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NORMAL LABOUR
AND
DELIVERY
Dr Jograjiya PG Student
Department of Obstetrics and Gynecology, ESIC-PGIMSR, Basaidarapur, New Delhi
CONTENTS
1. Definition of normal labour

2. Factors influencing progress of labour
3. Diagnosis of labour
4. Stages of labour
5. Mechanisms of labour
6. Management of labour
LABOUR
DEFINITIONS
Labour is defined as the onset of regular painful
Contractions with progressive cervical effacement and
dilatation of the cervix accompanied by
descent of the presenting part.
NORMAL LABOUR
The following criteria should be present

 Spontaneous expulsion,
 of a single,
 mature fetus (37 completed weeks – 42 weeks),
 presented by vertex,
 through the birth canal (i.e. vaginal delivery),
 within a reasonable time (not less than 3 hours or more than
18 hours),
 without complications to the mother,
 or the fetus.
NORMAL LABOUR
IMPORTANCE
Understanding the process of
labour is importance
• problems can be identified
• correctly managed
LABOUR AND DELIVERY
FACTORS THAT INFLUENCE
PROGRESS OF LABOUR
Power
Passenger Passage
THE NORMAL FEMALE PELVIS
1. The female pelvis provides the basic

framework of the birth canal.
2. The obstetric pelvis is divided into false and

true pelvis by the pelvic brim or inlet
Inlet
3. The true pelvis is important, for it is
through this confined space that the fetus
must pass on its journey through the birth
canal.
Cavity 4. The true pelvis is composed of inlet, cavity

and outlet.
Outlet
5. Types of female pelvis – gynaecoid,

anthropoid, android and platypelloid
NORMAL FEMALE PELVIS
The ideal normal female gynaecoid pelvis:

1. The brim is slightly oval transversely.
2. The sacral promontory is not prominent.
3. The transverse diameter is slightly longer than
the anteroposterior.
4. The sidewalls are parallel and straight.
5. The ischial spines are not prominent.
6. The sacrosciatic notches are wide.
7. The sacrum has a good curve.
8. The pubic arch angle are wide, i.e. more than 90
9. Inter tuberous diameter is wide
THE NORMAL FEMALE PELVIS
The important diameters of the female pelvis:

Diameters
(cm)
Anteroposterior Oblique Transverse
BRIM 11 12 13
CAVITY 12 12 12
OUTLET 13 12 11
THE FETAL SKULL
1. Sutures
2. Diameters
THE FETAL SKULL
1. Sagittal suture: - The sagittal suture lies
SUTURES between the parietal bones. It runs in an
anteroposterior direction between the anterior
and posterior fontanelles.
2. Coronal sutures: - The suture uniting the

parietal bones to the frontal bones is called the
coronal suture. It’s extend transversely from the
anterior fontanels and lies between the parietal
and frontal bone.
3. Frontal suture: - The frontal suture is between

the two frontal bones. It is an anterior
continuation of the sagittal suture.
4. Lambdoidal suture: - Is between the parietal

and occiptal bones.
THE FETAL SKULL
MOULDING OF THE FETAL SKULL

MOULDING is the ability of the
fetal head to change its shape and
so to adapt itself to the unyielding
maternal pelvis during the
progress of labour.
This property is of the greatest

value in the progress of labour.
THE FETAL SKULL
Diameters of the fetal skull – anterior posterior diameters

A
G AB ~ Suboccipto bregmatic – 9.5

D -Vertex
AC ~ Submento bregmatic – 9.5
E -Face
DE ~ Occipito frontal ~ 11-12
FG ~ Mento vertical – 13.5

F B -Brow
C
POWER ► Contractions + Maternal
pushing
Uterine contractions:
1. Initiate by pacemakers ~ uterotubal junction Additional force

2. Contraction waves meet at the fundus
3. Contraction waves progress downward
“maternal pushing”
 Shortening of muscle fibres
 Retractions
⁭Intra abdominal pressure
 ⁭intra uterine pressure
EXPULSION OF THE FETUS

UTERINE CONTRACTION
Uterine contractions
NORMAL CONTRACTION
1. Frequency ~ one in every 2 – 3 min with at least 1

minute interval
2. Intensity ~ strong (> 50 mmHg)
3. Duration ~ 45 – 60 sec
LABOUR AND DELIVERY
WHAT INITIATE LABOUR

