2. INTRODUCTION
• Chiefly concerned with preparation of birth
canal.
• To facilitate expulsion of the fetus in the
second stage.
MAIN EVENTS:
a) Dilatation of cervix & effacement of cervix.
b) Full formation of lower uterine segment.
3. DILATATION OF CERVIX
• Occurs prior to the onset of labor(pre-labor phase)
PREDISPOSING FACTORS:
a)softening of the cervix.
b)fibromusculoglandular hypertrophy.
c)increased vascularity.
d)accumulation of fluid in b/w collagen fibres.
e)breaking down of collagen fibrils by enzymes.
f)change in glycosaminoglycans in the matrix of
cervix.
5. EFFACEMENT OF CERVIX
• Refers to the process by which the muscular
fibres of cervix are pulled upwards & merges
with the fibres of lower uterine segment.
• Cervix becomes thin.
• In primigravidae,effacement preceeds
dilatation of cervix.
• In multiparae,both occur simulatenously.
• Results in expulsion of mucus plug.
6. FULL FORMATION OF LOWER
UTERINE SEGMENT
• Demarcation of an active upper segment &
relatively passive lower segment is more
pronounced.
• Wall of Upper segment becomes progressively
thickened.
• Progressive thinning of Lower segment.
• A distinct ridge is produced at junction of two c/a
PHYSIOLOGICAL RETRACTION RING.
7.
8. MANAGEMENT OF FIRST STAGE
• PRINCIPLES:
1) Noninterference with watchful expectancy so as to
prepare the patient for natural birth.
2) To monitor careflly the progress of labor,maternal
conditions & fetal behavior.
3) So as to detect any intrapartum complication early.
9. PRELIMINARIES
• Evaluation of current clinical condition.
• Onset of labor pains or leakage of liquor,if any.
• General,obstetrical examinations including vaginal
examinaion.
• Record of antenatal visits,investigation report,if
available are to be reviewed.
13. 2. BOWEL:
*An enema with soap & water given in early stage.
*If rectum feels loaded on vaginal exmination
3.REST AND AMBULATION:
*If membranes are intact,patient is allowed to walk.
*Prevents venacaval compression & descent of head.
*Ambulation can reduce the duration of labor,need of
analgesia &improve maternal comfort.
*If,however analgesic drug is given,she should be in
bed.
14. 3. DIET:
• Delayed emptying of the stomach in labor.
• Low ph – danger sign if aspirated following gen.
anesthesia,when needed unexpectedly.
• So,food is withheld during active labor.
• I.V fluid with ringer solution is given where any
intervention is anticipated.
4.BLADDER CARE:
• Bladder should be empty as it often inhibits uterine
contraction and may lead to infection.
• If patient fails to pass urine especially in late first
stage,catheterization is to be done.
15. 5.RELIEF OF PAIN:
Analgesic drug is used : Pethidine 50-100mg i.m
(when the pain is well established in the active phase
of labor)
Metoclopramide 10mg IM is given to combat
voiting due to pethidine.
Pethidine should not be given if delievery is
anticipated .
16. 6.ASSESSMENT OFPROGRESS OF LABOR
AND PARTOGRAPH RECORDING.
2.BLOOD PRESSURE
(Every 1Hrs)
3.TEMPERATURE
(At every 2 Hrs)
4.URINE
OUTPUT(volume,protein
or acetone)
5.ANY DRUG(oxytocin or
other)
1.PULSE
(EVERY 30 MINS)
17. ABDOMINAL PALPITATION
• Uterine contractions: frequency,intensity &
duration.
• Pelvic grip :
1.Gradual disappearance of poles of head(sincipit
&occiput).
2. For descent of fetal head in terms of fifth felt above
the brim is to be used.
• Shifting of maximal intensity of fetal heart
downward & medially.
18. TO NOTE THE FETAL WELL- BEING
• Fetal heart rate : noted every half hour along with
rhythm & intensity.
• Observation should be made immediately following
uterine contraction.(count for 60 seconds)
• Maternal pulse should be counted .
• Normal :110 to 150 per minute.
19. VAGINAL EXAMINATION
• Dilatation of the cervix in cms in relation to hours of
labor.
• To note the position of head & degree of flexion.
• To note the station of the head in relation to ischial
spines.
• Color of the liquor(if membranes are ruptured)
• Degree of molding of the head (occurs at junction
of occipitoparietal bones)
• Caput formation- progressive increase is more imp.
21. CEPHALOPELVIC DISPROPORTION(CPD)
• Refers to the disproportion b/w the head of the
baby & the mother’s pelvis.
• Occurs if fetal head is too large or mother’s pelvis is
small.
• Causes of complications like:
a)prolonged labor
b)fetal distress
c)delayed second stage
22. EVIDENCE OF MATERNAL
DISTRESS
• Anxious look with sunken eyes.
• Dehydration ,dry tongue.
• Acetone smell in breath.
• Rising pulse rate.(100/minute or more)
• Hot,dry vagina with offensive discharge.
• Scanty high colored urine with presence of
acetone.
23. EVIDENCE OF FETAL DISTRESS
• Passage of meconium (fetal stool) in the
liquor amnii.
• Increase in FHR (160/min) or Decrease
to less than 110/min.
• FHR takes long time to come back to
normal.
• Irregularity
