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NORMAL LABOR

Labor
-

Parturition or childbirth
Begins with onset of regular uterine
contraction
and ends with delivery of newborn and
expulsion of placenta

Criteria for diagnosis of Labor


1. Uterine contraction (at least 1 in 10 minutes
or 4 in 20 minutes) bi direct observation or
electronically using a cardiotocogram
2. Documented
progressive
changes
in
cervical dilatation and effacement
3. Cervical effacement of > 70-80%
4. Cervical dilatation >3 cm

Characterized
by
functional
and
mechanical changes of the cervix as well
as the uterus to prepare for the labor
process
3. Uterine Phase 2 ( stimulation)
Active labor, incorporate the 3 stages of labor
from the onset of labor to the delivery of the
fetus
4. Uterine Phase 3 ( involution)
Events of puerperium
Uterine involution
Breast feeding is encouraged
Restoration period
-

Physiologic processes involving birthing:


Prelude to childbirth
Preparation for childbirth
Process of childbirth
Puerperium: recovery from childbirth
Theories of parturition
1. Fetal signal
Sufficient maturation of the different organs
of the fetus especially the fetal lung and
brain
would signal the commencement of parturition
2. Progesterone withdrawal
If there is no progesterone, it will cause
smooth muscle contraction and uterine
contraction
3. Prostaglandin
Supported by the increase in levels of
prostaglandin in the maternal plasma and
urine during labor
-

4.
-

Prostaglandin
is a uterotonin and uterotropin

element
causes smooth muscle contraction

Oxytocin theory

Oxytocin facilitate the increase in intracellular


calcium causing smooth muscle contraction

Also responsible for prevention of postpartum


hemorrhage and promotion of uterine
involution and contraction after delivery of the
placenta
Associated with milk ejection during lactation

Phases of parturition
1. Uterine phase 0 (uterine quiescence )
Prior to conception until the initiation
of parturition
Prelude to parturition
Characterized by:
o Uterine contractility
o Unresponsiveness
o Cervix is unyielding and still firm
2. Uterine Phase 1 (activation)
Time of uterine awakening
Prepare patient before labor

UTERINE PHASE 0
Prelude to parturition
Period of myometrial quiescenc
or unresponsiveness
Occurs before implantation until about 3538 weeks AOG
UTERINE PHASE 1
Uterine awakening
Initiation of parturition / preparation
childbirth
Suspension of uterine tranquility
Uterine modification:
Increase myometrial oxytocin receptors
Increase gap junctions

for

Uterine irritability

Responsiveness to uterotonins
Transition from occasional painless to
more frequent contraction
Formation of LUS (counterpart in non
pregnant patient: ISTHMUS)
Cervical softening and ripening

Cervical changes:
Cervix softens, yields and easily dilatable
Cervical ripening (PGE2a, PGF2a, relaxin)

Collagen breakdown
collagen fibers

rearrangement of

Connective tissue/ extracellular matrix

Increase in hyaluronic acid,


increased water
Decrease in dermatan sulfate
o Smooth muscle

Cervical effacement: Primipara vs Multipara


Effacement: obliteration of cervix

Decreased intracellular Ca

relaxation
o Increase
cGMP

intracellular

cAMP

and

uterine relaxation

UTERINE PHASE 3
Events of puerperium
Maternal recovery from childbirth
o

Rigid persistent uterine contraction


prevents postpartum hemorrhage

Uterine involution and restoration to


non-pregnant state (4-6 weeks)
Mothers contribution to infant survival
o Maternal-infant bonding
o Onset of lactogenesis and milk-letdown
Restoration of fertility and ovulation
Dependent on duration of breastfeeding
o Lactation
o Prolactin-induced anovulation
o Amenorrhea
from onset of true labor to full cervical
dilatation (10 cm)
1st
UTERINE STAGE
stage
from full cervical dilatation to expulsion of
the
fetus
2nd
stage FETAL STAGE
from expulsion of the fetus to delivery of
the
placenta