“ONSET OF LABOUR”
NORMAL LABOUR
Causes of Onset of Labour:
- It is unknown but the following theories were postulated:
 Hormonal factors
1) Estrogen theory
2) Progesterone withdrawal theory
3) Prostaglandins theory
4) Oxytocin theory
5) Fetal cortisol theory
 Mechanical factors
1) Uterine distension theory
2) Stretch of the lower uterine segment by the presenting near term
LABOUR AND DELIVERY
DIAGNOSIS OF LABOUR
NORMAL LABOUR AND DELIVERY
SYMPTOMS AND SIGNS OF LA

Before labour begins, women usually notice one or more premonitory, or
warnings, signs that labour is about to begin.
They are:
 Painful regular uterine contractions
– as evidence by contraction at least
one in ten minutes
 Show – as evidence by mucus mixed
with blood
 Rupture of membranes – as
evidence by leaking liquor
LABOUR AND DELIVERY
DESCRIBE THE STAGES OF

LABOUR
STAGES OF LABOUR
Labour can be divided into three stages, which are unequal in length.
FIRST STAGE SECOND THIRD STAGE

STAGE
It begins with the onset of true The second stage of labour The third stage is that of
labour contractions and ends begins with complete dilatation separation and expulsion of
when the cervix is fully dilated of the cervix and ends with the placenta and membranes and also
(10 cm). birth of the baby. involves the control of bleeding.
Cervical effacement and The duration is about 1 to 1½ It begins after the birth of the
dilatation occur in the first stage hours in nulliparas and about 30 baby and ends with the expulsion
to 45 minutes in parous women. of the placenta and membranes.
First stage of labour consists of This is the shortest stage, lasting

two phases:- latent and active. up to 30 minutes, with an average
length of 5 to 10 minutes. There
is no difference in duration for
The first stage of labour is the
nulliparous and parous.
longest for both nulliparous and
parous women.
FIRST STAGE OF
LABOUR
PHASES OF THE FIRST STAGE OF LABOU

Divided into:
Latent phase – begins with onset of contracts and ends when cervix is 3 cm dilated and effaced
Active phase – begins after the cervix is 3 cm dilated
PHASES OF THE FIRST STAGE OF LABOU

LATENT Phase ACTIVE Phase
1. Begins with onset of contractions 1. Active process
2. Slow progress 2. Begins after 3 cm of cervical
3. Little cervical dilatation dilatation
4. Progressive cervical effacement 3. Period of active cervical
5. Ends once the cervix reaches 3
dilatation (average rate 1 cm/hr)
cm dilatation 4. S-shaped curve which is used to
6. Durations
define progress of labour
~ 8 hours for nulliparae 5. It has 3 component
~ 6 hours for multiparae a) acceleration - slow
b) maximum - fast
c) deceleration - slow
WHAT HAPPEN DURING

THE FIRST STAGE OF LABOUR
WHAT HAPPEN DURING THE FIRST STAG

1. Contractions:
CONTRACTIONS
1: Regular
2: Increasing in frequency
3: Stronger

2. Cervical dilatation and effacement:
Causes of cervical dilatation:
Contraction and retraction of uterine musculature
Mechanical pressure by the bulging membrane (fore
water)
The descend of the presenting part
Phases of cervical dilatation

Latent phase – the first 3 cm of dilatation; a slow
process (8 hours in nulliparous and 3 hours
in multiparous
Active phase – this is active process of cervical

dilatation; the normal rate is 1 cm/hour

3. Engagement of the presenting part:
FETAL HEART CHANGES
Do Uterine Contractions Affect Fetal Heart Rate?
Uterine contractions can affect fetal heart rate by increasing or

decreasing that rate in association with any given contraction.
The three primary mechanisms by which uterine contractions can

cause a decrease in fetal heart rate are compression of:
· Fetal head
· Umbilical cord
· Uterine myometrial vessels
PROGRESS OF FIRST STAGE OF LABOUR
Findings suggestive of satisfactory progress in first stage of labour are:
- regular contractions of progressively increasing frequency and duration;

- rate of cervical dilatation at least 1 cm per hour during the active phase of
labour (cervical dilatation on or to the left of alert line);
Findings suggestive of unsatisfactory progress in first stage of labour

are:
- irregular and infrequent contractions after the latent phase;

