Stages of labour +

Endocrine Changes
By Tom Bedford
Stages of Labour
Pre-labour

During the 3rd trimester

May get:
• “Bloody show” plug of mucous
& blood released
• “Water breaking” amniotic sac
rupture
1st stage – contractions
and dilation
Latent
• Slow irregular contractions which build up
to full cervical effacement (thinning of the
cervix and 3cm dilation).
Active
• Contractions more regular and stronger
• Dilation of the cervix to a max of 10cm
2nd stage - Delivery
Once cervical dilation is complete, the infant is pushed through the cervix and vagina

1. Descent: fetus moves into pelvic inlet. The degree of descent is referred to as fetal
station (see next slide)
2. Restitution: head externally rotates so the shoulder can pass through pelvic outlet
3. Expulsion: anterior shoulder slips under pubic symphysis followed by posterior and
then the rest of the body
 Fetal station

• Degree of descent (distance

from presenting (first) part
to the maternal ischial spine
• Measured in cm
• At 0cm we have
engagement of the head,
flexion (fetal chin against
chest) and internal rotation
of the shoulders
 Stage 3- placental
birth

• Uterine contractions cause

the placenta to separate
from the uterine wall
• Carefully removed so no
placental remnants are left.
Endocrine processes
 False contractions

• Uterine contractions are

inhibited by high
progesterone
• As gestation continues, the
myometrium becomes more
excitable resulting in mild
contractions – “false
contractions”
 Relaxin

Produced by corpus luteum and

placenta

Leads to:
• Dissociation of collagen fibres in
the cervix – making it more
malleable (referred to as
softening or “ripening” –gross).
This aids dilation
• Loosens connective tissue
between pelvic bones- facilitates
accommodation of fetal head
Estrogen
• Low in early pregnancy but rises with placental maturation
• Very high before labour

Causes
• Synthesis of conexons in uterine smooth muscle. Links smooth muscle for
coordinated contraction.
• Increase in receptors for oxytocin in the myometrium increasing sensitivity
to the hormone
• Increasing production of prostaglandins which also increases oxytocin
sensitivity + promotes cervical softening
• Levels remain constant through
gestation
• Sensitivity increases greatly due to
estrogen

Once myometrial responsiveness to

oxytocin reaches a critical threshold,
strong coordinated contractions occur.
Cortiotropin releasing hormone
• Produced by placenta, secreted into maternal and fetal circulation
• ↑estrogen = drives the entire labour circuit

CRH = ↑estrogen = ↑oxytocin sensitivity = strong uterine contractions

• Maternal serum CRH predict timing of labour with accuracy from

early 2nd trimester
• Cortisol causes ↑ surfactant production and lung maturation
Inflammatory peptides
NF-kB causes the production of inflammatory cytokines such as IL-8 and
prostaglandins which:
• increases the sensitivity of the uterus to contraction-inducing
chemical messengers
• helps soften the uterus