SlideShare una empresa de Scribd logo
1 de 35
Descargar para leer sin conexión
DR RAJEEV SOOD
     ASTT. PROF.
  DEPT. OF OBG
   IGMC SHIMLA
PARTURITION is defined as the process of bringing forth of
  young which comprises of multiple transformations in
  both uterine and cervical functions
There are four phases :
 Quiescence
 Activation phase
 Stimulation phase
 Involution phase.
QUIESCENCE      ACTIVATION     STIMULATION     INVOLUTION

FROM       CONCEPTION      BEGINNING OF   UP TO DELIVERY TILL THE
           TO INITIATION   PARTURITION    OF CONCEPTUS TIME

  PHASES OF PARTURITION
           OF
           PARTURITION
                           TO ONSET OF
                           LABOUR
                                                         FERTILITY IS
                                                         RESTORED


PREDOMIN   INHIBITORS      UTEROTROPIC    UTEROTONICS     OXYTOCIN
-ANTLY     PROGESTRONE ,   ESTROGEN,      OXYTOCIN        THROMBINS
INFLUENC   PROSTACYCLIN,   OXYTOCIN ,     PROSTAGLANDI
-ING       NITROUSOXIDE,   PROSTAGLAND    NS
FACTOR     RELAXIN         INS->
                           INCREASED
                           GAP JUNC.
UTERINE    CONTRACTILE     PREPARATION    CONTRAC         INVOLUTION
ACTIVITY   UNRESPONSIVE    FOR LABOUR     TIONS ALONG
           NESS.                          WITH FETAL &
                                          PLACENTAL
                                          EXPULSION
CERVIX     SOFTENING       RIPENING       DILATATION &    REPAIR
                                          EFFACEMENT
Physiology of normal labour
LABOUR
It is the third phase of parturition, comprising three
   stages:
First stage: from onset of labour pains till cervix is fully
   dilated.

Second stage of labour: from complete dilatation of
  cervix till the delivery.

Third stage of labour: placental separation &expulsion
FIRST STAGE OF LABOUR

Following are the major events during labour:
 Gradually increasing uterine contractions
 Retraction
 Dilatation of cervix
 Effacement of cervix
 Lower uterine segment formation
UTERINE CONTRACTIONS IN
LABOUR
Characteristics of normal uterine contractions:
 Pace maker: situated in the region of tubal ostia from where
  wave of contraction spread downwards.
  Sometimes there is emergence of multiple pace maker foci
  leading to less efficient contractions and hence causing
  primary dysfunction labour
 Fundal dominance with gradual diminishing contractions
  towards the lower segment.
 Polarity of uterus : when upper segment contracts, retracts
  and pushes the fetus down the lower uterine segment and
  cervix dilates in response.
   Lack of fundal dominance and the reverse polarity leads to
  spastic lower uterine segment. Here pacemaker does not
  work in rhythm.
 Good synchronization of contraction waves from
  both sides of uterus.
 Regular pattern of contractions
 Good relaxation in between the contractions
 Intra amniotic pressure during relaxation is 8mm
  rising beyond 20mm during contraction
Physiology of normal labour
INTENSITY: describes degree of uterine systole.
 increases with progress of labour.Maximum during 2nd
  stage of labour
DURATION: initially last for 10-15 seconds gradually
  increases up to 40-45 sec.
FREQUENCY: in the early stage of labour, contractions
  come at the interval of 10-15min and increases to maximum
  in 2nd stage of labour.
Clinically contractions are said to be good when they come
  after interval of 3-5minutes and at the height of
  contractions uterine wall can not be indented by fingers.
TONUS : intra uterine pressure in between the
  contractions.
During Quiscent stage- 2-3mm Hg
During first stage of labour 8-10mmHg.
Factors governing tonus are:
 Contractility of uterine muscles
 Intra abdominal pressure
 Over distension of uterus as in twins and
   hydramnios.
If the intensity diminishes, duration is shortened and
   period between the increases it leads to hypotonic
   uterine dysfunction. Here intrauterine pressure
   during the contractions remains below 25mm of Hg.
if there is increased frequency and duration without
   adequate relaxation in between it leads to inco-
   ordinate uterine action.
It comprises a rise in the base line tone which and hence
   diminishing the circulation in the intervillous space of
   placenta
LABOUR PAINS
Pain during contractions is along the cutaneous nerve
distribution of T10 to L1
Pain of cervical dilatation is radiated to back through sacral
  plexus
Causes of pain:
 Myometrial hypoxia
 Streching of peritonium over the fundus
 Streching of cervix during dilatation
 Compression of nerve ganglia
Retraction
Permanent shortening of uterine muscle.
net effects are :
 Formation of lower uterine segment.
 Maintain advancement of presenting part made during
  contractions
 Reduce the surface area of uterus and hence favouring
  placental separation.
 Effective haemostasis after separation of placenta.
FRIEDMAN graph of cervical
dilation
Latent phase : during which there is little dilatation
  occurs with considerable changes taking place in the
  connective tissue component of cervix which include:
 Breaking down of collagen by collagease and elastases.
 Accumulation of fluid between collagen fibres.
 Fibro- muscular glandular hypertrophy.
 Increased vascularity
Acceleration phase with cervical dilatation 2.5-4 cm.
Phase of maximum slope: between 4-9cm
Phase of decelaration: 9-10cm
Caused by:
(a)Uterine contraction and retraction: bucket
  handle manner of attachment of longitudinal muscle
  fibres of upper uterine segment with circular muscle
  fibres of lower uterine segment and cervix. Thus
  during contraction of upper segment the canal-
  shortens, retracts and opens.
Physiology of normal labour
(b)Bag of membranes : during labour the membranes
  attached to the lower uterine segment are detached