- OR rate of cervical dilatation slower than 1 cm per hour during the active
phase of labour (cervical dilatation to the right of alert line);
SECOND STAGE OF
LABOUR
SECOND STAGE OF LABOUR
1. Begins with FULL DILATATION and ends with DELIVERY OF

THE BABY.
2. It have TWO Phases

a) Propulsive phase – from full dilatation until presenting part has
descended
to the pelvic floor
b) Expulsive phase which ends with the delivery of the baby
Features of expulsive phase – 1) mother’s irresistible desire to bear
down
2) distension of perineum
3) dilatation of the anus
3. Average length
a) Primigravidae – 40 minutes
b) Multigravidae – 20 minutes
PROGRESS OF SECOND STAGE OF LABOUR
Findings suggestive of satisfactory progress in second stage

of labour are:
- steady descent of fetus through birth canal;

- onset of expulsive (pushing) phase.
Findings suggestive of unsatisfactory progress in second

stage of labour are:
- lack of descent of fetus through birth canal;

- failure of expulsion during the late (expulsive) phase.
THIRD STAGE OF
LABOUR
THIRD STAGE OF LABOUR
1. Begins after DELIVERY of the baby and ends with DELIVERY

OF THE PLACENTA / MEMBRANES.
2. It have TWO Phases

a) Separation phase
b) Expulsion phase
3. Duration – usually 15 minutes or less (if actively managed).
4. Average blood loss – 150 to 250 ml.

PHYSIOLOGICAL EFFECTS OF LABOU

FIRST STAGE SECOND STAGE THIRD STAGE
1. Minimal effects 1. Pulse increases 1. Blood loss from

ON THE MOTHER 2. Systolic BP the placental site
slightly (200 ml)
increased due 2. Blood loss from
to pain and laceration and
anxiety perineum (100
3. Minor injuries ml)
to the birth
canal
1. Moulding – overlapping of the vault bones
ON THE FETUS 2. Caput succedaneum – it is a soft swelling of the most dependent
part of the
fetal head
MANAGEMENT
OF
LABOUR
AIMS IN THE MANAGEMENT OF LABOUR
 To achieve delivery of a normal healthy

child
 To anticipate, recognize and treat

potential abnormal conditions before
significant hazard develops for the mother
or the fetus.
PRINCIPLES IN THE MANAGEMENT OF LABOUR
Diagnosis of labour
Monitoring the progress of labour
Ensuring maternal well-being
Ensuring fetal well-being.

MANAGEMENT
FIRST STAGE OF
LABOUR
MANAGEMENT OF THE FIRST STAGE OF LABOUR1
 On admission:
When the women presents at hospital, the woman’s antenatal record is
reviewed to discover whether there have been any abnormalities
during her pregnancy. When there are no records of antenatal care a
complete history must be taken.
 General examination of the mother

a) General conditions – evaluate the mother general health condition.
Look for pallor, edema, abdominal scar (LSCS) and maternal height.
b) Vital signs – Blood pressure, pulse, respiration and temperature are

taken and recorded
c) Heart and lungs
d) Urine analysis – for protein, sugar and ketones

 Abdominal examination:
a) A detailed abdominal examination should be carried out and recorded.
b) Determine the presentation and position of the fetus and also the
engagement
c) Auscultate the fetal heart
d) Evaluate the uterine contraction
Vaginal examination – the purpose is to
a) To make a positive diagnosis of labour
b) To make a positive identification of presentation
c) To determine whether the fetal head is engaged in case of doubt
d) To ascertain whether the fore waters have ruptured or to rupture them
artificially
e) To exclude cord prolapse after rupture of the fore waters
f) To confirm the degree of cervical dilatation and position of the presenting
part
g) To assess progress of labour.
h) To assess the adequacy of the pelvis.
 Bowel preparation:
If there has been no bowel action for 24 hours or the rectum feels loaded on vaginal
examination an enema is given.
 Bladder care
A full bladder may initially prevent the fetal head from entering the pelvic brim and
later impede descent of the fetal head. It will also inhibit effective uterine action.
The woman should be encouraged to empty her bladder every 1½ - 2 hours during
labour.
The quantity of urine passed should be measured and recorded and a specimen
obtained for testing.
 Nutrition in early labour

