clinical features of first stage of labour

 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


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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