  herniation of membranes through the cervical canal

 due to ball valve action of well flexed head, during uterine
 contraction hydrostaic pressure in forewaters increases

                  cervical dilatation
Physiology of normal labour
Fetal axis pressure: contractions of circular muscles of
  body of uterus

    Straightening of vertebral column of fetus

     Fundal contractions transmit through podalic pole in to
  fetal axis

     Mechanical streching of lower uterine segment and
  opening of cervical canal
Effacement of cervix
Muscular Fibres of cervix are pulled upwards and merge with
lower uterine segment.
Effacement precedes the dilatation in primegravidae
While it occurs simultaneously with dilatation in multiparae
Physiology of normal labour
Lower uterine segment formation
 During labour lower uterine segment is demarcated by
    physiological retraction ring above and fibromuscular
    junction of cervix and uterus below.
    formed maximally during labour.
   7.5-10 cm when fully formed and cylindrical during 2nd
    stage of labour
   Poor retractile property as compared to upper uterine
    segment.
    gradual thinning of lower uterine segment due to
    relaxation of its muscle fibres to allow elongation and
    descent of presenting part
 1)implantation of placenta of in lower uterine segment
 leads to placenta praevia.

 2)poor decidual reaction in this segment facilitates
 morbid adherent placenta.

 3)lower segment is entirely the passive segment of
 uterus. Because of poor retractile property,there is
 chance of post partum haemorrhage if placenta is
 implanted over the area.
Physiology of normal labour
 Uterine tetany: when there is no physiological
  differentiation between upper active and lower passive
  segment of uterus whole of the uterus goes in to a
  tonic muscular spasm holding the fetus inside.
 Poor decidual reaction in this segments facilitates
  morbid adherent placenta if implanted here
 Poor retractile property leads to post partum
  haemorrhage.
SECOND STAGE OF LABOUR
It two phases:
 (a)propulsive: from full dilatation until head
   touches the pelvic floor.
 (b)expulsive: since the time there is irresistible
   maternal desire to bear down until the baby is
   delivered .
Factors leading to expulsion of fetus from uterine cavity are :
 Reduced volume due to escape of large amount of amniotic
  fluid.
 Elongation of uterus due to contraction of circular muscle
  fibers keeping the fetal axis straight.
 Reduced transverse or anterioposterior diameter.
 Downward thurst offered by uterine contractions
  supplimented by voluntary contractions of abdominal
  muscle.
 Retraction of uterus which counterbalance the resistance
  offered by pelvic floor.
Third stage of labour

 It comprises expulsion of placenta with membranes
SEPERATION OF PLACENTA: due to shearing force
   instituted between the placenta and placental site due to
   marked reduction in the surface area in the placental site
   and inelasticity of placenta.



PLANE OF SEPERATION: runs through spongy layer of
  decidua basalis.
METHODS OF SEPERATION :
Marginal separation Of Placenta(Mathew Duncan):
 more frequent . Separation starts at the margins as it is
 mostly unsupported.
Central separation (Schultze): detachment starts at
 centre with opening of few uterine sinuses and
 collection of retroplacental haematoma. Gradually due
 to weight of placenta and retroplacental blood
 collection more and more placenta separates.
 SEPARATION OF MEMBRANES: The membranes in
  the upper part are thrown in to folds while those in the
  lower part are already detached due to stretching.
 Expulsion of placenta : After complete separation the
  placenta is forced in to the lower uterine segment and
  then in the vagina.
 Complete expulsion occures due bearing down efforts
  of by manual procedure.
HAEMOSTASIS
 Living ligature : as the arterioles pass tortuously through
  interlacing intermediate layers of myometrium they are
  actually clamped during uterine contractions.