No food is permitted after labour is established – to prevent regurgitation and
aspiration
It is important to maintain adequate hydration - via intravenous routes

 Position of labouring mother:

As long as the patient is healthy, the presentation normal, the presenting part
engaged, and the fetus in good condition, the patient may walk about or may be in
bed, as she wishes
 Monitoring the progress of labour

Once labour has become established, all events during labour should be recorded on
a partogram.
a) The well-being of the fetus
b) The well-being of the mother
c) The progress of the labour
 Pain relief
When the pains are severe an analgesic preparation may be given.
a) Opiate drugs – e.g. Pethidine given intramuscularly every 4 hour
b) Inhalational analgesia – e.g. Entonox
c) Epidural analagesia
LABOUR PAIN – causes1

 Pain in labour
The pain experienced by the woman in labour is caused by the:
1): Uterine contractions and uterine ischaemia.
2): Cervical dilatation. Dilatation and stretching of the cervix and

lower uterine segment stimulate nerve ganglia and are a major
source of pain.
3): Distention of the vagina and perineum. Marked distention of the

vagina and perineum occurs with fetal descent, especially during the
second stage.
LABOUR PAIN – causes2

 Pain in labour
Table 1: PAIN DURING THE STAGES OF LABOUR
STAGES OF LABOUR SORCES OF PAIN
Pain is caused mainly by uterine contractions, thinning of the lower

FIRST STAGE segment of the uterus, and dilatation of the cervix.
Pain result from two sources:

SECOND STAGE 1.The stretching of the vagina, vulva and perineum.
2.The contraction of the myometrium.
Pain is caused by the passage of the placenta through the cervix, plus that
THIRD STAGE produced by the uterine contractions.
PAIN RELIEF IN LABOUR – types

Three methods are in common use during labour:
1. Analgesic drugs (narcotics, e.g. pethidine)

which are given by intramuscularly injection.
2. Inhalation analgesia (e.g. Entonox).
3. Regional anaesthesia (e.g. epidural, spinal)

that blocks the sensory pain pathways.
MONITORING FETAL HEART
How Do Uterine Contractions Affect Fetal Heart Rate?
Uterine contractions can affect fetal heart rate by increasing or decreasing

that rate in association with any given contraction.
The three primary mechanisms by which uterine contractions can cause

a decrease in fetal heart rate are compression of:
· Fetal head
· Umbilical cord
· Uterine myometrial vessels
How To Monitor The Fetal Heart Rate?
 Auscultation methods
 Electronic monitoring ~ CTG

To detect fetal hypoxia
ABNORMAL
NORMAL
RECORDING THE
PROGRESS OF LABOUR
RECORDING THE PROGRESS OF LABOUR
PATIENT INFORMATION
FETAL INFORMATION
~ fetal well being
LABOUR INFORMATION
~ Dilatation
~ Descent
~ Contraction
MEDICATIONS
MATERNAL INFORMATION
~ Well being
RECORDING THE PROGRESS OF LABOUR - Partogram

Patient information: Fill out name,
gravida, para, hospital number, date and
time of admission and time of ruptured
membranes.
Fetal heart rate: Record every half hour.
Amniotic fluid: Record the colour of

amniotic fluid at every vaginal
examination:
I: membranes intact;
C: membranes ruptured, clear fluid;
M: meconium-stained fluid;
B: blood-stained fluid.
Moulding:
1: sutures apposed;
2: sutures overlapped but reducible;
3: sutures overlapped and not reducible.

Assess the progress of labour:
Cervical dilatation: Assessed at every
vaginal examination and marked with a
cross (X). Begin plotting on the partograph
at 3 cm.
Station : recorded as a circle (O) at every

vaginal examination.
Contractions: Chart every half hour;

palpate the number of contractions in 10
minutes and their duration in seconds.
Less than 20 seconds:

Between 20 and 40 seconds:
More than 40 seconds:

Progress of maternal well being:
Oxytocin: Record the amount of oxytocin
every 30 minutes when used.
Drugs given: Record any additional

drugs given – e.g. Pethidine
Pulse: Record every 30 minutes and

mark with a dot (●).
Blood pressure: Record every 4 hours

and mark with arrows ( )
Temperature: Record every 2 hours.
Protein, acetone and volume: Record

every time urine is passed.
MANAGEMENT
SECOND STAGE O
LABOUR
MANAGEMENT OF THE SECOND STAGE OF LABOUR1
Once the onset of the second stage has been confirmed

a woman should not be left without attendance.
Accurate observation of progress is vital, for the
unexpected can always happen.
 Maternal position:
With the exception of avoiding supine position, the mother
may assume any comfortable position for effective bearing
down.
The semi-recumbent or supported sitting position, with the

thighs abducted, is the posture most commonly adopted
 Bearing down
With each contraction, the mother should be encouraged to
bear down with expulsive efforts
 Observation during the second stage:

Four factors determine whether the second stage may be safely continued and
these must be carefully monitored throughout the second stage of labour.
1. Maternal conditions
Observation includes an appraisal of the mother’s ability to cope emotionally as
well as an assessment of her physical wellbeing. A maternal pulse rate is usually
recorded quarter-hourly and bloods pressure hourly
2. Fetal conditions - During the second stage, the fetal heart should be monitored
either continuously or after each contraction. stage may be associated with fetal
distress.
The liquor amnii is observed for signs of meconium staining.
3. Uterine contractions - The strength, length and frequency of contractions should

be assessed continuously.
4. The progress of descent - The progress should be recorded approximately every

30 minutes during the second stage.
 CONDUCTING THE DELIVERY1:
When delivery is imminent, the patient is usually placed in the dorsal

position, and the skin over the lower abdomen, vulva, anus and upper
thigh is cleansed with antiseptic solution and draped.
DELIVERY OF THE HEAD
1) Control the delivery of the head to prevent laceration

2) Performed episiotomy if requires
3) Performed Ritgen’s method
4) Cleared the airway after delivery of the had
 PERFORMING AN EPISIOTOMY:
EPISIOTOMY
"..is a surgical incision into the perineum to enlarge the space at the
outlet
IS EPSIOTOMY REALLY NEEDED?

Episiotomies are said to provide the following benefits:
1. Speed up the birth

2. Prevent Tearing
medical research has not proven
3. Protects against incontinence
any of these benefits
4. Protects against pelvic floor relaxation
5. Heals easier than tears
Episiotomies are not always necessary
Episiotomy should be considered only in the case of:
• Complicated vaginal delivery (breech, shoulder

dystocia, forceps,
vacuum);
• Scarring of the perineum;
• Fetal distress.
Incision of episiotomy
Episiotomy Types
Midline episiotomy Mediolateral episiotomy J-shaped episiotomy
The three major types of

episiotomy
Making an incision
Performing an episiotomy will
cause bleeding. It should not,
therefore, be done too early.
Wait until:
1) the perineum is thinned

out;
and
2) 3–4 cm of the baby’s head

Infiltrate perineum with is visible during a
local anaesthetic agent contraction.
DELIVERY OF THE SHOULDERS
Delivery of the anterior shoulder is aided by

gentle downward traction on the head.
The posterior shoulder is delivered by

elevating the head.
DELIVERY OF THE TRUNK
 After the delivery of the shoulders the baby is grasped

around the chest to aid the birth of the trunk.
 Finally, the body is slowly extracted by traction on the
shoulders and lifts the baby towards the mother’s abdomen.
 The time of delivery is noted.
CUTTING THE UMBILICAL CORD
 After delivery, it is therefore usual to wait 15 to 20 seconds

before clamping and cutting the umbilical cord.
 After cutting the cord a plastic crushing clamp is placed on
the cord 1 to 2 cm from the umbilicus and the cord is cut again 1
cm beyond the clamp.
IMMEDIATE CARE OF THE NEW BORN
Once the baby is breathing normally he should be dried and

warmly wrapped to prevent cooling and handle to the mother
to hold, cuddle and enjoy.
If spontaneous respiration is not established soon

after birth, resuscitation is the immediate priority.
The Apgar’s score of the baby should be noted

and recorded.
LABOUR AND DELIVERY
THE MECHANISMS OF
NORMAL LABOUR
- Occiput anterior -
Occiput anterior (OA)

Anterior
Occipital bone
Pubis
Right Left
Sacrum
Posterior
Occiput anterior positions