3rd
stage
4th

stage

PLACENTAL STAGE
an hour after the delivery of the placneta

CLINCAL ASPECTS OF LABOR

Cervical effacement : expressed in percent


Average length of cervix: 2-3 cm
Fully effaced( 100%) : paper thin thickness

UTERINE PHASE 2
Process of labor
3 stages of labor

Prodromes labor
Bloody show: extrusion of mucus plug
Lightening: 2-4 weeks before labor
Braxton-Hickscontractions
Weight loss: 1.3 lbs
Urinary frequency
Increased vaginal secretions
Increased backache and sacroiliac pain
Uterine changes
Pain
o Causes:

Biochemical regulation of muscle contraction

- Interaction between myosin and actin


ATPase o
Activation, ATP hydrolysis and force

generation

o Increased intracellular Ca
contraction

Hypoxia

Compression of nerve ganglia in


cervix and LUS
Stretching
of
cervix
(Fergusons reflex)
Stretching of peritoneum

Formation of the:
o Upper uterine segment (UUS): ACTIVE
o Lower uterine segment (LUS): INACTIVE

Uterine
Uterine
activity
Contraction
Thickness
Fibers
Function

activity
UUS(fundus)
Active
Thicker
Shorter
Contracts
Retracts to expel
fetus

LUS
(isthmus)
Passive
Thinner
Longer
Dilates,
expands, thins
out for fetal
expulsion

UTERUS

Contracts

dilates

upper segment
becomes thicker
(actively
contracing)

Shape
o Elongation of uterus (ovoid)

CERVIX

as contraction
occurs , the
hydrostatic
action of
amniotic sac or
the pressure of

Ddecrease horizontal diameter

Straightening of fetal vertebral


column

Longitudinal fibers drawn taut


LUS pulled up

lower segment

the presenting

becomes thinned
out (passive
acontraction)

cervical dilatation

part against the


cervix and LUS
dilates the
cervical canal
like a wedge

NORMAL LABOR
Uterine contraction (UC)
o Check for duration, intensity ,
frequency
o 10
mmhg:
palpation
perception threshold
o 15 mmhg

o
Picture: elongation of the shape of the uterus from
non-pregnant to uterus in labor
Last 2 pictures: formation of physiologic
Bandls ring between UUS and LUS

If exaggerated
pathologic Bandls ring
( deceleration phase)

o
Indicative of obstructed labor
o Present as hourglass appearance of
uterus/ figure of 8
o Corrected by operative delivery (CS) to
prevent uterine rupture

Lower limit of contraction


pressure required to dilate cervix
painful

60 mmhg

Normal spontaneous
contractions

Montevideo units (mmhg)


o

Measure intensity of UC over a 10-minute

period
Equal to average intensity (mmhg) of
UC x number of contraction in a 10
minutes
period
o Good UC: at least 200 Montevideo units
o Measured by a cardiotocogram
o

PATTERN OF FETAL DESCENT


Descent
First requisite to normal childbirth
Occurs at the phase of deceleration
Nulliparas
Engagement before labor onset
(rate) at deceleration: 1 cm/ hour
Multiparas
Engagement during active labor
(rate) at deceleration: 2 sm/ hour
Forces that cause descent:
Pressure of AF

Pressure of fundus on breech


Contraction of abdominal muscles
Straightening/ extension of fetal body

CHANGES IN SHAPE OF THE FETAL HEAD


Caput Succedaneum
-

Fetal scalp immediately over cervical os


becomes edematous in prolonged labors

Formed when the head is in lower portion of


birth canal and after the resistance of a rigid
vaginal outlet is encountered
Develops over the most dependent area of
the head

CARDINAL MOVEMENT OF LABOR


Engagement, descent, flexion, internal
rotation, extension, external rotation,
expulsion

Molding
Overlap of flat bones of vault of skull due
to compression of head during labor
leading to alteration in its shape
Results in a shortened
suboccipitophregmatic diameter and a
lengthened mentovertical diameter
Usually resolve within a week following delivery
Cephalhematoma
More pathologic fetal shape change
Subperiosteal
hemorrhage
due
accumulation of blood

to

CONDUCT OF LABOR
Identification of labor
Criteri
a
Contracttions
a. Frequency
b. Interval
c.

