DR. RAZAQ O. MASHA,FRCOG

Asst. Prof. & Consultant

FIRST STAGE:

Labour is the onset of regular uterine contractions with progressice effacement and dilatation of the cervix and descent of the presenting part.

PRE-LABOUR OR LATENT PHASE:

Period of increased uterine activity that occurs for a few weeks before active labour.

facilitates softening of the cervix

some cervical effacement

some dilatation

expansion of lower uterine segment

“Show” OR BLOODY SHOW Discharge from the vagina of blood tinged

mucus (extension of mucus plug from cervical canal).

Movements of Laboura.Engagementb.Descentc.Flexiond.Internal rotatione.Extensionf. External rotationg.Expulsion

ACTIVE MANAGEMENT

1.ARM2.Use of oxytocin 1.5 cm / hr multipara 1.2 cm / hr nullipara

I.O.L.a.Bishop’s Score:

- Cx effacement - Position - Dilatation - Station of the presenting

postb.PGE2c.ARM + oxytocin

From full dilatation to expulsion of the From full dilatation to expulsion of the fetusfetus

♦ ♦ DurationDuration

♦ ♦ InterventionIntervention

♣♣ ForcepsForceps

♣ ♣ VentouseVentouse

♣♣ Shoulder dystocia in Shoulder dystocia in macrosomic macrosomic babiesbabies

PAIN RELIEF:PAIN RELIEF:1.1. Non Pharmacological MethodsNon Pharmacological Methods

a.a. Psychological management – Psychological management – fear potentiates pain.fear potentiates pain.

b.b. Childbirth preparation classesChildbirth preparation classes

2.2. AnalgesiaAnalgesia-- Pethidine and metoclopramide Pethidine and metoclopramide

pathilorfanpathilorfan

3.3. EntonoxEntonox50% Nitrous oxide + 50% oxygen – self 50% Nitrous oxide + 50% oxygen – self administeredadministered

Separation of the placentaSeparation of the placenta

Retained placenta – durationRetained placenta – duration Manual removalManual removal

Primary dysfunction labourPrimary dysfunction labour

Secondary arrestSecondary arrest

INDUCTION OF LABOURINDUCTION OF LABOUR

InductionInduction AugmentationAugmentation

INDICATIONSINDICATIONS FetalFetal

a.a. Fetal compromiseFetal compromise

b.b. Rhesus diseaseRhesus disease

c.c. Diabetes MelitusDiabetes Melitus

Maternal / FetalMaternal / Fetala.a. P I HP I H

b.b. Pre labour rupture of membranesPre labour rupture of membranes

c.c. Post maturityPost maturity

d.d. Maternal disease – valvular heart Maternal disease – valvular heart disease, renal disease, PIHdisease, renal disease, PIH

Bishop ScoreBishop Score 00 11 22 33

Dilatation (m)Dilatation (m) ClosedClosed 1-21-2 2-32-3 5+5+

Length (cm)Length (cm) 33 22 11 00

ConsistencyConsistency FirmFirm mediummedium SoftSoft

PositionPosition PostPost MiddleMiddle AnteriorAnterior

Station HeadStation Head -3-3 -2-2 -1-1 00

METHODS OF INDUCTIONMETHODS OF INDUCTION

1.1. Prostaglandins 3mg dinoprostone Prostaglandins 3mg dinoprostone PGE2 tabs or intra cervical gel.PGE2 tabs or intra cervical gel.

2.2. AmniotomyAmniotomy

3.3. Oxytocin – has ADH actionOxytocin – has ADH action

4.4. Membrane SweepMembrane Sweep

5.5. Mechanical dilatorsMechanical dilators

Latent PhaseLatent Phase

Active PhaseActive Phase