Stages and Mechanism of normal delivery Stage 1 -from onset of regular contraction until cervix fully dilated -cervix

initially effaces ( become shorter and softer) before it dilates. Icm/h from 3 cm -takes up 12h in primip and 7.5 In multip -bp, temp and pulse checked half hourly -assess contraction every 15 min (strength and frequency-3-4/min) -vaginal exam every 4h to assess cervical dilatation -test urine for ketones and protein.give 10% dextrose if ketotic -measure fetal heart rate Stage 2 -time from complete dilatation until baby is born -mum has urge to push and uses abdo muscle and vasalva manoeuvre to help move the baby -as head descends-perineum stretches and anus gapes -takes up to 45-120 min in primip and 15-45 min in multip -prevent precipitate delivery ( intracranial bleeding) by pressure over perineum -delay clamping cord for 30 sec and hold baby 20 cm below introitus to reduce transfusion and o2 supplement

Stage 3 -delivery of placenta -placenta separates from uterus from spongy layer of deciduas basalis -it then buckles and small retroplacental haemorrhage helps the removal -sign of separation: cord lengthening rush of blood( retroplacental haemorrhage) per vaginam - uterus rises uterine contracts in the abdo

The mechanism