Assisting women during

is a remarkable privilege and a weighty responsibility.

their labor and delivery
As obstetrician Frequency, Intensity, Duration of uterine contractions
assessed the probability
of normal labour Effacement and degree of dilatation of the cervix

Uterine contraction
information about the pattern is so little
important, but
Progressive cervical dilatation and fetal descent occur development
Normal labor rather
of practical tool, analysis of labor data from large number of patients
characteristic
to help elucidate the types of labor and cause of the abnormalities

Prognosis According to the type of labor pattern and treatment given

Information can be used
to manage individual patien optimally
for obstetrician
 Can be obtained by represents time elapsed
using a simple Square- Horizontal axis during the patient in Vertical axis
ruled graphic template. labor, in hours.

divided into 10 equal Range : -5 till +5,

Each division to
segments. Two scale, Each division of fetal provides an accurate to
centimeters in
designated, cervical station depicts a access the rate descent
effacement or
dilatation, and fetal centimeters of station of the fetuses through
dilatation.
station. the birth canal
 Labor start by onset of
uterine contraction
cervical dilatation and
decent of the fetus through
birth canal, biochemical and
biophysical preparation of
the cervix
Increasing intensity and
frequency of Braxton Hicks
Prelabor maturation : the
latent phase
Little or no cervical
dilatation
Contraction maybe strong
Biochemical modification of
connective tissue
The latent phase followed by the active phase
upswing of the curve + cervical dilatation > 4 cm

Latent + active phase first stage of labor

Active phase, divided by 3,

Initial acceleration phase
Central linear phase of maximum slope
Terminal deceleration phase the descent of fetal to the pelvic floor
without interruption
Components Nulliparas Multiparas
Latent Phase Duration (hours) 20 14
Maximum slope of dilatation (cm/hr) 1.2 1.5
Deceleration phase duration (hour) 3 1
Maximum slope of decent (cm/hr) 1.0 2.0
 Prolonged latent phase Inadequate cervical opening, latent
Labor phase > 20 hours

disorder
Protraction disorders (of Dilatation or descent linear manner
during active phase
dilatation and descent)

Arrest disorder ( of dilatation Dilatation deceased for at least 2

hours
or decent, prolonged
deceleration phase) Prolonged deceleration phase
reflect delay of terminal phase
Dysfunction
Prolonged latent phase
Arrest of dilatation
Arrest of descent
Prolonged deceleration phase
Failure of descent
ProNlliparastracted dilatation
Protracted descent
Nulliparas Multiparas
> 20 hr duration > 14 hr duration
2 hr without progress in active 2 hr withour progress in active
phase phase
1 hr without progress after active 1 hr without progress after active
descent has begun descent has begun
> 3 hr duration < 1 hr duration
No descent by deceleration phase No descent by deceleration phase
or second stage onset or second stage onset
< 1,2 cm cm/hr slope <1.5 cm/hr slope
< 1,0 cm/hr slope < 2.0 cm/hr slope
 Oxytocin may be therapeutic
Once the condition is
No form theraphy has been value if the protraction
diagnosed (no CPD), the
shown effective in correcting disorder appears to have At least 25-30 % will require
patient be advised of the
the slow rates dillation and resulted from some cessarean delivery because
nature of her condition and
descent in protraction inhibitory influence, like of pressumed CPD.
the fact that the labour likely
disorders. anesthesia conduction or
to be quite prolonged.
drugs.

Prognosis : depends
on the method of
delivery that follows
the protracted labour.
40-50% likelihood that seccarean delivery will be neccessary.

Treated by uterotonic stimulation, unless there is abnormal fetal heart pattern or CPD.

Assess CPD using clinical cephalopelvimetry, pelvic architecture, fetal head dimensions,
molding, and Muller-Hllis manuver.

When CPD excluded, oxytocin stimulation can be expected to correct the arrest and result in
vaginal delivery in due course.
 When oxytocin is given for
The goal of oxytocin
Patients treated with the treatment of an arrest
disorder, about 85% of should be
oxytocin who have individualized, but
those patients who
normal postarrest respond with dilatation should generally
sloped can be expected that resumes at or above achieve firm
to deliver the prearrest rate of contraction (about 50
spontaneously without dilatation will have done mmHg in amplitude)
further complication. so within about 3 hours of that occur every 2-3
having the infusion
minutes
initiated.
 Certainly induce labor in
some women, augmenting
the progress of active
phase
Artificial rupture of fetal
membrane
Allows direct fetal heart
monitoring, providing
most precise data for heart
pattern interpretation.
 Upright postures
(stand, squat)
The proof of the But it cause no
may benefit some
Changing efficacy of harm, and may do
labors by altering
Maternal Position position changes some good.
pelvic diameter or
is lacking Should be tried.
increasing uterine
contractility
 Efficiency
Involves mayor assesed by
portion of fetal measuring the
descent and rate of descent
rotational of the
movements. presenting part
to birth canal.
Second
stage of
Active descent
labour
goverved by Has little
uterine contractile significant on
force; voluntary
maternal expulsive neonatal and
efforts, fetal size, maternal
position and
attitude.
morbidity
Defined in two ways
Labors that are exceptionally short (< 3 hours)
Labors in which there is abnormally rapid cervical dilatation fetal
descent
Else,
Very short labor
Rates 5cm/hr in nulliparas, and 10 cm/hr in multipatas
Can be prevented
Oxytocin ot therapeutic rest may be used with
equivalent benefit for prolonged latent phase.

Expectancy and support are most appropriate

for protraction disorders and oxytocin
stimulation is best for arrest disorders

If there is an CPD, cessarean sectio is

recommended as the option most sompatible
with safety.