Clinical course of first stage of labor
Before start first stage of labor;
1. Prodromal labour/ pre labour
Type of false labour contractions
1. Don't lead to cervical dilatation or effacement
2. Shelf formation; shelfing of uterus
Forward of uterus fundus making the upper abdomen look like shelf during standing position
3. Lightening
Descending of fetus
Relief of upper abdominal pressure symptoms as dyspnoea, papitation, dyspepsia.
4. Pelvic pressure symptoms
Rectal pressure
Difficulty in walking
Increase vaginal discharge
False labour pain
Constipation, micturition frequency increase
5. False labour pain
First stage of labour (established labour) clinical features
1. True labour pain
Every 3-5 minutes for 45 seconds.
Pain felt shortly after uterine contraction begin and before complete relaxation of uterus.
Passive phase;
dilate 1-3cm (4-6 hours)
Contraction of uterus slowly
Active phase;
dilate 4-8cm (4-8 hours)
Contraction get stronger
Hence, cervix fully dilated.
2. Dilatation of cervix and effacement of cervix (rim); ripening of cervix
Cervix is 8-10 cm dilated.
Cervix dilatation expressed by;
1 finger insert; 2cm
2 finger insert; 4cm
5 finger insert; 10cm
And cervix effacement occur; 25%, 50% and 100%
Cervix stretched go upper.
3. The show
Expulsion of bloody mucus plug
4. Formation of bag of fore-water
5. Polarity of uterus
Co-ordination between fundal contraction and cervical dilatation
Upper uterine segment contracts while lower uterine segment dilates pushes the fetus.
Following each contraction; uterine muscle fibres undergo retraction.
6. Partograph
Latent phase over cervix 3cm dilated.
Active phase starts with 3 cm cervix dilatation.
There are three component of active phase;
1. Acceleration phase
3-5cm in 4 hrs
2. Maximum slope
5-8cm in 1 hours
3. Deaccleration phase
8-10 cm in 2-4hrs
In active phase rate of cervix dilation;
In primigrivida; 1cm/hr
In multigravidae; 1.5cm/hr
7. Repture of membrane
8. Contraction and Retraction
9. Staus of membrane
1. If rupture of membrane after onset of labour but before full dilatation of cervix called early rupture of membrane.
2. When rupture before onset of labour called premature rupture.
Usually membrane remain intact until full dilatation of cervix.
Intact membrane can felt with finger during uterine contraction when becomes tense and bulge out through cervical opening.
3. With rupture membrane amount of liquor escape out through vagina.
Rupture of membrane can ownself rupture, cervix mucus plug rupture, artificial rupture of membrane.
10. Pain
4 pain within 10 minutes
Every 3-5 minutes; 45sec duration
Contractions;
10-20; mild contraction
20-40; moderate contraction
40-60; severe contractions
Maternal system sign
Pulse rate increase 10-15 beat/minutes during contraction.
Increase respiration
Systolic blood pressure increase about 10mmHg during contraction
Temperature normal
Transient (short term) fatigue; strong contraction
Fetal sign
Normal fetal rate; 110-140beats/minutes
Fetal heart rate slow 10-20 beats/minutes during contraction
Due to pain and contraction constrict blood capillary may cause fetal distress.
Bradycardia cardia during contraction; normal after contraction till next contraction
If not normal undergo C- section
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