Intensity

Discomfort
Cervix
Sedation

1.
2.

3.
4.
5.
6.

7.

Head floating before engagement


Engagement when the biparietal diameter
has reached the pelvic inlet. There is flexion
when there is the fetal chin is in close
proximity with fetal thorax.
Further descent, there will be internal rotation
where occiput will move towards symphysis
pubis anteriorly
Extension
Further extension will lead to external rotation
Restitution wherein there will be further rotation
of fetal body. The biacromion diameter would
then bring this to the AP diameter of the pelvic
outlet.

Follow the AP diameter when delivering


the shoulders by pulling it downward.
a. Anterior shoulder: pull downward
b. Posterior shoulder: pull upward

True labor

False labor

Regular
Gradually
Shortening
Gradually
Increasing
Back,
abdomen
Dilates
Doesnt stop
discomfort

Irregular
Remains long
Unchanged
Lower
abdomen
Doesn/t dilae
Relieves
discomfort

History and PE
o Vital signs: BP, PR, RR,
temperature o FH, FHT
o Leopoldd maneuver
o Uterine
contarctions:
frequency, intensity, duration
o IE
IE/ Vaginal exam
o Cervical effacement and dilatation
o Cervical position in the vaginal canal
o Descent position of presenting fetal pole

o
o
o

Determine station of the

presenting part
Pelvic adequacy by pelvic
pelvimetry and probably assess
pelvic type
Statis of BOW
Station
Level to which the
presenting part has
descended into maternal
pelvis (BPD)

ischial

spine

Timing based on character of


contactions

Avoid frequent IE for those


with ROM because of
increased ascending infection
But spontaneous ROM
in unengaged
presenting part
warrants IE to rule out
cord prolapse
With effective contractions, the
cervix dilates 1-2 cm/hr

Effacement affects
dilatation because a
thinned out cervix dilate
faster than uneffaced cervix
Fetal monitoring

CTG: 110-115 beats/ min

Stethoscope: 120-160 beats/ min

Take FHR every after


contractions
Get baseline CTG

Monitoring of fetal well being

Auscultation (Doppler
or fetal stethoscope)
Electronic fetal

st

1 stage
nd
2 stage
-

monitoring
provides precise
information about
FHT behavior in
relation to uterine
contractions
FHR checked
immediately after
a contraction
Low risk
High risk
Every 30 mins
Every 15 mins
Every 15 mins
Every 5 mins

Preparation of vulva and perineum


o Routine
perineal
shaving
delivery

(+) if lower than ischial spine

Subsequent vaginal exams

Landmark:
(station 0)

before

Shaving the pubic hair of women


in labor is done routinely before
birth as a hygienic practice in
some settings

Aim to minimize infection risk


if there is tearing or cutting od
the area between the vagina
and anus during birth process
Shaved area may make
stitching tears or cuts
easier

Enema (not really recommended)


o Decrease risk puerperal and neonatal
infections
o Shorten duration of labor
o Make
delivery
cleaner
for
attending personnel
Laboratory tests to request

Hb, Hct, urinalysis, blood typing, test


for syphilis, Hep B, HIV, Rh, antibody
screening for atypical antibodies

INTRAPARTUM NUTRITION
Oral food and fluid withheld during active
labor and delivery
Delayed gastric emptying time may cause
gastric contents to be vomited out and
aspirated during course of labor especially
when sedated
Diet of easy-to digest foods and fluids
during labor
IVF to treat or prevent dehydration,
ketosis, electrolyte imbalance
Mendelsons syndrome
o Aspiration of stomach contents into
the lungs during anesthesia
secondary to delayed gastric
emptying in labor
MATERNAL POSITION DURING FIRST SATGE OF
LABOR
- Walking and upright positions o
Reduce length of labor
o Do not seem to be associated with
increased intervention or negative
effects on mothers and babies
well being
Take up whatever comfortable position
o Left lateral decubitus position

