1. Dr. Yin Moe Han
Senior Lecturer
Obstetrics & Gynaecology Department
School of Medicine, UCSI University

2. NORMAL LABOUR
 normal, mature, alive
 vertex presentation
 spontaneous expulsion
 per vaginum
 within 24 hours
 without complications
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4. STAGES OF LABOUR
First stage of labour
Second stage of labour
Third stage of labour
Fourth stage of labour
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5. FIRST STAGE OF
LABOUR
onset of labour
8-12 hours
full dilatation of the cervix (10 cm)
Latent Phase –--- 0 – 3 cm
Active Phase –--- 4 – 10 cm
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6. SECOND STAGE OF
LABOUR
full dilatation of the cervix
up to 1 hour
birth of the foetus
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7. THIRD STAGE OF
LABOUR
birth of the foetus
5 - 15 mins not > 30 mins
delivery of placenta and
membranes
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8. FOURTH STAGE OF
LABOUR
UP TO 2 HOURS AFTER DELIVERY
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10. DIAGNOSIS OF
LABOUR
1. Diagnosis and confirmation of labour
2. Diagnosis of stage and phase of labour
3. Assessment of engagement and descent of the fetus
4. Identification of presentation and position of the fetus
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11. DIAGNOSIS AND CONFIRMATION OF
LABOUR
 Suspect or anticipate labour if the woman has :
 Intermittent abdominal pain
 Associated with blood-stained mucus discharge (show)
 Watery vaginal discharge or a sudden gush of water
 Confirm the onset of labour if there is :
 Cervical effacement—the progressive shortening and thinning of
the cervix during labour
 Cervical dilatation—the increase in diameter of the cervical
opening measured in centimetres
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12. EFFACEMENT AND DILATATION OF THE
CERVIX
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13. DESCENT
Abdominal palpation
Descent of the fetal head
 Assess descent
 in terms of fifths of fetal
head palpable above the
symphysis pubis
 Head entirely above the
symphysis pubis
 five-fifths (5/5) palpable
 Head entirely below the
symphysis pubis
 zero-fifths (0/5) palpable
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15. MECHANISM OF NORMAL
LABOUR
Cardinal movements of labour (LOA)
Engagement and Flexion Internal rotation to OA
descent
External rotation Restitution Extension
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16. ENGAGEMENT AND
DESCENT
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17. FLEXION
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18. INTERNAL ROTATION TO
OA
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19. EXTENSION
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20. RESTITUTION
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21. EXTERNAL
ROTATION
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22. DELIVERY OF ANTERIOR
SHOULDER
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23. BODY BORN BY LATERAL
FLEXION
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25. ASSESSMENT OF PROGRESS OF
LABOUR
 latent phase
 measuring changes in cervical effacement and dilatation
 active phase
 measuring the rate of cervical dilatation and fetal descent
 second stage
 assessing further fetal descent
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26. PROGRESS OF THE FIRST STAGE OF
LABOUR
 Plot on a partograph
once the woman enters
the active phase of
labour.
 Alternatively, plot a
simple graph of cervical
dilatation (cm) on the
vertical axis against time
(hours) on the horizontal
axis.
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27. VAGINAL
EXAMINATIONS
 1st stage of labour - 4 hourly  Cervix not dilated on 1st VE
 may not be possible to
 2 stage of labour - hourly
nd
diagnose labour
 After rupture of the membranes  If contractions persist
 Record following after each VE  re-examine the woman
 colour of amniotic fluid after 4 hours for cervical
 cervical dilatation changes
 descent (can also be assessed abdominally)  if there is effacement and
dilatation, the woman is in
labour
 Plot the findings on partograph  if there is no change, the
diagnosis is false labour
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28. Tha nk You
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