S.

NO TIME SPECIFIC CONTENT TEACHER LEARNER EVALUATION

OBJECTIVES ACTIVITY/AV AIDS

1 2 min Define labour DEFINITION: Teacher activity: What is normal labour ?

and normal Series of events that take place in the genital organs in an The teacher Define
labour. effort to expel the viable product of conception out of the labour with the help
womb Spontaneous expulsion, of power point
presentation,black
Criteria for normal labour: board.
1- Spontaneous in onset at term.
(37-completed weeks-42 weeks) Learner activity:
2 - Presented by vertex, Students are
3 - Through the birth canal (vaginal delivery), Listening carefully
4 - Within a reasonable time (more than 3, less than 18 and writing notes.
hours),
5 - Without complications to the mother, Without
complications to the fetus through the vagina into the
outer world is called normal labour.

2 5 min Explain about PHYSIOLOGY OF NORMAL LABOUR:

physiology of UTERINE CONTRACTIONS IN LABOUR: Teacher activity: What is tonus
normal labour. -There is good synchronization of the contraction waves Teacher Explain frequency,and
from both halves of the uterus. about physiology of intensity?
There is fundal dominance through midzone down to lower normal labour with
segment with gradual diminishing contraction wave which the help of black
takes about 10-20 seconds. board,power point
The waves of contraction follow a regular pattern . tiles.
Intra amniotic pressure rises beyond 20mm Hg during
uterine contraction. Learner activity:
Good relaxation occurs in between contractions to bring Students are
down the intra-amniotic pressure to less than 8 mm Hg. Listening carefully
Cntractions and taking notes.
Of the fundus last longer than that of the midzone.
S.NO TIME SPECIFIC OBJECTIVES CONTENT TEACHER LEARNER EVALUATION
ACTIVITY/AV AIDS
TONUS:
-It is the intrauterine pressure in between
contractions .
-During pregnancy ,as the uterus is quiescent
(inactive ),the tonus is of 2-3 mm Hg .
- during the first stage of labour,it varies from 8-10
mm Hg.It is inversely proportional to relaxation.

INTENSITY:
-The intensity of uterine contraction describes the
degree of uterine systole.
-Intrauterine pressure is raised to 40-50 mm Hg
during first stage and about 100-120 mm Hg in
second stage of labour during contractions .Inspite
of diminished pain in third stage ,the intrauterine
pressure is probably the same as that in the second
stage .

DURATION:
-In the first stage ,the contractions last for about 30
seconds initially but gradually increase in duration
with the progress of labour .Thus in the second stage
,the contractions last longer than in the first stage.

FREQUENCY:
-In the early stage of labour ,the contractions come
at intervals of 10-15 minutes The intervals gradually
shortens with advancement oh labour until in the
second stage ,when it comes every 2 or 3 three
minutes.
 Describe the physiology PHYSIOLOGY 1ST STAGE OF LABOUR : Teacher activity: What are the
3 20 of 1st stage of labour. -Duration: 12 hours in primigravida ,6 hours in Teacher Describe the physiological
min multigravida .Duration (length)of labour varies and physiology of 1st stage of event in 1st
influenced by: labour with the help of stage of labour?
 Parity ppt,booklet and
 pelvic shape blackboard.
 pelvic size
 psychological state Learner activity:
 presentation Students are writing and
 position. listening carefully.
Physiology of labour has two aspects /factors
as discussed below:
1)Uterine factors /actions.
2)Mechanical factors.
a)Uterine actions:
-Fundal dominance

b)Polarity:
-polarity is neuromascular harmony between upper
and lower pole (segment ) of uterus throughout
labour.
- When upper segment contracts,retracts and pushes
the fetus down the lower uterine segment and cervix
dilates in response.
-Good synchronization of contraction waves from
both sides of uterus.
-Regular pattern of contractions .
c) Uterine contractions and retractions:
bucket handle manner of attachment of longitudinal
muscle fibres of upper uterine segment with circular
muscle fibres of lower segment and cervix.Thus
during contraction of upper segment the canal –
shortens ,retracts and opens.
 d ) FORMATION OF UPPER AND LOWER UTERINE SEGMENT:
-By the end of the pregnancy the body of uterus devided into two upper
uterine segment and lower uterine segment . the upper uterine
segment is thick and muscular ,concerned with contraction.
-during labour lower uterine segment is demarcated by physiological
retraction ring above and fibromuscular junction of the cervix and uterus
below.
-7.5-10 cm when fully formed and cylindrical during 2nd stage of labour.
-Gradual thinning of the lower uterine segment due to relaxation of its
muscle fibres to allow enlongation and descent of presenting part.
-Lower uterine segment prepared for distension.

e) RETRACTION RING (BANDL’S RING):

Retraction ring is a ridge formed between upper and lower uterine
segment .

f) CERVICAL EFFACEMENT:
-Muscular fibres of cervix are pulled upwards and merge with lower
uterine segment .
- effacement preceds the dilation in primigravida while it occurs
simultaneously with dilation in multipara.

g) CERVICAL DILATION:
it is the process of enlargement of external os from a closed external os
to permit passage of fetal head.Full dilation of cervix is 10 cm.

MECHANICAL FACTORS:

a) Formation of fore water:

 Lower uterine segment Stretches

Attached chorion detaches from lower uterine segment i.e.chorion

loosens at lower uterine segment.