Provides maximal blood flow to

the baby
Restriction of activity for those with
ROM to prevent cord prolapse or when
sedation is administered

ANALGESIA AND ANEDTHESIA DURING LABOR


Ideal labor analgesia technique
st
nd
Reduce pain in 1 and 2 stage of labor
Not interfere with labor progress
Devoid of unwanted side effects
Techniques
Systemic
opiods
(Meperidine,
Nalbuphine, Butorphanol)
Neurazial analgesia (epidural and
spinal) o Spinal analgesia
Pudendal block
Initiated based on discomfort of patient who is:
In active phase of labor
With contractions of established pattern
Timing, route, dose and choice of agent should
be based on need to allay pain and likelihood
of delivering awake undepressed infants
Impress to the patient however that labor
pains are also physiologic
BLADDER FUNCTION
Bladder distention should be avoided because
it may cause:
o
Obstructed labor

o Bladder hypotonia
o Urinary stasis with subsequent
infection
AMNIOTOMY
- Artificial rupture of membrane

- Active phase of labor >5cm and if the


presenting part is engaged
- There Is release of prostaglandin
Uses:
- Speed up contraction and shorten length of
labor
- Assess status of fetus
- Increases labor contractions, improves labor
progress
Clinically indicated to observe color and
- amount
of amniotic fluid
Possible complication
Risk of chorioamnionitis
Umbilical cord prolapse: most immediate
Cord compression
Fetal heart rate decelerations
Increased
ascending
infection
rate,
bleeding from fetal or placental vessels and
discomfort from actual procedure
ACTIVE MANAGEMENT OF LABOR (AMOL)
Nulliparous female
1. AROM
Detection of painful uterine contractions,
passage of bloody show, complete
cervical effacement
2. Oxytocin drip if cervical dilatation is <1 cm/
hr (hastens labor)
MONITORING LABOR PROCESS
Labor curve
Friedmans labor curve or WHO parotgram
Friedmans curve: used in our institution
2 major events in labor:
1. Cervical
effacement
and
dilatation
(Sigmoid curve)
2. Fetal descent through birth
canal (Hyperbolic curve)
PHASES OF LABOR
Latent phase
o From onset of labor
o Slow rate of cervical dilatation: 0.6
cm/hr
Active phase
o Faster dilatation
o Multipara: 1.5 cm/hr
o Primipara: 1.2 cm/hr
o Divided into:

Acceleration phase

Predictive
outcome of labor
3-4 cm to 5 cm

Maximum slope

of

Overall efficiency
of machine
Rapid rate of dilatation

Deceleration
Feto-pelvic relationship
Cervix: 9cm to
full dilatation
Phase where descent
problems are
diagnosed

Latent phase
starts from onset
of uterine
contraction 0.6

cm/hr

Active phase

starts at 3-4 cm
cervical
dilatation

mulliparas: 20 hrs

not responsive to
sedation

multipara: 14 hrs

nullipara: 1.2
cm/hr
multipara: 1.5
cm/hr

Functional division of labor


Characteristic
Preparatory
Division
Functions
Contractions coordinated,
polarized, oriented; cervix
prepared
Interv
al
Latent and acceleration
phases
Measurement
Elapsed duration
Diagnosable
disorders

Prolonged latent phase

Dilatational
Division
Cervix actively dilated

Pelvis division
Pelvis negotiated; mechanism of
labor; fetal descent; delivery

Phase of maximum slope Deceleration phase and second


stage
Linear rate of dilatation
Linear rate of descent
Protracted dilatation;
protracted descent

Prolonged deceleration; secondary


arrest of dilatation; arrest of
descent; failure of descent

Acceptable or Normal Values (Important table)


