Physiology of Labor

HERMAN SUMAWAN
OBSTETRIC AND GYNECOLOGY
JENDERAL SOEDIRMAN UNIVERSITY/MARGONO SOEKARJO HOSPITAL
Parturition
Phase 1 of Parturition: Uterine Quiescence
and Cervical Softening

 Uterine Quiescence : myometrial unresponsiveness of

phase 1 continues until near the end of pregnancy
 Some low-intensity myometrial contractions are felt
during
the quiescent phase, but they do not normally cause
cervical dilatation.
 Contractions of this type become more common toward
the end of pregnancy, especially in multiparous women,
and are referred to as Braxton Hicks contractions or false
labor
Cervical Softening

Cervix has multiple functions during pregnancy :

 (1) maintenance of barrier function to protect the reproductive tract from
infection,
 (2) maintenance of cervical competence despite increasing gravitational
forces,
 (3) orchestration of extracellular matrix changes that allow progressive
increases in tissue compliance
 Softening—> an increase in tissue compliance, yet the
cervix remains firm and unyielding -> The end of
pregnancy, the cervix is easily distensible, and its
consistency is similar to the lips of the oral cavity
 Cervicalsoftening results from increased vascularity,
stromal hypertrophy, glandular hypertrophy and
hyperplasia, and slow, progressive compositional or
structural changes of the extracellular matrix
Phase 2 of Parturition: Preparation for
Labor
 Uterine awakening or activation- >the myometrial tranquility of phase 1
of parturition must be suspended
 Phase 2 is a progression of uterine changes during the last 6 to 8 weeks
of pregnancy
Myometrial Changes :
 Contraction associated proteins (CAPs) include the oxytocin receptor,
prostaglandin F receptor, and connexin 4
 Myometrial oxytocin receptors markedly increase along with
increased numbers and surface areas of gap junction proteins
such as connexin 43
 These lead to increased uterine irritability and responsiveness to
uterotonins—agents that stimulate contractions
 Formation of the lower uterine segment from the isthmus
 The fetal head often descends to or even through the pelvic
inlet—so-called lightening -> “Baby Drop”
 Cervical ripening -> cervical yielding and dilatation upon initiation of forceful uterine
contractions. Cervical modifications during this second phase principally involve connective
tissue changes
 The transition from the softening to the ripening phase begins
weeks or days before onset of contractions
 The total amount and composition of proteoglycans and glycosaminoglycans within the matrix
are altered
Phase 3 of Parturition: Labor

 The first stage begins when spaced uterine contractions of suficient frequency,
intensity, and duration are attained to bring about cervical thinning, or
effacement.
 This labor stage ends when the cervix is fu lly dilated—about 10 cm—to allow
passage of the term-sized fetus. The first stage of labor, therefore, is the stage of
cervical effacement and dilatation
 The second stage begins when cervical dilatation is complete
and ends with delivery. Thus, the second stage of labor is the
stage of fetal expulsion.
 the third stage begins immediately after delivery of the fetus and ends with the
delivery of the placenta. Thus, the third stage of labor is the stage of placental
separation and expulsion
Phase 4 of Parturition: The
Puerperium
 Immediately and for about an hour or so after delivery, the
myometrium remains in a state of rigid and persistent contraction and
retraction
 Uterine involution and cervical repair, both remodeling processes that restore
these organs to the nonpregnant state, follow in a timely fashion
PHYSIOLOGICAL AND BIOCHEMICAL
PROCESSES
REGULATING PARTURITION
 The functional loss of pregnancy maintenance factors
 Synthesis of factors that induce parturition
SUMMARY
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