Cervical dilatation

• centrifugal pull exerted on the cervix creates cervical dilatation

• the hydrostatic action of the amniotic sac or presenting part ( if membranes are
absent) dilates the cervical canal like a wedge

Cervical effacement
• is the obliteration or taking up of the cervix
• it is manifested clinically by shortening of the cervical canal from a length of
approximately 2 cm to a mere circular orifice with almost paper thin edges
• effacement causes expulsion of the mucus plug as the cervical cancal is shortened
 Stages and phases of Normal Labor
Although labor is a continuous process, it is divided into four functional stages because each has
differing physio- logical activities and requires differing management.

•The first stage of labor is the interval between the onset of labor and full cervical dilation (10
cm). The first stage is further divided into two phases:

• (1) The latent phase of labor encompasses cervical effacement and early dilation, and

•onset of labor to about 3-5 cm dilatation

Prolonged latent phase:

Nullipara > 20hrs

Multipara > 14hrs

•(2) the active phase of labor, during which more rapid cervical dilation occurs, usually begin
ning at approximately 4 cm up to full dilatation
The second stage of labor encompasses complete cer-vical dilation
through the delivery of the infant.

• The third stage of labor begins immediately after delivery of the

infant and ends with the delivery of the placenta.

•The fourth stage of labor is defined as the immediate postpartum

period of approximately 2 hours after delivery of the placenta, during
which time the patient under- goes significant physiologic adjustment.
4. Management

1st stage of labor: latent phase

•monitoring fetal well being during labor
•uterine contractions
•maternal VS 1st stage of labor: latent phase
• monitoring fetal well being during labor
•subsequent vaginal exam •• uterine contractions
maternal VS

•oral intake • subsequent vaginal exam

• oral intake
• IV fluid
•IV fluid • maternal position
• analgesia
•maternal position • amniotomy
• urinaary bladder fxn

•analgesia
•amniotomy
•urinaary bladder fxn
5. Steps of Vaginal delivery beginning with cardinal movements.

The mechanisms of labor (also known as the cardinal movements of

labor) refer to the changes of the position of the fetus as it passes
through the birth canal.

The fetus usually descends to where the occipital portion of the fetal
head is the lowermost part in the pelvis, and it rotates toward the largest
pelvic segment.
1. Engagement
2. Flexion
3. Descent
4. Internal rotation
5. Extension
6. External rotation or restitution
7. Expulsion
Engagement is defined as descent of the biparietal diameter of the
head below the plane of the pelvic inlet, sug- gested clinically by
palpation of the presenting part below the level of ischial spines (zero
station).

• Engagement commonly occurs days to weeks prior to labor in women

who have not delivered a child, whereas in women who have had
children it more commonly happens at the onset of active labor. In any
event, the importance of this event is that it suggests that the bony
pelvis is adequate to allow significant descent of the fetal head,
although the extension of this to the idea that delivery through the
pelvis will happen in the labor does not follow.
Flexion of the fetal head allows for the smaller diameters of the fetal
head to present to the maternal pelvis

Descent of the presenting part is necessary for the successful

completion of passage through the birth canal. The greatest rate of
descent occurs during the latter portions of the first stage of labor and
during the second stage of labor.

Internal rotation, like flexion, facilitates presentation of the optimal

diameters of the fetal head to the bony pelvis, most commonly from
transverse to either anterior or posterior.
Extension of the fetal head occurs as it reaches the introi- tus. To
accommodate the upward curve of the birth canal, the flexed head now
extends.

External rotation occurs after delivery of the head as the head rotates
to “face forward” rel- ative to its shoulders. This is known as
restitution, followed rapidly by delivery of the body, expulsion.