Stage of cervical Stage of fetal expulsion Stage of placental separation & effacement and dilatation Fetal descent and delivery expulsion characteristic: Happens after full cervical - Delivery of placenta & “Bloody show” dilatation and ends with membranes directly after Upon uterine contractions expulsion of fetus birth. pregnant women will feel - Placental separation is due pain Ancillary forces in Labor: to a disproportion between Ruptured bag of water uterine cavity & placental Maternal Intraabdominal size. Formation of distinct lower & pressure- most important upper uterine segments. force in fetal expulsion after After fetal delivery. The full cervical dilatation fundus is normally lies below the level of umbilicus. 2 Fundamental cervical Pushing Separation of amniochorion: changes during 1st stage of Contraction of abdominal labor muscles simultaneous with Occurs until separation of respiratory efforts w/ closed placenta is complete Cervical effacement: glottis. Peeled off by : Obliteration or taking up of cervix Nature of force is similar with Further uterine contractions defacation but with much Traction from separating higher intensity. placenta. Accomplishes little in 1st stage labor and is useful nd Cervical dilatation: Fetal descent follows a Placental extrusion: Stage ends with cervix fully hyperbolic curve when Separated after uterine dilated:10 cm plotted. contraction Due to centrifugal pull Onset occurs in maximum slope. Occupies lower uterine during uterine contraction -In nulliparas increase rate segment or upper vagina As uterine contraction cause pressure to of descent are observed Expelled by increase membranes, hydrostatic ordinarily during cervical intraabdominal pressure action of amniotic sac dilatation phase of Completion of 3rd stage dilates cervical canal maximum slope. of labor is accompanied by compressing and elevating fundus with minimal traction on umbilical cord. -Duncan mechanism -schultze mechanism From undilated, uneffaced cervix it becomes partly dilated, partly effaced until fully dilated, fully effaced.
Process of cervical dilation and
effacement causes the formation of the forebag of amniotic fluid.
Characteristics of uterine contractions: Painful b/c: (1-4)
Formation of the lower & upper
uterine segment Actively contracting part: (UPPER segment) - firm & hard on palpation - It contracts & retracts to expel the fetus - does not relax to its original length; becomes thicker. Inactive: lower segment -Softer, distended, & more passive Results of the thickening and thinning of uterine segments: Physiologic retraction ring: Marked ridge or boundary formed as a result of the lower segment thinning & concomitant upper segment thickening. Pathologic retraction ring: BANDL ring When the thinning of lower segment is extreme Occurs in obstructed labor. Elongation in uterus: fetal axis pressure 2 Phases of stage 1 stage of Labor Latent phase Active phase
3 divisions of stage 1 labor: Preparatory division Phase of maximum slope Pelvic division