Normal Labor
Prepared By: Dr. Asad Zerak MD, MPH
Definitions
oIs the process whereby the product of conception are expelled from
uterian cavity after 24th week of gestation.
oPremature labour: labour occurring before the commencement of the
37th week of gestation.
o Prolonged labour: labour lasting in excess of 24 hours in a
primigravida &16 hours in a multigravida.
Onset of labour
oThe onset of labour is defined as the time of onset of regular, painful
uterine contractions, which produce progressive effacement and
dilatation of the cervix.
ofalse labour: where the onset of painful contractions is not associated
with progressive dilatation of the cervix.
Cont…
Cont…
The clinical signs of the onset of labour include:
1. The onset of regular, painful contractions that produce progressive
cervical dilatation.
2. The exhibition of a vaginal show - the passage of blood stained
mucus.
3. Rupture of the fetal membranes - may occur at the time of onset of
contractions or it may be delayed until the delivery of the fetus.
Stages of labour
first stage:
The Second Stage
start Cervix reached full dilatation
end expulsion of the fetus
The Third Stage “Placenta Stage “
start • delivery of the child.
• expulsion of placenta.
end
Mechanism of labour
oEngagement of the head normally occurs before the onset of labour
in the primigravid woman but may not occur until labour is well
established in a multipara.
oOnly 2/5th of the head will be palpable per abdomen
Mechanism of labour
o1. Descent of the head provides a measure of the progress of labour.
o Descent occurs throughout labour.
o2. Flexion of the head occurs as it descends and meets the pelvic
floor, bringing the chin into contact with the fetal thorax.
oFlexion produces a smaller diameter of presentation
(suboccipitobregmatic diameter)
3. Internal rotation: The head rotates as it reaches pelvic floor and the
occiput normally rotates anteriorly from the lateral position towards
the pubic symphysis
4. Extension: The acutely flexed head descends to distend the pelvic
floor and the vulva, and the base of the occiput comes into contact
with the inferior rami of the pubis. The head now extends until it is
delivered. Maximal distension of the perineum
5. Restitution: Following delivery of the head, it rotates back to be in
line with its normal relationship to the fetal shoulders.
6. External rotation: When the shoulders reach the pelvic floor, they
rotate into the anteroposterior diameter of the pelvis. This is
accompanied by rotation of the fetal head so that the face looks
laterally at the maternal thigh.
o7. Delivery of the shoulders: The anterior shoulder is delivered first
by traction posteriorly on the fetal head so that the shoulder emerges
under the pubic arch. The posterior shoulder is delivered by lifting the
head anteriorly over the perineum.
oThis is followed by rapid delivery of the remainder of the trunk and
the lower limbs
Mother Intrapartum monitoring
Temperature
Normal Temperature 36.2°-37.2°
Frequency Every 4 hours
Pyrexia; due to Infection, Dehydration.
General principles of the management of the first
stage of labour :
• Pain relief during labour and emotional support for the mother (
Narcotic agents , inhalational analgesia and regional analgesia )
• hydration throughout labour.
Management of the second stage
Delivery of the head .
Controlled descent .
Minimizing perineal damage.
Clamping the cord .
Evaluation of Apgar score.
Evaluation of the Apgar score
0 1 2
Colour White Blue Pink
Tone Flaccid Rigid Normal
Impalpable >100
Pulse <100
beats/min beats/min
Respiration Absent Irregular Regular
Response Absent Poor Normal
Thank you
