Onset of Labour

It is characterised by:

True labour pain.

The show:

o It is an expelled cervical mucus plug tinged with blood from

ruptured small vessels as a result of separation of the membranes
from the lower uterine segment. Labour is usually starts several
hours to few days after show.

Dilatation of the cervix:

o A closed cervix is a reliable sign that labour has not begun. In

multigravidae the cervix may admit the tip of the finger before
onset of labour.

Formation of the bag of fore-waters:

o It bulges through the cervix and becomes tense during uterine

contractions.

Cause of Onset of Labour

It is unknown but the following theories were postulated:

Hormonal factors

Oestrogen theory:

o During pregnancy, most of the oestrogens are present in a binding

form. During the last trimester, more free oestrogen appears
increasing the excitability of the myometrium and prostaglandins
synthesis.

Progesterone withdrawal theory:

o Before labour, there is a drop in progesterone synthesis leading to

predominance of the excitatory action of oestrogens.

Prostaglandins theory:

o Prostaglandins E2 and F2 are powerful stimulators of uterine

muscle activity. PGF2 was found to be increased in maternal and
foetal blood as well as the amniotic fluid late in pregnancy and
during labour.

Oxytocin theory:

o Although oxytocin is a powerful stimulator of uterine contraction,

its natural role in onset of labour is doubtful. The secretion of
oxytocinase enzyme from the placenta is decreased near term due
to placental ischaemia leading to predominance of oxytocins
action.

Foetal cortisol theory:

o Increased cortisol production from the foetal adrenal gland before

labour may influence its onset by increasing oestrogen production
from the placenta.

Mechanical factors

Uterine distension theory:

o Like any hollow organ in the body, when the uterus in distended to
a certain limit, it starts to contract to evacuate its contents. This
explains the preterm labour in case of multiple pregnancy and
polyhydramnios.

Stretch of the lower uterine segment:

o by the presenting part near term.

Theories of Labor Onset

Labor is a coordinated sequence of involuntary, intermittent uterine

contractions. It is the series of events that expels the fetus and placenta out of
the mothers body. This is made possible by the presence of uterine
contractions and abdominal pressure that push the fetus out during the expulsion
period of delivery. Regular contractions result to gradual cervical effacement
and dilatation. Adequate pressure from abdominal muscles allows the baby to be
pushed outside the mothers womb.

Labor and delivery require a woman to utilize her coping methods

psychologically and physiologically. Normally, labor begins when the fetus
reaches a mature age (38-42 weeks age of gestation). This is to ensure survival
of the fetus with the extrauterine life. The mechanism that converts Braxton
HicksContractions (painless contractions) to strong and coordinated uterine
contractions is unknown. In some cases, labor occurs before the fetus reaches
the mature age (preterm birth) while in others it is delayed (postterm birth).

Although the exact mechanism that initiates labor is unknown. Theories have
been proposed to explain how and why labor occurs.

Uterine Stretch theory

The idea is based on the concept that any hollow body organ when stretched to
its capacity will inevitably contract to expel its contents. The uterus, which is a
hollow muscular organ, becomes stretched due to the growing fetal structures.
In return, the pressure increases causing physiologic changes (uterine
contractions) that initiate labor.

 Oxytocin theory

Pressure on the cervix stimulates the hypophysis to release oxytocin from the
maternal posterior pituitary gland. As pregnancy advances, the uterus becomes
more sensitive to oxytocin. Presence of this hormone causes the initiation of
contraction of the smooth muscles of the body (uterus is composed of smooth
muscles).

Progesterone deprivation theory

Progesterone is the hormone designed to promote pregnancy. It is believed that

presence of this hormone inhibits uterine motility. As pregnancy advances,
changes in the relative effects estrogen and progesterone encourage the onset of
labor. A marked increase in estrogen level is noted in relation to progesterone,
making the latter hormone less effective in controlling rhythmic uterine
contractions. Also, in later pregnancy, rising fetal cortisol levels inhibit
progesterone production from the placenta. Reduce progesterone formation
initiates labor.

Prostaglandin theory

In the latter part of pregnancy, fetal membranes and uterine decidua increase
prostaglandin levels. This hormone is secreted from the lower area of the fetal
membrane (forebag). A decrease in progesterone amount also elevates the
prostaglandin level. Synthesis of prostaglandin, in return, causes uterine
contraction thus, labor is initiated.

Theory of Aging Placenta

Advance placental age decreases blood supply to the uterus. This event triggers
uterine contractions, thereby, starting the labor.