Mean cervical dilatation prior to onset of labor
Duration of latent phase of labor
Rate of cervical dilatation in the max slope
Duration of the deceleration phase (starts at 8.5 or 9 cm cervical
dilatation)
Without sedation/ analgesia
With sedation/ analgesia
Rate of descent of the presenting part (during the deceleration phase)

Primipara
1.8 cm
20 hrs
1.2 cm/hr

Multipara
2.2 cm
14 hrs
1.5 cm/hr

2hrs
3 hrs
1cm/hr

1hr
2hrs
2cm/hr

Bishops score
FACTORS
Scor
e
0
1
2
3

Dilatatio
n
(cm)
Closed
1-2
3-4
5-6

Effacement
(%)
0-30
40-50
60-70
80

Station
-3
-2
-1, 0
+1, +2

Cervical
consistency
Firm
Medium
soft

WHO PAROGRAM
Simplified partograph (2003)
Divided into 3 color (green, yellow and red)

Position of
cervix
Posterior
Mid
Anterior

Score =/<4: unfavorable cervix


Score +/>6: high probability for
vaginal delivery

Mean cervical dilatation should not be lower


than 1 cm/hr

ASSESSMENT OF STATION

Important

Start of cervical dilatation and active phase


of labor is usually at 3-4 cm dilatation
Latent phase should not be longer than 8 hrs

Alert line
In the active phase of labor, plotting of cervical
dilatation will normally remain on, or to the lest
of, the alert line
Moving to the right of the alert line is a
warning that labor may be prolonged. The
woman may have to be transferred to a
tertiary facility
Action line
The action line is 4 hours to the right of the
alert line
If the labor reaches this line, woman lust be
carefully reassessed to determine the possible
reason for lack of progress and a decision
made on further management
Plot cervical dilatation (X) fetal head descent (0)
Normal partograph

Improved fetal alignment


Larger
anterior,
posterior
transverse pelvic outlet
Alternative methods of bearing down
o
o

No evidence that the rate of adverse perineal


outcomes is affected by different types of
nd
bearing down during 2 stage of labor

o Sustained breath holding or Valsalva


maneuver
o
Exhalatory method of pushing
EPISIOTOMY AND REPAIR
Purpose:
o Facilitate second stage of labor
to improve maternal and
neonatal outcome
Maternal benefit
o Reduced risk of:

Urinary and fecal incontinence


Sexual dysfunction

Median
Easy
Rare
Minimal
Excellent

Mediolateral
More difficult
More common
Common
Occasionally faulty

Less
Rare

More
Occasional

Common

common

descent of

Duration
o
Nullipara: 50 min
o Multipara: 20 min
Preparation for delivery
o Dorsal lithotomy
o Vulvar and perineal cleansing
o Sterile draping
o Scrubbing gowning, gloving

Maternal position during second stage of labor


Upright vs Recumbent
Upright position:
o Sitting (obstetric chair/ stool)
o Semi-recumbent (trunk tilted
backward 30 degree to the vertical)
o Kneeling squatting (unaided or
using squatting bars)
o Squatting aided with birth cushion
-

Subsequent pelvic floor


dyscfunction and prolapse

Management of second stage


Spontaneous delivery
o Delivery of head

Management
Identify: full cervical dilatation
Patient begins to bear down
presenting part

Perineual trauma

Fetal benefit
nd
o Shortened 2 stage of labor

Surgical repair
Faulty
Post-op pain
Anatomical
result
Blood loss
Dyspareunia
Rectal
extension

and

Benefits of upright position


o May be related to gravity
o Less aortovagal compression

Cardinal movement of labor


Crowning
Episiotomy

Modified Ritgens maneuver


o Delivery of shoulders and rest of body

Delivery of Head
With each contraction:
o Perineal opening becomes ovoid
to
circular
with
progressive
dilatation
o Perineum stretched to almost paperthin
o Rectal opening stretches
Crowning
o Stage where fetal head is encircled
by vulvar ring and failure to perform
episiotomy invites perineal
laceration
Ritgens maneuver
o When
vulvar
opening
reaches
diameter of 5 cm, a towel-draped hand
is used to exert forward pressure on
the chin of the fetus thru the perineum
o Other hand exerts pressure on
the pcciput

