Physiology of Labor

Parturition
Phase 1 of Parturition: Uterine Quiescence
and Cervical Softening
 Uterine Quiescence : myometrial unresponsiveness of
phase 1 continues until near the end of pregnancy
 Some low-intensity myometrial contractions are felt
during the quiescent phase, but they do not normally
cause cervical dilatation.
 Contractions of this type become more common toward
the end of pregnancy, especially in multiparous women,
and are referred to as Braxton Hicks contractions or false
labor
Cervical Softening

Cervix has multiple functions during pregnancy :

 (1) maintenance of barrier function to protect the
reproductive tract from infection,
 (2) maintenance of cervical competence despite
increasing gravitational forces,
 (3) orchestration of extracellular matrix changes that
allow progressive increases in tissue compliance
 Softening—> an increase in tissue compliance, yet the cervix
remains firm and unyielding -> The end of pregnancy, the
cervix is easily distensible, and its consistency is similar to
the lips of the oral cavity
 Cervical softening results from increased vascularity, stromal
hypertrophy, glandular hypertrophy and hyperplasia, and
slow, progressive compositional or structural changes of the
extracellular matrix
Phase 2 of Parturition: Preparation for
Labor
 Uterine awakening or activation- >the myometrial tranquility of phase 1
of parturition must be suspended
 Phase 2 is a progression of uterine changes during the last 6 to 8 weeks
of pregnancy
Myometrial Changes :
 Contraction associated proteins (CAPs) include the oxytocin receptor,
prostaglandin F receptor, and connexin 4
 Myometrial oxytocin receptors markedly increase along with
increased numbers and surface areas of gap junction proteins
such as connexin 43
 These lead to increased uterine irritability and responsiveness to
uterotonins—agents that stimulate contractions
 Formation of the lower uterine segment from the isthmus
 The fetal head often descends to or even through the pelvic
inlet—so-called lightening -> “Baby Drop”
 Cervical ripening -> cervical yielding and dilatation upon initiation of
forceful uterine contractions. Cervical modifications during this second
phase principally involve connective tissue changes
 The transition from the softening to the ripening phase begins
weeks or days before onset of contractions
 The total amount and composition of proteoglycans and
glycosaminoglycans within the matrix are altered
Phase 3 of Parturition: Labor
 The first stage begins when spaced uterine contractions of suficient
frequency, intensity, and duration are attained to bring about
cervical thinning, or effacement.
 This labor stage ends when the cervix is fu lly dilated—about 10
cm—to allow passage of the term-sized fetus. The first stage of
labor, therefore, is the stage of cervical effacement and dilatation
 The second stage begins when cervical dilatation is complete and
ends with delivery. Thus, the second stage of labor is the stage of
fetal expulsion.
 the third stage begins immediately after delivery of the fetus and
ends with the delivery of the placenta. Thus, the third stage of
labor is the stage of placental
separation and expulsion
Phase 4 of Parturition: The
Puerperium
 Immediately and for about an hour or so after
delivery, the myometrium remains in a state of
rigid and persistent contraction and retraction
 Uterine involution and cervical repair, both
remodeling processes that restore these organs to
the nonpregnant state, follow in a timely fashion
PHYSIOLOGICAL AND BIOCHEMICAL
PROCESSES REGULATING PARTURITION
 The functional
loss of pregnancy
maintenance
factors
 Synthesis of
factors that
induce parturition
SUMMARY
THANK YOU