First stage of labour Gynaecology dep ppt

Gynaecology

1. FIRST STAGE OF LABOUR
Name: kajol Yadav
Group: 1430

2. LABOUR
Labour is described as a process by
which the fetus placenta and
membranes are expelled through the
birth canal

3. NORMAL LABOUR
Occurs at term
Spontaneous in onset
Fetus presenting by the vertex
Process completed within 18 hours

No complications arise

4. FIRST STAGE OF LABOUR
Latent phase
 Mild, short contractions
 Cervix 0-3cms
6 – 8 hrs
 Active phase
 Moderate to strong contraction
 Cervix 4-7 cms
 4.6 h for nullipara and 2.4 h for multipara
 Transition
 Strong contraction
 Cervix 7-10cms

6. SIGNS AND SYMPTOMS OF
IMPENTING LABOUR
Lightening
Frequency of micturition
Spurious labour
Cervical changes
Premature rupture of membrane
Bloody show
Energy spurt
Gastrointestinal upset

7. EFFACEMENT

9. PREMATURE RUPTURE OF MEMBRANE

10. CAUSES OF ONSET OF LABOUR
 Uterine distension theory
 Oxytocin stimulation theory

Prostaglandin stimulation theory

Progesterone withdrawal theory
Estrogen stimulation theory
Fetal cortisol theory

11. CAUSES OF ONSET OF LABOUR

Uterine distension (Optimal distension theory)

Overstretching promotes muscle excitability
Oxytocin stimulation theory
 Oxytocin inhibit calcium binding to sacroplasmic reticulum
Increasing the intracellular calcium level
Promotes myometrial contraction

Sensitivity of oxytocin to myometrium increases in the late pregnancy
due to increase in the number of oxytocin receptors

Oxytocin promotes release of prostaglandins from the decidua

12. 
Prostaglandin stimulation theory
 Prostaglandin may diffuse to myometrium and initiate labour
Progesterone withdrawal theory
 Progesterone binds Calcium to the sacroplasmic reticulum
Decrease intracellular calcium level
Estrogen stimulation theory
 Increases the release of oxytocin from the maternal pituitary
 Promotes synthesis of receptors for oxytocin

13. PHYSIOLOGICAL PROCESS IN THE
FIRST STAGE OF LABOUR
UTERINE ACTION
Fundal Dominance
Polarity
Contraction and Retraction
Formation of Upper and Lower Uterine Segment
Retraction Ring
Cervical Effacement
Cervical Dialation
Ripening of the cervix

14. MECHANICAL FACTORS
Formation of the forewaters

General fluid pressure
Rupture of the membranes

Fetal axis pressure
Descend of presenting part

15. FACTORS INFLUENCING LABOUR
 PASSAGE WAY
 PASSENGER(FOETUS AND PLACENTA)
 POWERS
 POSITION OF MOTHER
 PSYCHOLOGIC RESPONCE

16. PHYSICAL EXAMINATION
VITAL SIGNS
 Elevated temperature – Infectious process
 Elevated pulse – Infection, Shock or Anxiety
 Elevated respiration – Shock and anxiety
 Elevated or lowered Bp – Hypertensive disorders or
shock

Elevated systolic or normal diastolic Bp - Anxiety

17. PHYSICAL EXAMINATION
 PHYSICAL MEASUREMENTS
 Height and weight
Fetal heart tone
 Normal – 120-160 beats per minute
 Heart rate below 120 or above 160 – Fetal distress
Lie, Presentation, Position and Variety
 Abnormal lie , presentation, or position
Edema of extremities
 One of the classical sign of preeclampsia
 Physiological edema is normal
Pelvic examination and vaginal examination
 Effacement
 Confirm abdominal diagnosis

18. PHYSICAL EXAMINATION
Lie, Presentation, Position and Variety
 Abnormal lie , presentation, or position
Edema of extremities
 One of the classical sign of preeclampsia
 Physiological edema is normal
Pelvic examination and vaginal examination
 Effacement
 Confirm abdominal diagnosis

19. PROGRESS
 ABDOMINAL EXAMINATION
 Regular abdominal examination throughout labour
 Nature of contractions like intensity, frequency and
duration are assessed clinically

No of contractions should be assessed in 10 minutes
 Duration of contraction should be assessed in seconds

Pelvic grip – gradual disappearance of the poles of the head
Shifting the maximal impulse of the FHS downward and
medially

20. OBSERVATIONS
MOTHER
 REACTION TO LABOUR
 VITAL SIGNS
URINALYSIS
FLUID BALANCE
PROGRESS

Abdominal Examination
Vaginal Examination

21. OBSERVATIONS
THE FETUS
THE FETAL HEART
FETAL BLOOD SAMPLING

AMNIOTIC FLUID
FETAL DISTRESS