Allows control of the delivery of the


head with extension so that the
smallest diameter of the head passes
over the introitus
Head delivered slowly with base of
occiput using the symphysis pubis
as fulcrum

Fetal nasopharyngeal clearing


o Wipe face, nares and throat of the
fetus quickly after delivery of the
head to prevent likelihood of
aspiration of amniotic fluid or blood
Nuchal cord
o A finger should be passed over the
neck of the fetus to detect presence of
nuchal cords (umbilical cord loops
around the neck) 025% of
pregnancy
o If loose- cord is passed over the
fetal head
o If tight cord quickly clamped and
cut and fetus promptly delivered

Delivery of shoulders
Occurs
spontaneously
when
transverse
diameter of thorax moves into the AP position
If delay in delivery occurs, head is grasped
with the hands placed over the ears and
hooked on the mandible
Gentle downward traction is done until the
anterior shoulder is delivered then upward
movement is done to deliver posterior
shoulder, then the rest of the body follows.

Delivery of the body


1 hand remains to support fetal head and
another hand is slid along back in order to
grasp the feet as they appear
Fetus held with head directed downeards
to promote drainage of secretions
If infant held at or below level of introitus,
for 3 minutes, additional 80cc of blood is
transferred from mother to fetus = 50mmhg
enough to prevent IDA later in infancy
Cord clamping
Milking of cord towards the baby prior to
clamping also gives additional blood of
fetus
Clamp cord halfway between mother and
fetus,
5cm from babys umbilicus, then cut
between clamps
After which dry and wrap the baby.
THIRD STAGE OF LABOR
Definition:
rd
o 3 stage of labor: commences with
the delivery of the fetus and ends
with delivery of the placenta and its
attached membranes
Duration:
o Normally 5 to 15 minutes
o 30 minutes have been suggested if
there is no evidence of significant
bleeding
Characterized by uterine retraction
and placental separation

Methods of placental separation


Schultze method
o Placenta separates in the center and
folds in on itself(80%), as it descends
into the lower part of uterus

Fetal surface appears at vulva


with membranes trailing behind
o Minimal visible blood loss as
retroplacental clot contained
within membranes (inverted sac)
Duncan method
o Separation starts at the lower edge of
placenta
o (20%) lateral border separates
o Maternal surface appears first at vulva
o

Usually accompanied by more bleeding


from placental site due to slower
separation and no retroplacental clot

Signs of placental separation (Matching tyoe)


Uterus becomes globular and firmer
(Calkins sign)
o Occurs as placenta descends into the
LUS and the body of the uterus
continues to retract
Sudden gush of blood
o

The retro placental clot is able to escape


as the placenta descends to the LUS

Uterus rises in the abdomen (Schroders sign)


o Because the placenta, having
separated, passes down into the LUS
and
vagina
o Its bulk pushes the uterus upward
Lengthening of the cord (Ahlfelds sign)

Management of third stage


Wait for signs of placental separation
Deliver placenta
o Spontaneous
o Maneuvers:

Manual removal of retained placenta


Check placenta and membranes
o For completeness and normality
o Abnormal placenta: succentriate lobe

Brandt- Andrews
Modified Credes

Manual removal
Active management of third stage
o Oxytocin
+
ergometrine
controlled cord traction

Brandt-Andrews maneuver
Traction is extended on the cord as the
uterus is elevated gently
Pressure exerted between the symphysis
and uterine fundus, forcing the uterus
upward and placenta outward, as traction
on the cord is continued

