 4 hrs

2. Maximum slope

5-8cm in 1 hours

3. Deaccleration phase

8-10 cm in 2-4hrs

In active phase rate of cervix dilation;

In primigrivida; 1cm/hr

In multigravidae; 1.5cm/hr

7. Repture of membrane

8. Contraction and Retraction

9. Staus of membrane

1. If rupture of membrane after onset of labour but before full dilatation of cervix called early rupture of membrane.

2. When rupture before onset of labour called premature rupture.

Usually membrane remain intact until full dilatation of cervix.

Intact membrane can felt with finger during uterine contraction when becomes tense and bulge out through cervical opening.

3. With rupture membrane amount of liquor escape out through vagina.

Rupture of membrane can ownself rupture, cervix mucus plug rupture, artificial rupture of membrane.

10. Pain

4 pain within 10 minutes

Every 3-5 minutes; 45sec duration

Contractions;

10-20; mild contraction

20-40; moderate contraction

40-60; severe contractions

Maternal System Sign

Pulse rate increase 10-15 beat/minutes during contraction.

Increase respiration

Systolic blood pressure increase about 10mmHg during contraction

Temperature normal

Transient (short term) fatigue; strong contraction

Fetal Sign

Normal fetal rate; 110-140beats/minutes

Fetal heart rate slow 10-20 beats/minutes during contraction

Due to pain and contraction constrict blood capillary may cause fetal distress.

Bradycardia cardia during contraction; normal after contraction till next contraction

If not normal undergo C- section

First Stage of Labour

noreply@blogger.com (Medilog Bio Health) — Sat, 28 Oct 2023 15:16:00 +0000

First Stage of Labor

Stars from onset of true labor pain and full dilatation of cervix. (8-10cm)

Time period;

In primigrivida; 10-12 hours

In multigravidae; 6-8 hours

Events in first stage labour

1. Latent Phase

Dilatation of cervix; 0-3cm

Duration in primi;8hrs

Duration in multi; 4hrs

Cervix dilatation rate; 0.35cm/hr

2. Active Phase

Latent phase over when cervix 3cm dilated and active phase start.

Dilatation of cervix; 4-7cm

In primigrivida;

Duration in primi; 4-8 hrs

Cervix dilatation rate;1cm/ hr

In multigravidae;

Cervix dilatation rate;1.5 cm /hr

3. Transitional Phase

Dilatation of cervix; 7- 10cm

False Labour Pain

noreply@blogger.com (Medilog Bio Health) — Sat, 28 Oct 2023 15:13:00 +0000

Braxton Hicks (False Labour Pain)

1. Contraction occur at irregular interval.

2. Contraction vary in length and intensity

3. Dull/ irregular pain confined at lower abdomen

4. No dilation of cervix

5. Intensity remains unchanged

6. Effacement not occur

7. No hardening of uterus

8. Cervix may soften, but no change in effacement or dilatation

9. Usually no change

10. No bloody show

11. Bag of water not formed

12. Relieve by emema

True Labour Pain

noreply@blogger.com (Medilog Bio Health) — Sat, 28 Oct 2023 15:13:00 +0000

True Labour Pain

1. Contraction occur at regular intervals.

2. Contraction increases in duration and intensity.

3. Strong pain/ rediate backward, thighs and lower abdomen.

4. Dilation of cervix

5. Intensity gradually increases

6. Effacement occurs

7. Hardening of uterus

8. Interval between contraction are gradually shorten.

9. Bloody show

10. Bag of water formed

11. Not relieved by enema

12. Formation of upper and lower segment due to descending of presenting part.

True Labor Pain Vs False Labor Pain

noreply@blogger.com (Medilog Bio Health) — Sat, 28 Oct 2023 15:11:00 +0000

Difference Between True Labour Pain and False Labour Pain

True Labour Pain

1. Contraction occur at regular intervals.

2. Contraction increases in duration and intensity.

3. Strong pain/ rediate backward, thighs and lower abdomen.

4. Dilation of cervix

5. Intensity gradually increases

6. Effacement occurs

7. Hardening of uterus

8. Interval between contraction are gradually shorten.

9. Bloody show

10. Bag of water formed

11. Not relieved by enema

12. Formation of upper and lower segment due to descending of presenting part.

Braxton Hicks (False Labour Pain)

1. Contraction occur at irregular interval.

2. Contraction vary in length and intensity

3. Dull/ irregular pain confined at lower abdomen

4. No dilation of cervix

5. Intensity remains unchanged

6. Effacement not occur

7. No hardening of uterus

8. Cervix may soften, but no change in effacement or dilatation

9. Usually no change

10. No bloody show

11. Bag of water not formed

12. Relieve by emema

Essential Features of Normal Labour

noreply@blogger.com (Medilog Bio Health) — Sat, 14 Oct 2023 15:28:00 +0000

Essential Features of Normal Labour

1. Passenger

Fetal skull and size.

Position of fetus;

Fetal lie;

Longitudinal (vertical)

Transverse (horizontal)

Oblique

Fetal presentation

Fetal attitude

Fetal position

Fetal station

2. Passage

Cervix dilates (10cm dilatation), cervix effacement (100%) effaced.

3. Power

Uterine contraction/pain

Involuntary uterine contractions and voluntary pushing of fetus, frequency, intensity, bearing effort, true labour pain, false labour pain.

Birth canal obstruction may be caused due to;

Tumor/ cyst/ CPD

To make false labour pain to true labor pain 60 drops/ minutes oxytocin.

