1st stage of labour
TRANSCRIPT
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• Cervix fully EFFACED
• Mild, irregular contractions become more rhythmic and stronger
• Cervical dilatation starts
• Can last even up to 12-16 hours
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• Cervix dilates rapidly up to 10cm
• At a rate of 1cm/hour or more
• Foetal descent begins
• Lasts for 2 – 6 hours
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• Duration shorter in multi
• Considered as prolonged if,
– >12hrs in primi
– >8hrs in multi
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• Maternal well-being
• Foetal well-being
• Progression of labour
• Adequate hydration
• Pain relief
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• Graphical presentation of the progress of labour
• Monitor active phase of 1st stage
• Instant visual assessment of maternal & fetal well being & progression of labour
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– Vital signs
– Urine
– Hydration
– FHR
– Character of liquor
– Moulding
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– Cervical dilatation
– Station
– Uterine contractions
– Oxytocin
– Pain relief
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• Heart rate auscultation
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• Intact membranes
• Ruptured membranes• Liquor colour
• Meconium stained
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2 main components
Abdominal examination
PV examination
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– Can be felt by palpation
– Maximum expected is
• 3 in 10min
• One lasting >40 sec
• 2min relaxation in between
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• Palpate the number of contractions in 10 minutes
and calculate the duration of one contraction
Less than 20sec
Between 20 and 40sec
More than 40sec
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Recording of uterine contractions
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• If contractions are not satisfactory,
Oxytocin infusion
5U for primi
2U for multi
Starting 15drops/min
Can increase by 15drops/min every ½ hour
Up to max. of 60drops/min
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• Palpation of foetus
– To detect progressive descent of head
– Expressed in 1/5th
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• Routinely done every 4 hourly
• Important to determine progression
• 4 main things to check
– Cervical dilatation
– Effacement
– Descent
– Moulding
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• 2 important indicator lines are marked in Partogram
Alert line - A line drawn at the end of the latentphase demonstrating progress of 1cmdilatation per hour
Action line - A line drawn parallel and 4 hrs to theright of alert line
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• Overlapping of skull bones
0 - bones are separated
+ - bones touching , can be separated
++ - bones overlapping
+++ - bones overlapping severely
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• Types in 1st stage
1. Prolonged latent phase
2. Primary dysfunctional labour
3. Secondary arrest
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• Latent phase > 14-16hrs in primi
> 8-10 hrs in multi
• Poor uterine contractions
• Possibilities
– Occipito posterior position of foetus
– Cephalopelvic disproportion
– Cervical dystocia
– Uterine dysfunction
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• Slow progression in active phase
• Falls to right of action line
• Possibilities
–Uterine Inertia (ineffective uterine contraction)
– Malposition (2nd commenest)
– Cephalopelvic disproportion
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• Progression normal in latent and early active phase and arrest of cervical dilatation during late active phase.
• No cervical dilatation > 2hrs at any point beyond 6cm dilatation
• Possibilities
–CPD
–OP position
–Inadequate uterine contraction
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• Non pharmacological
Psychoprophylaxis
Psycotherapy
Physical methods
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• Pharmacological
Pethidine1mg/kg
Primi – 1st when cx is 3cm, 2nd after 4hrs of 1st dose
Multi – single dose when cx is 3cm
Morphine 10mg SC or IM
Preferred in heart disease
Nitrous oxide gas (Entonox)Mixed with oxygen 1:1
Given via face mask