Labour and

delivery
Dr. Amani Shaman
 LECTURE OVERVIEW

Definitions Anatomy of the fetal Management of 1st,

head and maternal 2nd and 3rd stages of
pelvis normal labour
monitoring of maternal well
being
monitoring of fetal well-being
monitoring progress of labour
 Definition of Labour
Labor is the process that Pregnancy and birth
leads to childbirth. It are physiological
begins with the onset of processes, and thus,
regular uterine labor and delivery
contractions that bring should be considered
about demonstrable normal for most
effacement and women.
dilatation of cervix and
ends with delivery of
the newborn and
expulsion of the
placenta.
 TRUE LABOUR FALES LABOUR
1) Regular contractions 1) Irregular
2) Increase in frequency 2) Remain the same
and intensity
3) Unchanged
3) Cervix dilate
4) No relive with sedation
4) relive
5) Abd and back pain 5) Lower abd
Components of normal labour

Passenge
Powers Passages
r
 Powers

Uterine
Maternal
contraction
effort
s
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 Passages

Maternal pelvis

Inlet

Outlet
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 Passenger
1. Fetal size

2. Fetal presentation

3. Fetal position

4. Moulding
 Mechanism of labour
Fetal Fetal Fetal
Fetal Lie:
presentation: attitude: position:

The
Fetal lie presenting relationship of
describes part is the an arbitrarily
the portion of the chosen por­tion
fetal body of the fetal
relationship that is either presenting part
of the fetal foremost to the right or
long axis to within the left side of the
that of the birth canal or birth canal.
mother. in closest
proximity to i

cephalic ,
breech and
the shoulder
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 Largest and least compressible part of the fetus
• therefore the most important obstetrically

Comprises of
ANATOMY • (1) base of skull (ossified, non compressible, protecting brain
stem)
OF THE • (2) cranium
• (a) bones: occipital, 2 parietal, 2 frontal and 2 temporal
FETAL HEAD interconnected with membrane; therefore compressible
• (b) sutures (where the bones meet): saggital, lambdoid,
coronal
• © fontanelles (where the sutures meet): ant and post

The compressibility of the fetal skull means

the bones can overlap (moulding) in order for
the skull to change shape negotiating the
maternal pelvis
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 (1) change it’s shape
and size (moulding)
HOW DOES THE,
HEAD NEGOTIATE
?THE PELVIS (2) change it’s position
(flexion and rotation)
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The Cardinal Movements of Labor
 Engage in transverse position
Rotate in mid-pelvis
Flexed descent onto perineum
Mechanism Crowning
of birth Extension of neck
Restitution
Delivery anterior shoulder
Delivery posterior shoulder
 First stage cervical dilatation
and effacement

Second stage is the

STAGES OF expulsion of the fetus
LABOUR
Third stage is the delivery of
4 the placenta