4. Position

Maternal postures and physical position.

Position of labour

Positions of pushing

5. Psychology

The response to mother (anxiety, nervousness, stressed).

Stages of Labour

noreply@blogger.com (Medilog Bio Health) — Sat, 14 Oct 2023 15:13:00 +0000

Stages of Labour

1. Cervix dilatation;

Normal dilatation of cervix; 8-10 cm

2. Pain;

Within 10 minutes 4 pain occurs.

Mild pain; 20sec

Moderate pain; 20-40sec

Severe pain; 40-60sec

3. Contraction;

Mild; 20 seconds

Moderate; 20-40 seconds

Severe; 40-60 seconds

Total Duration;

Primigrivida; 12-18 hours

Multi gravida; 6-8 hours

There are four stages of labour;

1. 1st stage

2. 2nd stage

3. 3rd stage

4. 4th stage

1. First stage

Stars from onset of true labor pain and full dilatation of cervix.

2. Second stage

Starts from full dilatation of cervix and ends with delivery (expulsion of fetus from birth canal)

3. Third stage

Begins after expulsion of fetus and ends with expulsion of placenta and membrane.

4. Fourth stage

1. First Stage

Stars from onset of true labor pain and full dilatation of cervix. (8-10cm)

Time period;

In primigrivida; 10-12 hours

In multigravidae; 6-8 hours

Events in first stage labour-

1. Latent phase

Dilatation of cervix; 0-3cm

Duration in primi;8hrs

Duration in multi; 4hrs

Cervix dilatation rate; 0.35cm/hr

2. Active phase

Latent phase over when cervix 3cm dilated and active phase start.

Dilatation of cervix; 4-7cm

In primigrivida;

Duration in primi; 4-8 hrs

Cervix dilatation rate;1cm/ hr

In multigravidae;

Cervix dilatation rate;1.5 cm /hr

3. Transitional phase

Dilatation of cervix; 7- 10cm

2. Second Stage

Starts from full dilatation of cervix and ends with delivery (expulsion of fetus from birth canal).

In primigrivida; 1-2hrs

In multigravidae; 30 minutes

Events in 2nd stage

1. Propulsive phase

Start from full dilation of cervix upto descent of presenting part to pelvic floor.

2. Expulsive phase

Maternal bearing down efforts and ends with delivery of baby.

3. Third Stage

Begins after expulsion of fetus and ends with expulsion of placenta and membrane.

Time period;

In primigrivida; 22-30 minutes

In multigravidae; 22-30 minutes

Average; 15 minutes

4. Fourth Stage

Observational stage;

Observe general condition of patient and baby and behaviour of uterus.

At least one hours after birth (4 hour mother and baby).

Stages of Labor

noreply@blogger.com (Medilog Bio Health) — Sat, 14 Oct 2023 15:10:00 +0000

Stages of Labour

Pre labour (Braxton Hicks); ready for labour.

There are four stages of labour;

1. 1st stage

2. 2nd stage

3. 3rd stage

4. 4th stage

1. First Stage

Stars from onset of true labor pain and full dilatation of cervix.

2. Second Stage

Starts from full dilatation of cervix and ends with delivery (expulsion of fetus from birth canal)

3. Third Stage

Begins after expulsion of fetus and ends with expulsion of placenta and membrane.

4. Fourth Stage

(Observation stage); at least one hours after birth, (4 hour's mother and baby).

Observe general condition of mother and baby and behaviour of uterus.

Physiology of Normal Labour

noreply@blogger.com (Medilog Bio Health) — Fri, 06 Oct 2023 11:39:00 +0000

Physiology of Normal Labour

1. Uterine contraction

Tonus

Intensity

Duration

Frequency

2. Retraction

Uterus in labor in which muscle fibres are permanently shortened.

Help in expulsion of fetus

Formation of lower uterine segment and dilatation and effacement of cervix.

Help in separating placenta; reduce surface area of uterus.

Types of Labor Contractions

noreply@blogger.com (Medilog Bio Health) — Fri, 06 Oct 2023 11:38:00 +0000

Types of Labor Contraction

1. Braxton Hicks contraction/ false labour pain

2. Preterm labour contractions

3. True labour pain

1. Braxton Hicks contraction/ Spurious Labour

Found more in primigrivida than parous woman.

Appear prior to onset of true labor pain.

1-2 weeks in primigrividae and few days in multiparae.

Dull in nature

May be painless

Not in regular intervals

Pain may be often infront of abdomen or rediating towards thigh.

Usually relieved by enema or sedative.

2. Pre labour/ Preterm Labour Contractions

Contraction begins 2-3 weeks before onset of true labor in primigrivida and few days before in multiparae.

Lightening

(Presenting part sinks into true pelvis; lesser pelvis.

Micturition or constipation due to pressure by engaged presenting part.

It is welcome sign.

CPD (cephalopelvic disproportion rule out, head entering pelvic inlet.

3. True Labour Contraction

Uterine contraction at regular intervals

Frequency contraction gradually increase

Intensity and duration increases progressively

Associated with show; expulsion of cervix mucus plug; mixed with blood.

Descent of presenting part

Formation of "bag of forewaters"; due to stretching of lower uterine segment, bulge into cervical canal. Hind water and fore water.

Progessing effacement and dilatation of cervix/ dilatation of internal OS.

Not relieved by enema or sedatives.