Mechanism of Labour

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Normal labour and its management

a) Definition and stages

Labour: Regular involuntary coordinated, painful uterine
contractions associated with cervical effacement and dilatation
• Regular frequent uterine contractions
• Cx changes (dilatation & effacement) or
• SROM
Delivery: Expulsion of the product of the conception after fetal
viability.
Anterior Pubis Right Left Occipital bone
MECHANISMS OF NORMAL LABOUR
Occiput anterior

DFICERIEL
D: Descent
F: Flexion
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
Cardinal movements of labour (LOA)
MANAGEMENT 1st STAGE OF LABOUR
Assessment, Preparation care & Partogram
I. Assessment
1. History: - Woman’s antenatal record is reviewed
2. Complete history .
II. Examination
A General
a) Pallor, edema, abdominal scar (LSCS)
b Vital signs: BP, pulse, RR and Temp
c) Heart and lungs
B. Abdominal examination:
a. Presentation and position and engagement
b. Auscultate the fetal heart
c. Evaluate the uterine contraction
C. Vaginal examination –
i. PP: - Presentation Engagement, station
Position
 ii) Membranes Intact or absent: exclude
cord prolapse after ROM
iii) Cx Consistency, position Dilatation
Effacement,
iv) Pelvis Adequacy.- Do not do vaginal
examination: vaginal bleeding before the
placenta previa is excluded.
Sterile speculum examination: suspected
ROM, if the woman is not in labour.
Admission to labour ward: Active labour:
Regular painful contractions and cervical
dilatation 3 cm {less time in the labor ward
less intrapartum oxytocics less analgesia}
Investigations
- Urine: Protein Sugar ketones
- Blood: CBC RBS Grouping cross match for
high risk patients.
II. Preparation and care
1. Bowel preparation: Indicated: No bowel action for 24 h or Rectum feels loaded on
vaginal examination similar length of labor and most maternal and neonatal outcomes
generates discomfort in women
3. Nutrition - No food is permitted after labour is established {prevent regurgitation
and aspiration}
Small amount of clear fluid or frozen pineapple, Ice chips to moisten the mouth
Maintain adequate hydration via intravenous routes
4. Perineal shaving - No {is associated with similar maternal febrile morbidity, wound
infection, and neonatal
infection compared with just selective clipping of hair}
 
Routine early ARM - Not recommended {decrease duration of labor( 60 min, mostly
because of shorter 1st stage), decrease use of oxytocin, similar incidence of NRFHR
monitoring similar neonatal outcomes compared with selective (later or no) AROM
26% increase in CD} should be reserved for failure to progress
contd
5. Position:
Walk about or in bed, as she wishes
As long as the patient is healthy presentation normal
presenting part engaged fetus in good condition
6. Pain relief - Severe: an analgesic
a) Opiate drugs. e.g. Pethidine IM/4 h
b) Inhalational analgesia e.g. Entonox
c) Epidural analagesia
Progress of the Labour
III. Monitoring the progress of labour Once labour has become
established, all events during labour should be recorded on a
partogram.
a) Well-being of the fetus
b) Well-being of the mother
c) Progress of the labour
Patient information: name, gravida, para, hospital number,
date and time of admission and time of ruptured membranes
contd
 A. Condition of the fetus
I. FHR: every half hour.
II. Memb & Liq: every vaginal examination I= intact, A= abscent C= clear, M= meconium B= blood,
III. Moudling: 0 (separated) + (touching) ++(overlap) +++ (severe overlap)
Monitor FHR
 Auscultation methods
 Electronic monitoring: CTG
NORMAL ABNORMAL
 B. Progress of labour
I. Cervical dilatation (cm). every vaginal examination Plot x In active phase Alert line: drawn at a rate
of 1 cm /h cervical dil The mean rate of the slowest 10% of normal PG Action line: drawn 4 h to the
right of alert line. Intervention should take place
II. Descend: every vaginal examination Plot O (amount of head palpable above pelvic brim) and
Position
III. Contractions: every half hour Frequency/10 m, Duration & Intensity: stippled (<20 sec, weak);
striped (20-40 sec, moderate); complete (>40 sec, strong).
Recording the progress of labour frequency of cervical examinations. Most studies: every 2 h. {risk of
chorioamnionitis increases with the increasing number of examinations}.
C. Condition of the mother
I. Medications: Oxytocin: amount /30 min Drugs IV Fluids
II. V/S: B.P: /4 h mark with arrows ( ) P: /30 min mark with a
dot (●). T: /2 hours.
III. Urine: every time urine is passed. Vol, alb, ketones WHO
partogram, 2002 Simple & easy to use. The latent phase has
been removed . Plotting on begins in the active phase when the
cervix is 4 cm dilated.