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FIRST STAGE
Defined as stage of cervical os dilatation from zero to 10cms in
which there are painful palpable uterine contractions and exist in
two phases viz latent and active phase.
Latent phase concept: The latent phase marks the cervical os
dilatation from zero till 3cms in primgravida or 4cm in multigravid
associated often with painful, palpable contractions of increasing
frequency and intensity of at least one in 10 minutes interval. It is a
prodromal stage which show much variation in duration and
represents the earliest part of first stage labour which essentially is
innocuous and not predictive if any sinister subsequent Active phase
problems.
Diagnosis: Parturient at term with contractions at least one in every
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10 minutes interval and cervical os dilatation less than 3cm in
primigravida or 4cm in multigravida.
Approach to management: In the absence of any other
complications (like post-datism, hypertensive diseases fetal
distress or rupture of membranes) treatment is observation until
conversion to active phase labour.
Classifications:
(e) Normal latent phase when the duration of the latent phase is
within 8 hours before conversion to Active phase
(f) Prolonged latent phase when the latent phase duration is over 8
hours but within 24 hours.
(g) False labour is a latent phase case where the latent phase
features persist over 24 hours without conversion to active
phase. Thus false labour is the diagnosis in retrospect of a
parturient in
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whom the latent phase feature is still persisting after 24 hours without
conversion to active phase. False labour may be contractile or non
contractile. Latent phase is a mere pro dromal stage which deserve
treatment with observation only and no intervention in the absence of
any complications.
Active phase concept: This is the later aspect of first stage labour
marking the cervical os dilatation from 3cms in the primigravida or
4cm in the multigravida until full cervical os dilatation at 10cm and
often is the inferred aspect of labour in which strong enough
contraction is generated and sustained to lead on to the delivery of
the fetus and placenta per vagina.
It is characterised by regular, painful palpable contractions of
increasing frequency and intensity associated with progressive
effacement and dilatation of the cervical os, and descent of the
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Presenting part leading to the delivery of the fetus and placenta per
vaginam with minimal risk to mother and baby within a 12 hours
duration.
Diagnosis: A parturient with contractions at least one in every 10
minutes interval with cervical os dilation of at least 3cm in the
primigravida and 100% effacement of the cervix or 4cms in the
multigravida with at least 50% effacement.
Duration: Active phase is 12 hours in all women irrespect of Age,
Parity or race. Any duration over 12 hours is prolonged labour.
Monitoring of Active phase: This is objectively done with the
cervical dilatation rate derived from at least two sterile consecutive
vaginal examination in the parturient. The normal rate of progress
is nowadays one centimeter per hour. Any cervical os dilatation rate
of less than one centrimeter per hour is slow labour progress.
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Operational Management of Active phase
This is founded on the followings –
- Management begins when the first VE in labour confirms
parturient in active phase.
- Assessment of progress in active phase in best with cervical
dilatation rate and not descent or contractions.
- The normal progress in active phase is cervical dilatation rate
of 1cm per hour provided fetal membranes are ruptured.
- Supervision is based on the anticipation that progress will be
as for normal rate of 1cm per hour hence VE at some
specific interval like (2-4) hourly
- Slow Active phase labour is a cervical dilatation rate less
than 1cm per hour.
Results
Analysis of data was performed in 1998 – 2000 viz:
6. Prolonged labour was reduced from 33% to 1%
7. C/S rate was reduced to 6% from the 28% in 1991
8. The oxytocin argumentation rate rate was 24%
9. Vaginal deliver rate was 90% from the previous 82%
10. The perinatal mortality rate was 43/1000 from the previous
87/1000.
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CONCLUSION
This A.M.L. protocol is an excellent example of the adaptation of
the principles of A.M.L. for local needs and in line with
available resources. Viz
d) It did not require senior obstetric staff to be involved in the
diagnosis of Active phase but the Senior staff were later
mandatory involved if the cases because difficult and staying
longer in labour ward. This is commendable rational use of the
source Senior obstetric staff manpower.
f) It did not require VE every hourly but (2-4) hourly
g) It did not augment labour as soon as slow labour progress was
diagnosed when the Alert line was crossed but only 2 hour later
which objectified augmentation only for the proven cases of
labour dystocia.