The document discusses normal labour and delivery. It describes the stages of labour including the first, second, and third stages. It explains the interaction between the powers (uterine contractions), passengers (fetus), and passages (pelvis and birth canal). It discusses assessing cervical dilation, fetal position and station, and monitoring the fetus. It also covers managing each stage of labor, identifying abnormal labour, and addressing complications.

1. NORMAL LABOUR
DR KISHWAR
ASSIST PROF GYNAE /OBS
PAK RED CRESCENT MEDICAL AND DENTAL
COLLEGE

2. REGULAR UTERINE CONTRACTION
LEADING TO PROGRESSIVE
DILATATION OF CERVIX AND
DESCENT OF FETUS

3. LABOUR
INTERACTION OF
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4. ANATOMY OF PELVIS
• pelvic inlet
• mid cavity
• pelvic outlet

5. PELVIC INLET

6. MID CAVITY

7. PELVIC OUTLET

8. TYPES OF PELVIS

9. FETAL SKULL
• vault
• face
• base
• SUTURES
• lines formed where individual bony plates
meet
• sutures of skull are soft ,unossified
membranes

10. • FONTONELLES
• junction of various sutures
• ANT FONTANELLE/BREGMA
• POST FONTANELLE

11. FETAL SKULL

12. FETAL DIAMETERS

14. EFFECTS OF FETAL ATTITUDE ON
PRESENTING PART

15. STAGES OF LABOUR
• FIRST STAGE
• SECOND STAGE
• THIRD STAGE

16. MECHANISM OF LABOUR
• ENGAGEMENT
• DESCENT
• FLEXION
• INTERNAL ROTATION
• EXTENSION
• RESTITUTION
• EXTERNAL ROTATION
• DELIVERY OF SHOULDERS AND FETAL BODY

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18. • EFFACEMENT
• It relates to the length of the cervix .It is useful
during latent phase,during induction of
labour,in threatened preterm labour.
It reflects cervical remodelling and is defined
either as cervical length in cm or as no ,partial
or full effacement.
DEFINITION

19. MALPRESENTATION
• anything other than a vertex
• presentation that are not deliverable vaginally
at term will include
• face(mento posterior)
• brow
• shoulder

20. • It is defined in cm.
• full dilatation where no cervix is palpable is
taken as 10 cm
• PRESENTATION:
• is the part of the fetus within the pelvis
adjacent to the cervix .presentation can be
delivered vaginally at term are:
• vertex ,face(mento ant) ,breech
DILATATION

21. POSITION
• it is relationship of the denominatorof the
presenting part of the fetus to fixed points of
the fetus to fixed points of the maternal pelvis
• the denominator is the most definable point
of the presenting part
• occiput for vertex presentation
• sacrum for breech presentation
• mentum for face presentation

22. • fixed points on the maternal pelvis are
• the symphysis pubis anteriorly
• the sacrum posteriorly
• STATION
• of the presenting part relates to descent
within the pelvis .

23. • it is an important part of vaginal
examination
• easiest is to palpate the saggital suture and
note the following
• no moulding
• +1suture together with no gap
• +2 sutures overlap but reduce with gentle
pressure
• +3 sutures overlap but donot reduce with
gentle pressure
MOULDING

24. • CAPUT:
• it is reflection of scalp oedema
• it is seen in prolonged labour but it is
alsoresent in normal labour
• all of the above features should be
represented graphically at every vaginal
examination.

25. LABOUR
• DEFINITION
• STAGES OF LABOUR
• FIRST STAGE ...latent....3-8 hrs
• Active ......2-6 hrs
• 1cm per hr
• SECOND STAGE
• 2hr... primigravida
• 1hr ...multigravida

26. MANAGEMENT OF NORMAL LABOUR
• HISTORY
past obstetrical history, frequency duration and
strength of uterine contraction.
rupture of membrane ,colour and amount of liquor
fetal movements
any medical problem
GENERAL PHYSICAL EXAMINATION
ABDOMINAL EXAMINATION
Presentation,lie , palpation for uterine contraction a

27. VAGINAL EXAMINATION
• cervix is assesed for cervical
dilatation,effacement and application to the
presenting part,condition of membrane
• in normal labour vertex is presenting part and
position is determined by locating posterior
fontanelle
• if posterior fontanelle is not palpable it
indicate prolonged labour.

28. • STATION
• relation of lowest part of head to the ischial
spine
• vaginal assesment of station should be taken
along with assesment of degree of
engagement on abdominal examination.
• if the head is below ischial spine and occiput is
anterior then outlook is favourable for the
vaginal delivery.

29. • condition of fetal membranes should be
assesed .if they have ruptured note the colour
and amount of fluid draining .
• copious amount of clear fluid are good
prognostic feature .
• scanty ,heavy blood stained or meconium
stained is warning sign for fetal compromise.

