The Biology of labor

makmur sitepu

Divisi Feto-Maternal Departemen Obgin FK-USU/RS.HAM

Parturition
Normal Pregnancy
Uterine quiescence Closed cervix
Fetus

Parturition
Coordinated uterine activity Maturation of the fetus Maternal lactation Progressive cervical dilation
Placenta Membranes

Mother

Initiation of Labor
Fetus
Sheep
Fetal ACTH and cortisol
Placental 17 hydroxylase Estradiol Progesterone Placental production of oxytocin, PGF2

Humans
Fetal increased DHEA
Placental conversion to estradiol Increased decidual PGF2 and gap junctions Increased oxytocin and PG receptors Decreased progesterone receptors
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Initiation of labor
Oxytocin
Peptide hormone Hypothalamus-posterior pituitary Fetal production
Maternal serum increase in second stage of labor

Oxytocin receptors
Fundal location 100-200 x during pregnancy

Actions
Stimulate uterine contractions Stimulate PG production from amnion/decidua
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Theories of labor
Progesteron withdrawal.
Has quieting effect on uterus Counterbalance estrogen.

Oxytocin production
Posterior pituitary As pregnancy progresses oxytocin receptor

 Prostaglandin production Endothelin production

Contraction smooth muscle. High level in amniotic fluid.

Estrogen stimulation > 34 35 weeks.

Promotes oxytocin production in myometrium.

Fetal cortisol. Distention of uterus.

Exact couse of onset labor not clear.

Most current belief is that of

A PROSTAGLANDIN CASCADE.

Maternal and Fetal Endocrine Systems Involved in Increased Placental Production of CRH.

Calcium channel

Oxytocin receptor

Extracellular

Phospholipase C

Intracellular

cAMP
Ca+

MLCK

+ Oxytocin + Prostaglandin

Ca store

Uterine contractions
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Contraction

Prostaglandin
Fetal membranes

Rupture

Partogram

11/19/2013

KASUS

Ny. DL, usia 28 tahun, G1P0A0 HPHT = 20 November 2009

Pemeriksaan 4 jam kemudian diperoleh :
Status present Status obstetricus : dalam batas normal : His = 3x30 detik/10 menit DJJ = 148x/i, regular Dilatasi servik : 6 cm Penurunan kepala : 2/5 Penyusupan : +2 Ketuban masih utuh

Dua jam kemudian Ny.DL mengalami pembukaan lengkap.

Penurunan Kepala : 1/5 Penyusupan : +2 His : 4 x 50 detik/ 10 menit Djj : 150x/1, regular. ketuban pecah dan timbul rasa ingin mengedan.

Kasus dengan TFU 34 cm

Kepala 3/5 minus station -13 EBW : 155 x (34 - 13) = 3255 gram.

 HPHT: 20 November 2009

TTP: 27 agustus 2010 Usia Kehamilan saat ini 39 minggu.

Kepala Sudah memasuki PAP Taksiran berat janin JT : 3255 gram.