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FIRST STAGE
ONSET OF LABOUR
Uterine contractions.
Cervical changes
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Formation of lower uterine segment
Descent of fetus
Formation of bag of waters and finally rupture .
UTERINE CONTRACTIONS
Part of uterus below the uterovesical fold of peritoneum , where the peritoneum is
only loosely attachment. (7-10cm ). Develops from isthmus and cervix
Develops gradually as pregnancy proceeds.
After effacement and dilatation , cervix incoporated into lower uterine segment
Upper part contracts , becomes smaller and thicker. ( Retraction )
Lower segment distends becomes thinner and fibres lengthen with each contraction
Junction seen as a demarcation, called physiological retraction ring.
Clinical significance : caesarean section ,placenta previa, pathological retraction ring (
bandl ring)
FETAL DESCENT
Due to stretching of the lower uterine segment, the membranes are detached from
their loose attachment to decidua and bulge into cervical canal as cervix dilates.
It contains liquor, it is called bag of membranes
During contractions the bag becomes tense and convex. It is certain sign of labour
Hydrostatic pressure is the pressure exerted by uterine contractions when the bag
of membranes is intact , which in turn dilates the cervical canal like a wedge.
Towards the end of first stage, the membranes rupture .
In vertex presentation,as head fits into the lower segment and the bag of membranes
is well applied to the head- hour glass appearance.
conical appearance – malformations *
MANAGEMENT OF FIRST STAGE OF LABOUR
PREPARATION OF PATIENT
Clean the vulva and the perineum
If hair in the lower part is likely to interfere in the time
of delivery it may be clipped with with scissors
Routine shaving is not advocated
Mother should be encouraged to walk about in
first stage and advised to empty the bladder and
bowel frequently
The maternal temperature and pulse is recorded
every hour
Labour involves 3 functional division
Preparatory division : shows considerable changes in the
connective tissue and collagen of cevix takes place with only a little
cervical dilatation. This stage is affected by sedatives and anasthesia
Dilatation phase : cervical dilatation occurs at a maximum rate of
1.0cm/hr in primigravida and 1.5cm/hr in multigravida. The phase is
not affected by sedation and anasthesia
Pelvic division : full dilatation with descent and delivery of
fetus . Cardinal movement of fetus takes place during this
phase .
AMNIOTOMY
Performed after the women goes into active labour
Benefits
rapid labour
Detection of meconium staining of liqour
CARE OF URINARY BLADDER
Women should be asked to void urine and bladder distension should
be avoided
If she cannot void urine catheterisation is indicated
ASSESSMENT OF PROGRESS OF LABOUR
PARTOGRAM
Course of labour during first stage and second stage of
labour is monitored by plotting the cervical dilatation and
descent of fetus in against time in hours . This is refered to
as partogram
USE
Detecting delay at various stages of labour to provide
prompt treatment
INFORMATION CONTAINED IN A PARTOGRAM
Patient information :name,age,gravida,para,date and time of admission
fetal heart rate : every half hour
Amniotic fluid ;record the colour of amniotic fluid at every vaginal examination
o I : membrane intact
o C : membranous ruptured, clear fluid
o M : meconium stained fluid
o B : blood stained fluid
Cervical dilatation
Descent assessed by abdomen palpation
Hours :time elapsed after onset of active labour
Time : record actual time
Contraction :these needed to be recorded in every every half an
hour
Oxytocin : record the amount of oxytocin per volume IV fluid in
drop/minute every 30 minute when used
Drugs :record any additional drugs if given
Pulse: record every 30 minutes and marked with a dot
blood pressure : record every 4 hrs and mark with arrows
Temperature : record every two hours
Urine records : protein , acetone and volume when passed
MONITORING UTERINE CONTRACTION
Time of onset and dissapearance of contraction is noted
by palpating the uterus with palm of hand
Intensity is measured from the degree of firmness of the
uterus
Frequency, duration and intensity are noted at regular
intervals
FETAL HEART RATE MONITORING
Fetal heart rate is checked immediately after contraction ,
atleast every 30 minutes in first stage of labour .
In high risk pregnancy auscultation is done every 15 minutes
It is identified with the sthethescope or a doppler
ultrasound device
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