MECHANISM OF LABOUR for occiput ante

DEFINITION:
The “mechanism of labour” refers to the sequencing of
events related to posturing and positioning that allows the
baby to find the “easiest way out”.
For a normal mechanism of labour to occur, both the fetal

and maternal factors must be harmonious.
MECHANISM OF LABOUR for occiput anter

Events of mechanism of labour:
F: Flexion and descent

I: Internal rotation of the fetal head
C: Crowning
E: Extension
R: Restitution
I: Internal rotation of the shoulders
E: External rotation of the fetal head
L: Lateral flexion of the body
MECHANISM OF LABOUR for occiput anterior (OA
Descend Internal rotation of shoulder
F
I External rotation of head
LOA LOA
C
E LOT
R Restitution
I Flexion
E
L LOA
OA
Internal rotation Extension

Lateral flexion of body
OA
Crowning OA
Delivery
MANAGEMENT
THIRD STAGE OF
LABOUR
MANAGEMENT OF THE THIRD STAGE OF LABOUR
 BIRTH OF THE PLACENTA1:
Delivery of the placenta occurs in two stages:
(1) separation of the placenta from the wall of the uterus and
into the lower uterine segment and/or the vagina, and
(2) actual expulsion of the placenta out of the birth canal.

THE THIRD STAGE OF LABOUR
 MECHANISM OF PLACENTA SEPARATION1:
Two mechanisms of placental separation occurs:

1- Mathews-Duncan mechanism 2- Schultz mechanism
The leading edge of the placenta If the placenta is inserted at the

separates first and the placenta is fundus and central area separates
delivered with its raw surface first, the placenta inverts and draws
exposed. the membranes after it, covering the
raw surface (inverted umbrella)
LABOUR AND DELIVERY
WHAT ARE THE SIGNS OF

PLACENTA SEPARATION
CLINICAL SIGNS OF PLACENTAL SEPARATION
Placental separation takes place within 5 minutes after the delivery of the
infant. Signs suggesting that detachment or separation has taken place
include:
1. The uterus becomes globular and hard. This sign is the earliest to appear.
2. There is often a sudden gush of blood
3. The uterus rises in the abdomen because the placenta,

having separated, passes down into the lower segment
and vagina, where its bulk pushes the uterus upward
4. Cord lengthening. This is the most reliable clinical sign

of placental separation.
 BIRTH OF THE PLACENTA2:
After the placental separation takes place the

placenta can be delivered by the:
1. Passive management – wait for spontaneous

expulsion of placenta
2. Active management
LABOUR AND DELIVERY
ACTIVE MANAGEMENT OF
THE THIRD STAGE OF LABOUR
ACTIVE MANAGEMENT OF THE THIRD STAGE
Active management of the third stage (active delivery of the

placenta) helps prevent postpartum haemorrhage.
Active management of the third stage of labour includes:
~ use of oxytocin
~ controlled cord traction, and
~ uterine massage.
MANAGEMENT OF THE THIRD STAGE OF
LABOUR
ACTIVE MANAGEMENT OF THE THIRD STAGE
~ Use of oxytocin
Oxytocic drugs should be given with the birth of the anterior shoulder.
Syntocinon is the most used oxytocic known to be effective; the

addition of ergometrine may reduce blood loss.
SYNTOMETRINE (oxytocin 5 IU + ergometrine 0.5 mg) – widely

used
EXPULSION OF THE PLACENTA BY ACTIVE

MANAGEMENT
When these signs have appeared the placenta is ready for

expression. If the patient is awake, she is asked to bear down while
gentle traction is made on the umbilical cord.
The popular and effective method of delivering the placenta is by

Brandt-Andrews method.
BRANDT’S ANDREW METHOD
Once the signs of placental separation have occurred the obstetrician

assists delivery of the placenta by controlled cord traction as described
by Brandt-Andrews’ method.
A) Placenta separation B) Controlled cord traction C) Delivery of the membranes

EXAMINATION OF THE PLACENTA
The placenta, membranes, and umbilical cord should be examined

for completeness and for anomalies.
EXAMINATION OF THE PERINEUM
At the same time, the perineal region, vulva outlet, vaginal canal, and
the cervix should be carefully examined for lacerations.
If the perineum has been torn or an episiotomy made, tear or incision

should be repaired immediately.
 REPAIR OF EPISIOTOMY:
Note: It is important that absorbable sutures be used for closure.
Vaginal mucosa
1. Identify apex
2. Begin suturing
1.0 cm above apex
3. Continuous sutures
4. Ends at the level of

