NORMAL LABOUR: NORMAL ANATOMY

NORMAL LABOUR: NORMAL PHYSIOLOGY

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NORMAL LABOUR

FIRST STAGE

SECOND STAGE

THIRD STAGE

LATENT PHASE: 0-4cmACTIVE PHASE: 4-10cm

FULL DILATION TO EXPULSION OF FETUS

BIRTH TO EXPULSION OF PLACENTAExpectant (physiological) vs Active (CCT +OT)

Cervical effacement vs

cervical dilation

Cervix closed, 3 cm long

Cervix effaced, 1 cm dilated

Cervix 5 cm dilated

Cervix fully dilated

FIRST STAGE OF LABOUR: LATENT vs ACTIVE PHASE

MODIFIED WHO

PARTOGRAM

1. Engagement of the fetal head in the transverse position. 2. Descent and flexion of the fetal head.

3. Internal rotation. The fetal head rotates 90 degrees to the occipito-anterior position

4. Delivery by extension. The fetal head passes out of the birth canal head is tilted backwards

5. Restitution. The fetal head turns through 45 degrees to restore its normal relationship with the shoulders, which are still at an angle.

6. External rotation. The shoulders repeat the corkscrew movements of the head, which can be seen in the final movements of the fetal head.

TERMINOLOGY OF VAGINAL DELIVERY

WHAT IS NORMALITY

Term / Preterm / Post dates

Spontaneous rupture of membranes / Prolonged rupture of membranes/Preterm prolonged rupture of membranes

Fetal monitoring during labour: Intermittent fetal auscultation / continous cardiotocograph

Analgesia during normal labour: nothing/birth partner/ TENS/ 1-1 midwifery care/ drugs/ epidural

the Ferguson reflex

Bishop score

WHAT IS NORMAL?Term: 37 completed weeks to 42 weeks gestation Preterm: 24-37 completed weeksPost-dates: after 42 weeks (postmature, prolonged pregnancy, post-term)

SROM = spontaneous rupture of membranes at term

PROM = prelabor or premature rupture of membranes at term (labour doesn't ensue within 24 hours of ROM)PPROM = preterm, premature rupture of membranes

ARM = artificial rupture of membranes (used for labor induction)

Fetal monitoring during normal labour:

Intermittent fetal auscultation

Continous cardiotocograph (CTG)

NothingWaterTENSbirth partner1-1 midwifery careDrugsEpidural

Analgesia during labour

the Ferguson reflex: as pressure on the cervix increases, the Ferguson reflex increases uterine contractions so that the second stage can go ahead.

Bishop score

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