Active management of the third stage of labor


Prophylactic use of uterotonic drugs
o Oxytocin,
ergonovine,
methylergonovine
Early umbilical cord clamping and cutting
Controlled cord traction for delivery of
the placenta
FOURTH STAGE OF LABOR
The hour immediately following delivery
Note for postpartum hemorrhage
o Cause: uterine atony
Placenta, memebranes, and umbilical
cord should be examined
Uterus and perineum evaluated
Early breastfeeding
st
Exclusive breastfeeding for the 1 6 months of
st
life and should be continued for at least 1
year of life should be continued for as long as
mutually desired by mother and child
BP and PR must be recorded immediately
after delivery and every 15 minutes for the
first hour (American Academy of pediatrics
and the American College of Obstetricians
and gynecologist (2007)
Uterine firmness attained by gentle uterine
massage, ice packs over hypogastrium,
bladder emptying, uterotonic agents
Assess for retained blood clots in uterine
cavity
or
unrepaired
vaginal/
cervical
lacerations
Inspect for perineal lacerations:
st
o 1
degree: fourchettes, perineal
skin, vaginal mucosa
nd
o 2 degree: 1 + fascia
o 3rd degree: 2 + anal sphincter
th
o 4 degree: 3 + rectal mucosa
Inspect for hematoma formation
Uterotonic agents
Agents
which
stimulate
myometrial
contractions
Oxytocin
o Gives as IV infusion and NEVER in bolus
o To prevent marked fall in arterial BP
and cardiac output

To prevent antidiuresis caused

by reabsorption of water
water intoxication
Ergot derivatives:
o Ex:
methylergonovine,
methylergometrine

o
o
o

Given IV/ IM/ orally


Produce
tetanic
uterine
contractions that last for hours
Not given for those with HPN or
cardiac disease

SUMMARY
Obstetric care is unique, it concerns 2
individual the mother and her unborn child
Timely intervention based on sound
judgment and application of honed skills
may spell the difference between a
successful birth and catastrophe
The obligation of the obstetrician is clearthe responsibility great and the rewards of
success immeasurable.

PLOTTING THE PARTOGRAM USING THE


FRIEDMANS CURVE
CASE 1
M.A 25 years old G1P0, 40 weeks AOG
-

Since 4 hours PTA


on and off hypogastric
and lumbosacral pains, mild, 10-20 minutes
interval (start of labor)

1 hour PTA
moderate pains, 5-6 minutes
interval, 30 -40 second duration

Admission
IE: cx 4cm, 80%, soft, midline, vertex,
LOT, station 0, BOW (+)

Labor progress

1 hour after
cervix 5cm, 80%, soft,
anterior, vertex, station 0, BOW (+)

2 hours after
cervix 7 cm, 90%, soft,
anterior, vertex, station 0, BOW (+)

3 hours after
cervix 9 cm, 100%, soft,
anterior, vertex, station 0, BOW (+)

1 hour after
BOW ruptures spontaneously:
cervix fully dilated and effaced, vertex

30 mins later

5 mins later
placental delivery, with
membranes presenting

SVD live baby boy, 3.2 kg

Cervical dilatation: follows a sigmoid curve


(X) Station: hyperbolic curve (O)
st
1 X: start at 1.8 because she is primip
(refer to acceptable normal values table)
CASE 2
W.T, 30 y/o, G3P2 (2002), 38 weeks
4 hrs PTA regular UC, every 5-10 min, 30
sec, moderate
IE on admissioin: 3 cm, 60%, cephalic, st-1,
intact
BOW
After 2 hrs: 5 cm, 70 %, cephalic, st-1, (+)
BOW
After 2 hrs: 7 cm, 80 %, cephalic, st 0, (+) BOW
After 2 hrs: 8 cm, 90 %, cephalic, st 0,
amniotomy done
After 1 hr: fully dilated, fully effaced st +1, (-)
BOW
Afetr 1 hr: fully dilated, effaced st +3, (-) BOW
to
DR
After 20 mins BABY OUT
After 10 mins PLACENTA OUT

Cervical dilatation follows a sigmoid curve


(X) Station: hyperbolic curve (O)
Stats at 2.2 cm because she is a multip