Continuous sutures Interrupted sutures Interrupted suture or
vaginal opening subcuticular
MANAGEMENT AFTER
DELIVERY
IMMEDIATE MANAGEMENT AFTER THE
DELIVERY
 EARLY POSTPARTUM MANAGEMENT:
The hours immediately following delivery and the birth of the placenta are a critical
period as postpartum haemorrhage can occurs due the relaxation of the uterus.
The patient is kept in the delivery suite for 1 hour postpartum under close
observation. She is check for bleeding, the blood pressure is measured, and the pulse
is counted.
Before discharging the patient from the delivery suit it is mandatory:
 To check the uterus frequently to make sure it is firm and not relaxing.
 To remove any presence of intrauterine blood clots. The presence of these clots will
interfere with retraction and the normal haemostatic mechanism of the uterus.
 To look at the introitus to see that there is no haemorrhage.
 To keep the bladder empties because full bladder can also interfere with uterine
retraction.
 To examine the baby to be certain that it is breathing well and that the colour and
tone are normal.

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NORMAL LABOUR

1. Definition of normal labour

The following criteria should be present

1. The female pelvis provides the basic

2. The obstetric pelvis is divided into false and

Cavity 4. The true pelvis is composed of inlet, cavity

5. Types of female pelvis – gynaecoid,

The ideal normal female gynaecoid pelvis:

The important diameters of the female pelvis:

Anteroposterior Oblique Transverse

2. Coronal sutures: - The suture uniting the

3. Frontal suture: - The frontal suture is between

4. Lambdoidal suture: - Is between the parietal

MOULDING OF THE FETAL SKULL

This property is of the greatest

Diameters of the fetal skull – anterior posterior diameters

G AB ~ Suboccipto bregmatic – 9.5

FG ~ Mento vertical – 13.5

1. Initiate by pacemakers ~ uterotubal junction Additional force

EXPULSION OF THE FETUS

1. Frequency ~ one in every 2 – 3 min with at least 1

WHAT INITIATE LABOUR

SYMPTOMS AND SIGNS OF LA

DESCRIBE THE STAGES OF

FIRST STAGE SECOND THIRD STAGE

First stage of labour consists of This is the shortest stage, lasting

PHASES OF THE FIRST STAGE OF LABOU

PHASES OF THE FIRST STAGE OF LABOU

WHAT HAPPEN DURING

WHAT HAPPEN DURING THE FIRST STAG

WHAT HAPPEN DURING THE FIRST STAG

Phases of cervical dilatation

Active phase – this is active process of cervical

WHAT HAPPEN DURING THE FIRST STAG

Do Uterine Contractions Affect Fetal Heart Rate?

Uterine contractions can affect fetal heart rate by increasing or

The three primary mechanisms by which uterine contractions can

PROGRESS OF FIRST STAGE OF LABOUR

Findings suggestive of satisfactory progress in first stage of labour are:

- regular contractions of progressively increasing frequency and duration;

Findings suggestive of unsatisfactory progress in first stage of labour

- irregular and infrequent contractions after the latent phase;

1. Begins with FULL DILATATION and ends with DELIVERY OF

2. It have TWO Phases

PROGRESS OF SECOND STAGE OF LABOUR

Findings suggestive of satisfactory progress in second stage

- steady descent of fetus through birth canal;

Findings suggestive of unsatisfactory progress in second

- lack of descent of fetus through birth canal;

THIRD STAGE OF LABOUR

1. Begins after DELIVERY of the baby and ends with DELIVERY

2. It have TWO Phases

3. Duration – usually 15 minutes or less (if actively managed).

4. Average blood loss – 150 to 250 ml.

PHYSIOLOGICAL EFFECTS OF LABOU

1. Minimal effects 1. Pulse increases 1. Blood loss from

 To achieve delivery of a normal healthy

 To anticipate, recognize and treat

Monitoring the progress of labour

Ensuring maternal well-being

Ensuring fetal well-being.

 General examination of the mother

b) Vital signs – Blood pressure, pulse, respiration and temperature are