Normal Delivery

Prepared by:

Dr. Gehanath Baral

MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of
Nepal
Visiting Professor: CTGU
20th March,2007
 Labor
1st def:
• Series of events for Expulsion of fetus

1. Out of uterus

2. Through the vagina

3. Into the outer world

2
 Labor
2nd def:

• The process by which the fetus is expelled

from the uterus.

3
 Labor
3rd def:

1.Contractions (painful, regular >1/10min)



2.Effacement and dilatation 

3.Descent of presenting part.

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 Normal labor
1. Spontaneous
2. At term
3. Vertex
4. Not prolonged
5. Natural with minimal assistance
6. Without complication to mother & baby

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 Abnormal labor
• Any deviation from normal

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 True labor pain
• Contraction • Cervical change
1. Painful
2. Regular interval 1. Effacement
3. +intensity 2. Dilatation
4. +duration

• “Show” • Formation of bag of

membrane

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 Stage of labor
Stage Primi Multi Def.

1st  12H 6H Onset  Full

dilatation

2nd  1-2H 1/2-1H Full dilatation

 Birth
3rd  5-15min 5-15min Birth 
Placental
delivery
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 Terminology
1. Contraction  1. No permanent
shortening
2. Retraction  2. Permanent shortening

3. Lower uterine segment 3. Cervical isthmus


4. Upper uterine segment 4. Uterine corpus

5. Effacement  5. Shortening & thinning of
Cx
6. Dilatation  6. Increase in diameter of
cx os

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 Placental separation
• Central • Marginal

1. RPC forms 1. Least supported

margin separates
2. Less frequent
2. Frequent

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 Mechanism of labor
• Defn.:- 1. Engagement
Series of movements 2. Descent & Flexion
of fetus in birth canal 3. Internal rotation
during labor 4. Crowning
5. Extension
6. Restitution
7. External rotation
8. Lateral flexion

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Engaging diameter

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Engagement/Descent

13
Engagement/Flexion1

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Engagement/Flexion2

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Internal Rotation

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Extension

17
Extension1

18
Extension2

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Restitution

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External Rotation

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Anterior Shoulder Delivery

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Posterior Shoulder Delivery

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 Partograph
Defn.:-
• Graphical • Tracing esp. of cx
representation of dilatation & head
progress of labor descent against the
duration of labor in
hours.

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 Phases of labor
• Latent phase • Active phase
1. Acceleration
2. Phase of maxm
slope
3. Deceleration
• <3cm dilation • >3cm dilatation
1. Primi=1cm/hr
2. Multi=1.5cm/hr
• Early onset of labor • Active labor

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 P/V findings
1. Os dilatation  In cm
2. Cx effacement  In %
3. Station  In +/- cm
4. Membrane  +/-
5. Position  Of denominator
6. Pelvic adequacy  Adequate /
Inadequate

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 Descant/Engagement
1. 5/5Above brim • Free/Floating
2. 4/5 • Not engaged
3. 3/5 • Not engaged
4. 2/5’0’station, at • Engaged
ischial spine
5. 1/5 • Engaged
6. 0/5 • Engaged

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Descant/Engagement

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 3rd stage
• Firm non ballottable • Firm ballottable ut
ut

• Static length of cord • Permanent

lengthening of cord
• Fundal ht below
umbilicus • Fundal ht towards
umbilicus

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 Management of labor
1. Support to the pt • Antiseptic & aseptic
2. Positioning of the pt precaution during
3. Hand wash/Scrub 1. Exam
4. Sterile gloves 2. Conduction of
5. Vulval toiletting delivery
6. P/V exam

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 P/V exam
• Indication • Contraindication

1. To confirm labor 1. APH / Placenta previa

2. To assess progress of
labor 2. Repeated exam
3. After membrane rupture
4. To diagnose stage of 3. Cord presentation
labor
5. Prior to intervention 4. Ruptured uterus

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