NORMAL LABOUR AND DELIVERY Part 02

DEFINITION OF LABOUR   The Spontaneous expulsion of products of conception by maternal forces after 24 weeks of GA preterm (> 20...

DEFINITION OF LABOUR 

The Spontaneous expulsion of products of conception by maternal forces after 24 weeks of GA

preterm (> 20 but < 37 weeks GA)

term (37-42 weeks)

post-term (> 42 weeks) 

Diagnosis of Labour

1. regular, painful uterine contractions increasing in frequency, accompanied by progressive DILATATION and EFFACEMENT of cervix, and normally associated with DESCENT of presenting part
2. Braxton-Hick contractions

irregular and painless, occur throughout pregnancy and not associated with any dilatation, effacement or descent

Symptoms and Sings

1. Pain : Colicky , intermittent pain radiates from loin to groin
2. Dribbling
3. Show : Per vaginal Blood stain mucus discharge
4. Uterine contraction
5. Per Vaginal Examination : Softening of cervix,Opening of internal os ,Effacements 

FOUR STAGES OF LABOUR

First Stage of Labour

Latent phase

1. uterine contractions typically infrequent and irregular
2. slow cervical dilatation (usually to 3-4 cm) and effacement

Active phase

1. rapid cervical dilatation to full dilatation (nulliparous ~1.2 cm/h and ~1.5 cm/h in multiparas)
2. phase of maximum slope on Friedman curve
3. painful, regular contractions 3/10 min, lasting 45-60 seconds,with 2 min relaxation 
4. contractions strongest at fundus, weakest at lower segment

Second Stage of Labour

1. from full dilatation to delivery of the baby
2. mother feels a desire to bear down and push with each contraction
3. progress measured by descent

Third Stage of Labour

1. separation and expulsion of the placenta
2. can last up to 30 minutes before intervention indicated 
3. signs of placenta separation: gush of blood, lengthening of cord, uterus becomes globular

Fourth Stage of Labour

1. first postpartum hour 
2. monitor vital signs and bleeding +/- oxytocin 
3. repair lacerations  ensure uterus is contracted (palpate uterus and monitor uterine
   bleeding)
4. 3rd and 4th stages of labour most dangerous to the mother (i.e. hemorrhage)

Course of Normal Labour

Stage	Nulliparous	Multi parous
first second third	6-18 hours 30 minutes-3 hours 5-30 minutes	2- 10 hours 5-30 minutes 5-30 minutes