Physiology of First stage

of Labour
 1. UTERINE CONTRACTION
• Braxton hicks contraction
becomes more painful uterine
contraction during which mother
experience pain in hypo gastric
region radiating to thigh.
• It originates in fundus mainly &
spreads downwards.
• Mother experience pain & uterus
becomes hard.
 Characteristics of uterine contractions
1.Intensity: gradually increases with advancement
of labour. It may be mild , moderate or strong.
2. Duration:
• It is time of beginning of one contraction to
relaxation.
• It is counted in seconds.
• It increases in duration with progress of labour.
• In first stage it lasts for about 30 seconds, in
second stage it lasts for about 60-90 seconds
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3. Frequency:
• Number of uterine contractions.
• In early labour it comes at 10-15 minutes
whereas in 2nd stage it comes every 2-3
minutes.
• It is calculated in / 10 minutes.
• E.g., 4 to 5/ 10 minutes
 2. RETRACTION
• Progressive shortening of muscle fibers
following a contraction.
• Retraction starts towards the end of the
first stage and becomes intense in 2nd and
third stage.
• Because of retraction, there is reduction of
surface area of uterus which helps in
gradual descent of presenting part.
Retraction
 3. FUNDAL DOMINANCE
• Contraction starts in fundal region and spreads
downwards.
• So fundus and midzone remains hard during
contraction while weak contraction in lower
uterine segment.
 4. POLARITY OF UTERUS
• Upper segment contracts and retracts to expel
the fetus while lower pole dilates to allow the
expulsion of fetus.
• There is co ordination between fundal
contraction and cervical dilatation is called
polarity of uterus.
Polarity of uterus
 5. FORMATION OF UPPER & LOWER
UTERINE SEGMENTS
• The wall of upper segment becomes thicker
and there is thinning of the lower segment.
• A distinct ring is produced at the junction of
upper & lower segment is called
Physiological retraction ring.
• Fully formed lower uterine segment
measures 7.5 to 10 cm develops from
isthmus.
Physiological retraction ring
 6. SHOW
• It is the blood stain mucoid discharge few
hours after labor has been started.
• It is because of the oozing of blood from
ruptured capillary of cervix & decidua because
of separation of membrane due to stretching
of lower uterine segment.
• So mucus plug mixed with blood is called
show.
 7. EFFACEMENT & DILATATION
Effacement ( Taking up of cervix):
• It is thinning out of cervix & cervix become
shorten because of merging of cervix with lower
uterine segment due to pull of upper segment.
• It is measured in %.
• When cervical canal is 2.5 cm, it is called 0%
effaced.
• When cervical canal merges with lower segment
and becomes papery thin, it becomes 100%
effaced.
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Dilatation :
• It is the dilatation of cervix.
• Dilatation has two phase.
– Latent phase : 0-3 cm dilatation within 8 hours
– Active phase : 3 – 10 cm dilatation
• 1 cm/ hr in primi gravida
• 1.5 cm/ hr in multi gravida
• It is felt with the finger and recorded in
centimeters.
• E.g., 1 finger = 1.5 cm
 8. BAG OF WATER
• Bag of fore water is formed by separation of
membrane from lower uterine segment during
contraction.
• It bulges during contraction.
• Fetal head plugs cervical canal like ball valve,
thus dividing amniotic cavity into fore water
(fluid in front of head).
• On full dilatation of cervix, increased force of
strong uterine contraction causes rupture of
fore water.
Bag of Water
 Signs & Symptoms of first stage of Labor

• Pain
– Hardening of uterus
– After contraction passes off, uterus felt soft.
– Contraction comes at 3-5 minutes interval
and lasts for about 30-45 seconds.
• Show
– Blood stain mucoid plug
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• Dilatation & effacement of cervix

• Status of membrane
– Membrane remains intact till full dilatation.
– It may rupture at any time after full dilatation
– If it ruptures before full dilatation of cervix, its
called PROM.
– Intact membrane during contraction remain
tense and bulge.
– With rupture of membrane, there is increase
in uterine contraction.
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• Station of head
– By P/V examination, station of head is
measured in relation to ischial spine.
– It is recorded as 0, + 1 or – 1.
– When head is at the level of ischial spine, it
calls 0 station.
– When presenting part is above ischial spine, it
is stated as – (minus). E.g., -1, -2, -3 , floating
– When presenting part is below ischial spine, it
is stated as + (plus). E.g., +1, +2, +3 , on
perineum.