STAGES OF LABOR

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STAGES OF LABOR
DR. RAZAQ O. MASHA,FRCOG Asst. Prof. Consultant
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FIRST STAGE Labour is the onset of regular
uterine contractions with progressice effacement
and dilatation of the cervix and descent of the
presenting part. PRE-LABOUR OR LATENT
PHASE Period of increased uterine activity that
occurs for a few weeks before active labour.
? facilitates softening of the cervix ?
some cervical effacement ? some dilatation
? expansion of lower uterine segment
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• Show OR BLOODY SHOW
• Discharge from the vagina of blood tinged mucus
  (extension of mucus plug from cervical canal).
• Movements of Labour
• Engagement
• Descent
• Flexion
• Internal rotation
• Extension
• External rotation
• Expulsion

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• ACTIVE MANAGEMENT
• ARM
• Use of oxytocin
• 1.5 cm / hr multipara
• 1.2 cm / hr nullipara
• I.O.L.
• Bishops Score
• - Cx effacement
• - Position
• - Dilatation
• - Station of the presenting post
• PGE2
• ARM oxytocin

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2nd Stage

• From full dilatation to expulsion of the fetus
• ? Duration
• ? Intervention
• ? Forceps
• ? Ventouse
• ? Shoulder dystocia in macrosomic babies

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• PAIN RELIEF
• 1. Non Pharmacological Methods
• a. Psychological management fear
  potentiates pain.
• b. Childbirth preparation classes
• 2. Analgesia
• - Pethidine and metoclopramide pathilorfan
• 3. Entonox
• 50 Nitrous oxide 50 oxygen self
  administered

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3rd Stage

• Separation of the placenta
• Retained placenta duration
• Manual removal
• Primary dysfunction labour
• Secondary arrest

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INDUCTION OF LABOUR

• Induction
• Augmentation
• INDICATIONS
• Fetal
• Fetal compromise
• Rhesus disease
• Diabetes Melitus

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• Maternal / Fetal
• P I H
• Pre labour rupture of membranes
• Post maturity
• Maternal disease valvular heart disease, renal
  disease, PIH

Bishop Score 0 1 2 3
Dilatation (m) Closed 1-2 2-3 5
Length (cm) 3 2 1 0
Consistency Firm medium Soft
Position Post Middle Anterior
Station Head -3 -2 -1 0
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• METHODS OF INDUCTION
• 1. Prostaglandins 3mg dinoprostone PGE2 tabs
  or intra cervical gel.
• 2. Amniotomy
• 3. Oxytocin has ADH action
• 4. Membrane Sweep
• 5. Mechanical dilators
• Latent Phase
• Active Phase