Increased intra-uterine pressure Causes

Loosened part of sac of fluid

To bulge downward into dilatating internal os ( 6-12mm)

Cuts off fluid in front of head divides the fluid into two

Fore water hind water

( Below head towards os) ( Latter i.e above head in uterus side)
b) FETAL AXIX PRESSURE:
Contraction of circular muscles of body of uterus

Straightening of the vertebral column of fetus

Fundal contractions transmit through podalic pole in to fetal axis

Mechanical stretching of lower uterine segment and opening of

cervical canal.

c) RUPTURE OF MEMBRANE :
Membranes rupture when cervix is fully dilated and no longer
supports the bag of forewater . Sometimes ,the membrane do
not rupture even in second stage.

d) GENERAL FLUID PRESSURE: when membranes are intact -

Pressure of uterine contractions

Exerted on fluid (amniotic)

Pressure is equalized throughout uterus and fetal body

4 10 Elaborate the -PHYSIOLOGICAL PROCESSES IN SECOND STAGE OF LABOUR: Teacher What are the
min physiological activity: physiological
process in  Three physiological changes result from a continuation of the Teacher events in second
second stage of same forces,which have been at work during the first stage of Elaborates stage of labour?
labour. labor. physiological
 (1) DECEND process in
Decend of the fetal presenting part,which began during the first stage of second stage of
labor and reached its maximum speed toward the end of first stage of labour with the
labor,continues its rapid pace through the second stage of labour until help of
reaching the pelvic floor ppt,blackboard,
Handouts.

 The average maximum rate of decend is 1.6cm per hour in Learner

nulliparas and 5.4cm per hour in multiparas. activity:
Students are
 (2)UTERINE ACTION Listening
 Contraction during the second stage are frequent,strong and carefully and
slightly longer that is approximately every two minutes,lasting writingnotes.
60-90 seconds.
 They are of strong intensity and become expulsive in
nature.After the painful contractions she experienced during the
transition ,the woman usually feels relief to be in second stage
and be able to push if she so desires.

 The hard contractions of transition are now past and the cervix
is fully dilated .The woman’s body seems to” take a breath”
before starting expulsive efforts.The contractions space out and
are not so intense. The woman rests and may even nap.

 This quiet period may last as long as an hour and is longer in

primigravidae than in multigravidae.Gradually momentum builds
as the fetal head decends through the pelvis,the contraction
 become more forceful and the woman begins to voluntarily bear
down with expiratory ,grunty, short pushes.

 SOFT TISSUE DISPLACEMENT

 As the hard fetal head decends,the soft tissues of the pelvis
become displaced.Anteriorly,the bladder is pushed upwards into
the abdomen where it is at less risk of injury during fetal decend.
 Posteriorly ,the rectum becomes flattened into the sacral curve
and the pressure of the advancing head expels any residual fecal
matter.
 The levator ani muscles dilate ,thin out and become displaced
laterally,and the perineal body is flattened,stretched and
thinned.The fetal head becomes visible at the vulva ,advancing
with each contraction,and receding during the resting phase
until crowing takes place and the head is born.

5 8 Discuss about -PHYSIOLOGICAL PROCESS IN THIRD STAGE OF LABOUR: What are the
min the Teacher physiological
physiological  The third stage of labour comprises the phase of placental activity: process in third
process in third sepration ; its decent to the lower segment and finally its Teacher stage of labour?
stage of labour. expulsion with the membrane. Discuss about
the
 PLACENTAL SEPARATION:At the beginning of labour, the physiological
placental attachment roughly corresponds to an area of 20cm in process in third
diameter.There is no appreciable diminution of the surface area stage of
of the placental attachment during first stage . labourwith the
help of
 During the second stage ,there is slight but progressive pamphlet,chart,
diminution of the area following successive retraction ,which Blackboard.
attains its peak immediately following the birth of the baby.
Learner
 After the birth of the baby ,the uterus measures about 20cm activity:
vertically and 10cm antero-posteriorly,the shape becomes Listening
 discoid. carefully and
writing.
 The wall of the upper segment is much thickened while the thin
and flabby lower segment is thrown into folds.

-MECHANISM OF SEPARATION :
 There are two ways of separation of placenta:
 Central separation (schultz)
 Marginal separation(mathews-duncan)

 SEPARATION OF THE MEMBRANES:

 The membranes which are attached loosely in the active part
are thrown into multiple folds.
 Those attached to the lower segment are already separated
during its stretching
 The separation is facilitated partly by uterine contraction and
mostely by weight of the placenta as it descends down from the
active part.
 The membranes so separated carry with them remnants of
decidua vera giving the outer surface of the chorion its
characteristic roughness.

-EXPULSION OF PLACENTA :

 After complete separation of the placenta,it is forced down into

the flabby lower uterine segment or upper part of the vagina by
effective contraction and retraction of the uterus.
Thereafter,it is expelled out by either voluntary contraction of
abdominal muscles(bearing down efforts)or by manual procedure.
-Mechanism of control of bleeding :

 Living ligature -After placental separation, innumerable torn

sinuses which have free circulation of blood from uterine and
ovarian vessels have to be obliterated.
 The occlusion is effected by complete retraction where by the
arterioles,as they pass tortuously through the interlacing
intermediate layer of the myometrium,are literally clamped
during uterine contractions.

 Thrombosis -occurs to occlude the torn sinuses,a phenomenon

which is facilitated by hyper-coagulable state of pregnancy .

 Myotemponade-Apposition of the walls of the uterus following

expulsion of the placenta() also contributes to minimise blood
loss.