Normal labour, first stage by Yin Moe

1. Dr. Yin Moe Han
Senior Lecturer
Obstetrics & Gynaecology Department
School of Medicine, UCSI University

2. normal, mature, alivenormal, mature, alive
vertex presentationvertex presentation
spontaneous expulsionspontaneous expulsion
per vaginumper vaginum
within 24 hourswithin 24 hours
without complicationswithout complications
NORMAL LABOUR
07/31/1207/31/12 221st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

3. 07/31/1207/31/12 331st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

4. STAGES OF LABOUR
First stage of labourFirst stage of labour
Second stage of labourSecond stage of labour
Third stage of labourThird stage of labour
Fourth stage of labourFourth stage of labour
07/31/1207/31/12 441st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

5. FIRST STAGE OF
LABOUR
onset of labour onset of labour
8-12 hours8-12 hours
full dilatation of the cervixfull dilatation of the cervix (10 cm)(10 cm)
Latent Phase –--- 0 – 3 cmLatent Phase –--- 0 – 3 cm
Active Phase –--- 4 – 10 cmActive Phase –--- 4 – 10 cm
07/31/1207/31/12 551st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

6. SECOND STAGE OF
LABOUR
full dilatation of the cervix full dilatation of the cervix
up to up to 1 hour1 hour
birth of the foetusbirth of the foetus
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7. THIRD STAGE OF
LABOUR
birth of the foetusbirth of the foetus
5 - 15 mins not > 30 mins5 - 15 mins not > 30 mins
delivery of placenta and delivery of placenta and
membranesmembranes
07/31/1207/31/12 771st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

8. FOURTH STAGE OF
LABOUR
UP TO 2 HOURS AFTER DELIVERYUP TO 2 HOURS AFTER DELIVERY
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9. 07/31/1207/31/12 991st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

10. DIAGNOSIS OF
LABOUR
1.1.Diagnosis and confirmation of labour Diagnosis and confirmation of labour
2.2.Diagnosis of stage and phase of labour Diagnosis of stage and phase of labour
3.3.Assessment of engagement and descent of the fetusAssessment of engagement and descent of the fetus
4.4.Identification of presentation and position of the fetus 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 hasSuspect or anticipate labour if the woman has: :
Intermittent abdominal painIntermittent abdominal pain
Associated with blood-stained mucus discharge (show)Associated with blood-stained mucus discharge (show)
Watery vaginal discharge or a sudden gush of waterWatery vaginal discharge or a sudden gush of water

Confirm the onset of labour if there isConfirm the onset of labour if there is::
Cervical effacement—the progressive shortening and thinning of Cervical effacement—the progressive shortening and thinning of
the cervix during labourthe cervix during labour
Cervical dilatation—the increase in diameter of the cervical Cervical dilatation—the increase in diameter of the cervical
opening measured in centimetresopening measured in centimetres    
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12. EFFACEMENT AND DILATATION OF THE
CERVIX
 
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13. DESCENT
Abdominal palpationAbdominal palpation
Assess descentAssess descent
in terms of fifths of fetal in terms of fifths of fetal
head palpable above the head palpable above the
symphysis pubissymphysis pubis
Head entirely above the Head entirely above the
symphysis pubissymphysis pubis
five-fifths (5/5) palpablefive-fifths (5/5) palpable
Head entirely below the Head entirely below the
symphysis pubissymphysis pubis

zero-fifths (0/5) palpablezero-fifths (0/5) palpable  
Descent of the fetal headDescent of the fetal head
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14. 07/31/1207/31/12 14141st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

15. MECHANISM OF NORMAL
LABOUR
Cardinal movements of labour (LOA)
Engagement and
descent
Flexion  Internal rotation to OA
Extension Restitution External rotation
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16. ENGAGEMENT AND
DESCENT
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17. FLEXION
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18. INTERNAL ROTATION TO
OA
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19. EXTENSION
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20. RESTITUTION
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21. EXTERNAL
ROTATION
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22. DELIVERY OF ANTERIOR
SHOULDER
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23. BODY BORN BY LATERAL
FLEXION
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24. 07/31/1207/31/12 24241st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

25. ASSESSMENT OF PROGRESS OF ASSESSMENT OF PROGRESS OF
LABOURLABOUR
latent phaselatent phase
measuring changes in cervicalmeasuring changes in cervical effacementeffacement and and dilatationdilatation
active phaseactive phase
measuring the rate of cervical measuring the rate of cervical dilatationdilatation and fetal and fetal descentdescent
second stagesecond stage
assessing further fetal assessing further fetal descentdescent
07/31/1207/31/12 25251st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

26. PROGRESS OF THE FIRST STAGE OF
LABOUR
Plot Plot on a partograph on a partograph
once the woman enters once the woman enters
the the active phaseactive phase of of
labour. labour. 
Alternatively, plot a Alternatively, plot a
simple graph of simple graph of cervical cervical
dilatation (cm) on the dilatation (cm) on the
vertical axisvertical axis against time against time
(hours) on the horizontal (hours) on the horizontal
axis. axis.
07/31/1207/31/12 26261st Stage - Dr. Yin Moe Han1st Stage - Dr. Yin Moe Han

27. VAGINAL
EXAMINATIONS
11
stst
stage of labour - stage of labour - 4 hourly4 hourly
22
ndnd
stage of labour stage of labour - - hourly hourly
After rupture of the membranesAfter rupture of the membranes
Record following after each VERecord following after each VE
colour of amniotic fluidcolour of amniotic fluid
cervical dilatationcervical dilatation

descentdescent (can also be assessed abdominally)(can also be assessed abdominally)
Plot the findings on partographPlot the findings on partograph
Cervix not dilated on 1
st
VE
may not be possible to
diagnose labour
If contractions persist
re-examine the woman
after 4 hours for cervical
changes
if there is effacement and
dilatation, the woman is in
labour
if there is no change, the
diagnosis is false labour
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28. Thank YouThank You
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