Fourth stage is the early

recovery
 • Latent phase corresponds to the
preparatory division.
– Onset is the point at which mother perceives
regular contraction and ends once dilatation
reach>6 cm.
First stage of – Prolonged >20 and >14 in nullipara and
multipara respectively.
labour – However, a subsequent study of
contemporary women in labor reported the
95th percentile in nulliparas and multiparas
as 30 and 24.5 hours, respectively
– Factors that affected latent phase duration
include: excessive sedation or epidural
analgesia and unfavorable cervical condition.
 • Active phase:
– Cervical dilation of 6cm or more, in the presence of uter­ine
contractions, can be taken to reliably represent the the threshold
of active labor.
– Zhang observed that the median (95th percentile) times for the
cervix to dilate from 4 to 10 cm in nulliparas and multiparas were
5.3 hours (16.4) and 3.8 hours (15.7), respectively.
First stage – In contrast, Friedman reported the corresponding mean
(95th percentile) durations in nulliparous and parous women
of labour were 4.6 hours (11.7) and 2.4 hours (5.2), respectively
– Active-phase abnormalities have been reported to occur in 25
percent of nulliparous and 1 5 percent of multiparous labor
– Subdivided active-phase problems into protraction and arrest
disorders.
– the American College of Obstetricians and Gynecologists and the
Society for Maternal-Fetal Medicine in 2014 jointly advised only
making a diagnosis of first-stage arrest in women with cervical
dilation ≥6 cm (ie, in the active phase), ruptured membranes, and
no cervical change over a period of at least four to six hours  .
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FRIEDMAN’S CURVE
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 • Begins with complete cervical dilation and ends
with fetal delivery.
• Zhang observed that the median (95th percentile)
duration of the second stage in nulliparous and
parous women with epidural anesthesia was 1.1
Second hours (3.6) and 0.4 hours (2.0), respectively.
• Without epidural anesthesia, the median
stage of (95th percentile) was 0.6 hours (2.8) and 0.2
hours (1.3), respectively
labour • The median duration is approximately 50 min­
utes for nulliparas and about 20 minutes for
multiparas
• Higher maternal body mass index does not
interfere with second-stage labor length
 • This stage begins
immediately after fetal
Third delivery and involves
stage of separation and expulsion
labour of the placenta and
membranes.
 • Immediately and for about an
hour after delivery, the myome­
trium remains persistently
contracted. This directly
Fourth compresses large uterine vessels
stage of and allows thrombosis of their
labour lumens to prevent hemorrhage.
This is typically augmented by
endog­enous and
pharmacological uterotonic
agents
 • Mean length of first- and second-
stage labor was approximately:
– 9 hours in nulliparas without regional
Labour analgesia, and that the 95th
percentile upper limit was 18.5 hours.
duration – For multiparas were a mean of 6
hours and a 95th per­centile
maximum of 13.5 hours
Management of Normal Labour

1 2 3
Monitor Monitor fetal Monitor the
maternal well- well-being progress of
being labour
 Maternal blood pressure, temperature, pulse,
and respiratory rate are recorded.

Temperature, pulse, and blood pressure are

evaluated at least every 4 hours
Management
of normal Periodic pelvic examinations are typically
performed at 2- to 3-hour intervals to evaluate
labour labor progress.

oral intake of moderate amounts of clear liquids

is reason­able for women with uncomplicated
labor.

for those with planned cesarean delivery, liquids

are halted 2 hours before and solids are stopped
6 to 8 hours prior to surgery
 • CTG:
– In the absence of any abnormalities, the fetal heart rate
should be checked immediately after a contraction at least
every 30 minutes and then every 15 minutes during the
second stage.
– If continuous electronic monitoring is used, the tracing is
eval­uated at least every 30 minutes during the First stage
Management of and at least every 1 5 minutes during second-stage labor.
normal labour – For women with pregnancies at risk, fetal heart
auscultation is performed at least every 15 minutes during
First-stage labor and every 5 minutes during the second
stage.
– Continuous electronic monitoring may be used with
evaluation of the tracing every 15 minutes during the first
stage of labor, and every 5 minutes during the second
stage.
 • Cervical Assessment:
– Cervical effacement reflects the length of the
cer­vical canal compared with that of an
uneffaced cervix.
Management – Cervical dilation is determined by estimating
of normal the average diameter of the cervical opening
labour – The position of the cervix is determined by the
relation­ship of the cervical os to the fetal head
– consistency of the cervix is determined to be
soft, Firm, or inter­mediate between these
two.
– The Fetal station, that is, the level of the
presenting fetal part in the birth canal, is
described in relationship to the ischial spines.
 Cervical assessment
On admission

●At four-hour intervals in the first stage 

●Prior to administering analgesia/anesthesia

●When the parturient feels the urge to push (to determine whether
the cervix is fully dilated)

●At two-hour intervals in the second stage

●If FHR abnormalities occur (to evaluate for complications such as

cord prolapse or uterine rupture)
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 • CBC
Laboratory
• Blood type and screened.
studies
• Urine analysis.
 With descent of the presenting part, she develops the
urge to defecate.

In most cases, bearing down is reflexive and

Management of spontaneous dur­ing second-stage labor.

second stage of
Uter­ine contractions and the accompanying expulsive
labour forces may now last 1 minute and recur at an interval no
longer than 90 seconds.

A woman is not encouraged to push beyond the

completion of each contraction.

Active management of labour

 • Signs of placental separation
include a gush of blood,
lengthening of the umbilical
THIRD STAGE OF
LABOUR
cord, and anterior-cephalad
movement of the uterine
fundus, which becomes firmer
and globular after the placenta
detaches.