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Normal labour, first stage by Yin Moe
1. Dr. Yin Moe Han
Senior Lecturer
Obstetrics & Gynaecology Department
School of Medicine, UCSI University
2. NORMAL LABOUR
normal, mature, alive
vertex presentation
spontaneous expulsion
per vaginum
within 24 hours
without complications
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4. STAGES OF LABOUR
First stage of labour
Second stage of labour
Third stage of labour
Fourth stage of labour
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5. FIRST STAGE OF
LABOUR
onset of labour
8-12 hours
full dilatation of the cervix (10 cm)
Latent Phase –--- 0 – 3 cm
Active Phase –--- 4 – 10 cm
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6. SECOND STAGE OF
LABOUR
full dilatation of the cervix
up to 1 hour
birth of the foetus
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7. THIRD STAGE OF
LABOUR
birth of the foetus
5 - 15 mins not > 30 mins
delivery of placenta and
membranes
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8. FOURTH STAGE OF
LABOUR
UP TO 2 HOURS AFTER DELIVERY
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10. DIAGNOSIS OF
LABOUR
1. Diagnosis and confirmation of labour
2. Diagnosis of stage and phase of labour
3. Assessment of engagement and descent of the fetus
4. Identification of presentation and position of the fetus
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11. DIAGNOSIS AND CONFIRMATION OF
LABOUR
Suspect or anticipate labour if the woman has :
Intermittent abdominal pain
Associated with blood-stained mucus discharge (show)
Watery vaginal discharge or a sudden gush of water
Confirm the onset of labour if there is :
Cervical effacement—the progressive shortening and thinning of
the cervix during labour
Cervical dilatation—the increase in diameter of the cervical
opening measured in centimetres
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13. DESCENT
Abdominal palpation
Descent of the fetal head
Assess descent
in terms of fifths of fetal
head palpable above the
symphysis pubis
Head entirely above the
symphysis pubis
five-fifths (5/5) palpable
Head entirely below the
symphysis pubis
zero-fifths (0/5) palpable
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15. MECHANISM OF NORMAL
LABOUR
Cardinal movements of labour (LOA)
Engagement and Flexion Internal rotation to OA
descent
External rotation Restitution Extension
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16. ENGAGEMENT AND
DESCENT
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25. ASSESSMENT OF PROGRESS OF
LABOUR
latent phase
measuring changes in cervical effacement and dilatation
active phase
measuring the rate of cervical dilatation and fetal descent
second stage
assessing further fetal descent
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26. PROGRESS OF THE FIRST STAGE OF
LABOUR
Plot on a partograph
once the woman enters
the active phase of
labour.
Alternatively, plot a
simple graph of cervical
dilatation (cm) on the
vertical axis against time
(hours) on the horizontal
axis.
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27. VAGINAL
EXAMINATIONS
1st stage of labour - 4 hourly Cervix not dilated on 1st VE
may not be possible to
2 stage of labour - hourly
nd
diagnose labour
After rupture of the membranes If contractions persist
Record following after each VE re-examine the woman
colour of amniotic fluid after 4 hours for cervical
cervical dilatation changes
descent (can also be assessed abdominally) if there is effacement and
dilatation, the woman is in
labour
Plot the findings on partograph if there is no change, the
diagnosis is false labour
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