Dr. Yin Moe HanSenior Lecturer

Obstetr ics & Gynaecology DepartmentSchool of Medicine, UCSI University

normal, mature, alivenormal, mature, alive vertex presentationvertex presentation spontaneous expulsionspontaneous expulsion per vaginumper vaginum within 24 hourswithin 24 hours without complicationswithout complications

NORMAL LABOUR

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STAGES OF LABOURFirst stage of labourFirst stage of labour

Second stage of labourSecond stage of labour

Third stage of labourThird stage of labour

Fourth stage of labourFourth stage of labour07/31/1207/31/12 441st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

FIRST STAGE OF LABOURonset of labour onset of labour

8-12 hours8-12 hours

full dilatation of the cervixfull dilatation of the cervix (10 cm)(10 cm)

Latent Phase –--- 0 – 3 cmLatent Phase –--- 0 – 3 cm Active Phase –--- 4 – 10 cmActive Phase –--- 4 – 10 cm

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SECOND STAGE OF LABOUR

full dilatation of the cervix full dilatation of the cervix

up to up to 1 hour1 hour

birth of the foetusbirth of the foetus

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THIRD STAGE OF LABOUR

birth of the foetusbirth of the foetus

5 - 15 mins not > 30 mins5 - 15 mins not > 30 mins

delivery of placenta and delivery of placenta and membranesmembranes

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FOURTH STAGE OF LABOUR

UP TO 2 HOURS AFTER DELIVERYUP TO 2 HOURS AFTER DELIVERY

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DIAGNOSIS OF LABOUR

1.1. Diagnosis and confirmation of labour Diagnosis and confirmation of labour

2.2. Diagnosis of stage and phase of labour Diagnosis of stage and phase of labour

3.3. Assessment of engagement and descent of the fetusAssessment of engagement and descent of the fetus

4.4. Identification of presentation and position of the fetus Identification of presentation and position of the fetus

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DIAGNOSIS AND CONFIRMATION OF LABOUR

Suspect or anticipate labour i f the woman hasSuspect or anticipate labour i f the woman has : : Intermittent abdominal painIntermittent abdominal pain Associated with blood-stained mucus discharge (show)Associated with blood-stained mucus discharge (show) Watery vaginal discharge or a sudden gush of waterWatery vaginal discharge or a sudden gush of water

Confirm the onset of labour if there isConfirm the onset of labour if there is :: Cervical effacement—the progressive shortening and thinning of Cervical effacement—the progressive shortening and thinning of

the cervix during labourthe cervix during labour Cervical dilatation—the increase in diameter of the cervical Cervical dilatation—the increase in diameter of the cervical

opening measured in centimetresopening measured in centimetres    

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EFFACEMENT AND DILATATION OF THE CERVIX

 

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DESCENT Abdominal palpationAbdominal palpation

Assess descentAssess descent in terms of f i f ths of fetal in terms of f i f ths of fetal

head palpable above the head palpable above the symphysis pubissymphysis pubis

Head entirely above the Head entirely above the symphysis pubissymphysis pubis f ive-f if ths (5/5) palpablefive-f if ths (5/5) palpable

Head entirely below the Head entirely below the symphysis pubissymphysis pubis zero-fif ths (0/5) palpablezero-fif ths (0/5) palpable   

Descent of the fetal headDescent of the fetal head

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MECHANISM OF NORMAL LABOUR

Cardinal movements of labour (LOA)

Engagement and descent

Flexion  Internal rotat ion to OA

Extension Restitut ion External rotat ion

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ENGAGEMENT AND DESCENT

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FLEXION

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INTERNAL ROTATION TO OA

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EXTENSION

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RESTITUTION

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EXTERNAL ROTATION

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DELIVERY OF ANTERIOR SHOULDER

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BODY BORN BY LATERAL FLEXION

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ASSESSMENT OF PROGRESS OF ASSESSMENT OF PROGRESS OF LABOURLABOUR

latent phaselatent phase measuring changes in cervicalmeasuring changes in cervical effacementeffacement and and dilatationdilatation

active phaseactive phase measuring the rate of cervical measuring the rate of cervical dilatationdilatation and fetal and fetal descentdescent

second stagesecond stage assessing further fetal assessing further fetal descentdescent

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PROGRESS OF THE FIRST STAGE OF LABOUR

Plot Plot on a partograph on a partograph once the woman enters once the woman enters the the active phaseactive phase of of labour. labour. 

Alternatively, plot a Alternatively, plot a simple graph of simple graph of cervical cervical dilatation (cm) on the dilatation (cm) on the vertical axisvertical axis against time against time (hours) on the horizontal (hours) on the horizontal axis. axis.

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VAGINAL EXAMINATIONS

11stst stage of labour - stage of labour - 4 hourly4 hourly

22ndnd stage of labour stage of labour - - hourly hourly

After rupture of the membranesAfter rupture of the membranes

Record following after each VERecord following after each VE colour of amniotic fluidcolour of amniotic fluid cervical di latationcervical di latation descentdescent (can also be assessed abdominally)(can also be assessed abdominally)

Plot the findings on partographPlot the findings on partograph

Cervix not dilated on 1st VE

may not be possible to diagnose labour

If contractions persist

re-examine the woman after 4 hours for cervical changes

if there is effacement and dilatation, the woman is in labour

if there is no change, the diagnosis is false labour

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Thank YouThank You07/31/1207/31/12 28281st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han