30. MANAGEMENT OF LATENT PHASE OF
LABOUR
• appropriate analgesia and support should be
offered.
• Most can safely go home come when the
contractions increase in strength and frequency
• patients are encourged to mobilize.
• encouragement and reassurance are extremely
important.
• intervention during this phase should be avoided
• light food and drinking is allowed
• vaginal examination after 4 hrs to determine
whether active phase has been reached.

31. MANAGEMENT OF ACTIVE STAGE OF FIRST
STAGE OF LABOUR
• pulse measured hrly,temp and BP 4
hrly,frequency of contraction after 30 min
• vaginal examination after 4 hr.urine tested for
ketosis and pr.
• progress of labour should be recorded on
partograph.

32. PARTOGRAM
• Graphic record of labour
• it allows an instant visual assesment of rate of
cervical dilatation and comparison with
expected norm so that slow progress can be
recognized early and appropriate actions can
be taken.

35. • mobility is encouraged
• vaginal examination after 4hrs
• 1cm dilatation per hr
• descent of presenting part during each pelvic
examination
• membranes may be intact,may have ruptured
or intact.
• pt should have one to one care

36. • foetal monitoring should be done
• women can drink or have iv fluids tobprevent
ketosis.
• light food is acceptable if no risk factor for
operations
• shaving and enemas are not required
• antacids are required if there are
complications.

37. • Variety of methods of pain relief are available
• ACTIVE MANAGEMENT
• its collection of intervention which was routinely
recommended to nulliparous women to maximize
the chances of normal birth.
• it includes one to one care
• 2 hrly vaginal examination
• early rupture of membranes
• augmentation with oxytocin if slow progress
• only one to one care is beneficial

38. ASSESMENT OF FETAL WELBEING
• observation of colour of liquor
• intermittent auscultTion of fetal heart by
pinard stethoscope,hand held doppler
• continuous external Electronic monitoring
EFM by using CTG
• fetal scalp sampling .

40. • baseline fetal heart 110-160
• variability of 5 to 25 bpm
• accaleartion
• no deceleration
• uterine contraction
• fetal movement

41. • normal CTG
• suspicious CTG
• pathological CTG
FETAL BLOOD SAMPLING
DELIVER THE PATIENT

42. SECOND STAGE
• CROWNING
• delivery of fetus
• neonatal care
• THIRD STAGE OF LABOUR
• signs of placental separation
• active management of third stage of labour
• physiological management of third stage of
labour
• examination of placenta and vulva for tears.

44. ABNORMAL LABOUR
• Labour is abnormal when there is poor
progress and / or the fetus shows signs of
compromise.If there is fetal malpresentation,a
multiple gestation ,uterine scar, induced
labour

45. DEFINITION
• It is defined as cervical dilatation of less then 2
cm in 4 hrs .It is associated with failure of
descent and rotation of head.
• progress in labour is dependent on three
variables .
• powers : efficiency of uterine contractions
• passengers:fetus ,size,presentation,position
• passages:uterus,cervix,bony pelvis.

46. • abnormalities in one or more of these factors
can slow the progress of labour.
• plotting of serial vaginal examination on the
partogram will help to heighlight poor
progress during first stage of labour

47. PROLONGED LATENT PHASE
• During latent phase changes occur in ground
substance ,glycoprotein,collagen content and
hydration state of cervix which result in remodelling
and effacement. during this period women
experience painful contraction and need support.
unnecessary intervention to accelerate labour are
not implemented at this stage. patient should be
reassured and simple analgesia should be given.If
there is any medical indication then induction
protocol should be followed

48. PRIMARY DYSFUNCTIONAL LABOUR
• It is defined as poor progress during the active
phase of labour .
• poor and inco-ordinate uterine activity is
significant factor
• it may culminate in obstructed labour,
maternal infection ,uterine rupture and
postpartum haemorrhage.

49. • optimization of maternal
welbeing.hydration,pain relief
• provision of one to one care
• mobilization
• augmentation with oxytocin
• delivery by caessarian section.

50. SECONDARY ARREST
• cessation of cervical dilatation following
abnormal period of active phase dilatation
• CAUSES
• Cephalo pelvic disproportion(antomical
disproportion between fetal head and maternal
pelvis)
• obstructive hydrocephalus,fetal thyroid,neck
tumours ,malposition esp occipito posterior
position.

51. • CPD is suspected in labour
• if there is slow progress despite efficient
contraction.
• fetal head is not engaged
• vaginal examination shows moulding
• and caput formation
• head is poorly applied to cervix.

52. • CPD is suspected in labour
• if there is slow progress despite efficient
contraction.
• fetal head is not engaged
• vaginal examination shows moulding
• and caput formation
• head is poorly applied to cervix.

53. • oxytocin can be given carefully to
primigravida with mild to moderate CPD as
long as CTG is reactive
• Oxytocin must never be given in multiparous
woman where CPD is suspected.

54. • Tight application of the presenting part on the
cervix is vital to good progress in labour.
• Face presentation may apply poorly to the
cervix and resulting progress is poor although
vaginal birth is possible.

56. THANK YOU

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