NORMAL LABOUR

Fengquanling 封全灵
Department of Obsterics
and Gyncology, the Third
Affiliated Hospital, Zhengzhou
University, Zhengzhou
Fenmian
Labor (The physical efforts of childbirth)
Parturition
Delivery (The act of giving birth)
 LABOR
Labor is the process of birth.
The process from the onset of
parturition to expulsion of the
fetus and placenta after full 28
weeks of pregnancy is called
labor.
 Delivery

It is a process that the uterus

contracts to expel the fetal and
accessory of the fetal (including
placenta, cord and membranes)
from its cavity.
the premature delivery The pregnant
age is full of 196 days (28 weeks) and less
than 259 days (37 weeks ) .
the term delivery The gestational age is
full of 259 days (37 weeks) and less than
294 days (42 weeks ).
the post term delivery The age is full
of or more than 294 days (42 weeks ).
 premature term postterm
LMP

0 12 28 37 40 42
First trimester second third

Gestational age (week)

The four factors affect delivery
1. powers uterine muscle
(or forces) abdominal muscles
diaphragm muscle
2. birth canal soft & pelvis
3. fetus size position shape
4. mental & psychological
 The character of uterine
contraction
 rhythmicity
(regular or intermittent pattern)
 symmetry & polarity
 retraction
 rhythmicity

marker
polar

progressive retrograde

the interval

the duration the duration

 Normal uterine contraction

Duration (second) Interval (minute) intensity

Weak
Latent 30~40 5~6
avtive 40~50 2~3
Second 60 or more 1
Strong
Symmetry & Polarity
uterotubal
junction

Strong

Weak
 Retraction

large small

In labour when the muscle fibres relax

they do not return to their former length
but become progressively shorter.
 Cervical effacement &
Physiological retraction ring

protuberant smooth

Isthmus be distend and forms the lower segment

 Cervical effacement & dilatation
---in nullipara

Cervical effacement takes place before cervical dilatation

Cervical effacement & dilatation
---in multipara

Cervical effacement and dilatation occur at same time

nullipara multipara
Pelvic inlet plane
Anteroposterior
diameter (11cm)

Transverse
diameter (13cm)

Left oblique
diameter (12.75cm)

Which is the longest?

mid plane of pelvis
Pelvic outlet plane

9cm

11.5cm
 front
back

back
axis of pelvis inclination of pelvic
The soft birth canal

Soft tissue of pelvic

floor
 occipital

Fetus parietal

The fetal skull &

frontal
Diameters of the
fetal skull

temporal
 Fetus
The sagittal suture
The frontal suture
The coronal suture
plastic
The anterior fontanelle
(or bregma) (rhombic)
The posterior fontanelle
(triangular )
 Diameters of
the fetal skull
suboccipitobregmatic
diameters (9.5 cm )
occipito-frontal
diameter (11.3 cm )
mentovertical
(13.3cm)
biparietal diameter
(9.3 cm. )
 Three stages of labour
First stage (of cervical dilatation)……
Start to full dilatation of the cervix
Second stage (of expulsion of fetus)……
full dilatation to birth of baby
Third stage (of expulsion of placenta) ……
birth of baby to delivery of placenta
 Partograms

Latent phase Active phase

 Normal time of three stages
First stage ……
takes about 11~12 hours in n &6~8h in m
Second stage (of expulsion of fetus)……
1~2h & minutes or 1h
Third stage (of expulsion of placenta) ……
5~15m, less than 30m
 The mechanism of labour

The mechanism of labour is the series

of passive movements of the baby,
particularly its presenting part, as it
descends through the birth canal.
 The mechanism of labour
Engagement
Flexion
Descent
Internal rotation
Delivery
Extension
Restitution & External rotation
 Indication of labor
Show
sign False labor
lightening
 Diagnosis of labour
True labor False labor
 Regular • Irregular
contractions contractions
 ‘Show’ • No ‘Show’
 Progressive • No progressive
dilatation and dilatation and
Effacement of effacement of cervix
cervix
 ‘Show’
A little blood and mucus
discharged from the vagina.
This is from separation of the
membranes at lower pole causing
bleeding which mixes with the
mucus of the cervix and vagina.
 Show &
formation of fore-waters

just
 Diagnosis of labor
Progress in labour is gauged by
 Increasing strength, frequency
and duration of uterine contractions
 Dilatation of the cervix
 Descent of the presenting part
Dilatation of the cervix
Descent of the presenting part

negative

positive Ischial spine

Descent of the presenting part
 Management of labour
------Care of mother & baby
 Diet, Pulse rate, Blood pressure, Urination,
Defecation,psychology, shave&wash perineum
Take rectal & vaginal examination
Progress (dialatation & descent)
Close monitoring of FHR
Draw partogram
Preparation for delivery
Partograms
Deceleration---sign of hypoxia

Monitoring paper
monitoring of FHR
mons pubis

labium

perineum

Wash and sterilize

 Episiotomy

lateral episiotomy median episiotomy

Delivery
Managrment of umbilical cord
delivering
 Apgar scoring system
sign 0 1 2

heart rate absent slow(below100) over 100

respiration absent slow&irregular good,crying

muscle tone flaccid some flexion of active motion

extremities
reflex no grimace vigorous cry
irritability response
color of skin blue pale body pink,extremities complete
blue pink
 Separation sign of placenta

umbilicus

•Globular,firmed,elevated fudus •A little of bleeding

•Cord protrude further •Don’t recede any longer
Assistance to delivery of placenta

Clockwise or reversely rotation

thanhs
Engagement
The mechanism by which
the biparietal diameter
passes through the pelvic
inlet with the lowest point
of fetal skull apprpaching
or reaching to the level of
ischial spine is designated
engagement.
 Flexion

resistance
Internal rotation
 Extension
Symphysis pubis

bregma

margin of the perineum

Restitution & External rotation
Descent
Delivery