 Thrombosis: occlude torn sinuses as pregnancy is
  hypercoagulation state.

 Myotamponade: apposition of walls of uterus after
  expulsion of placenta.
Physiology of normal labour
THANK YOU

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

POLYHYDRAMINOS
POLYHYDRAMINOSPOLYHYDRAMINOS
POLYHYDRAMINOS
 
1st stage managment
1st stage managment1st stage managment
1st stage managment
 
Partograph
Partograph Partograph
Partograph
 
Cord Prolapse
Cord ProlapseCord Prolapse
Cord Prolapse
 
Physiology and Mangement of 2nd stage labour
Physiology and Mangement of 2nd stage labourPhysiology and Mangement of 2nd stage labour
Physiology and Mangement of 2nd stage labour
 
Second stage of labor
Second stage of laborSecond stage of labor
Second stage of labor
 
Amniotic fluid embolism
Amniotic fluid embolismAmniotic fluid embolism
Amniotic fluid embolism
 
Mechanism of normal labour
Mechanism of normal labourMechanism of normal labour
Mechanism of normal labour
 
3rd stage OF LABOUR
3rd stage OF LABOUR 3rd stage OF LABOUR
3rd stage OF LABOUR
 
Hyperemesis gravidarum
Hyperemesis gravidarumHyperemesis gravidarum
Hyperemesis gravidarum
 
Maternal pelvis
Maternal pelvisMaternal pelvis
Maternal pelvis
 
Third stage of labour
Third stage of labourThird stage of labour
Third stage of labour
 
Classification of pelvis
Classification of pelvisClassification of pelvis
Classification of pelvis
 
Fourth stage of labor
Fourth stage of labor Fourth stage of labor
Fourth stage of labor
 
Sign and symptoms of pregnancy
Sign and symptoms of pregnancySign and symptoms of pregnancy
Sign and symptoms of pregnancy
 
Prolonged labour
Prolonged labourProlonged labour
Prolonged labour
 
Aph
AphAph
Aph
 
Cervical ripening and the bishop score
Cervical ripening and the bishop scoreCervical ripening and the bishop score
Cervical ripening and the bishop score
 
Management of postpartum haemorrhage
Management of postpartum haemorrhageManagement of postpartum haemorrhage
Management of postpartum haemorrhage
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 

Destacado

Physiology of labor
Physiology of laborPhysiology of labor
Physiology of laborsarahracal
 
Labour and its stages
Labour and its stagesLabour and its stages
Labour and its stagesShrooti Shah
 
The Normal Labor
The  Normal  LaborThe  Normal  Labor
The Normal Laborsosojammoly
 
Psychological changes during pregnancy.ppt
Psychological changes during pregnancy.pptPsychological changes during pregnancy.ppt
Psychological changes during pregnancy.pptShama
 
Normal Labor & Delivery
Normal Labor & DeliveryNormal Labor & Delivery
Normal Labor & DeliveryMahmoud Saeed
 

Destacado (9)

Physiology of labor
Physiology of laborPhysiology of labor
Physiology of labor
 
puerperium
puerperiumpuerperium
puerperium
 
Normal labor
Normal laborNormal labor
Normal labor
 
Labour and its stages
Labour and its stagesLabour and its stages
Labour and its stages
 
The Normal Labor
The  Normal  LaborThe  Normal  Labor
The Normal Labor
 
physiological changes in puperium
physiological changes in puperiumphysiological changes in puperium
physiological changes in puperium
 
Normal Puerperium
Normal PuerperiumNormal Puerperium
Normal Puerperium
 
Psychological changes during pregnancy.ppt
Psychological changes during pregnancy.pptPsychological changes during pregnancy.ppt
Psychological changes during pregnancy.ppt
 
Normal Labor & Delivery
Normal Labor & DeliveryNormal Labor & Delivery
Normal Labor & Delivery
 

Similar a Physiology of normal labour

stagesmanagementoflabour-190204140838.pptx
stagesmanagementoflabour-190204140838.pptxstagesmanagementoflabour-190204140838.pptx
stagesmanagementoflabour-190204140838.pptxArun072
 
Pathophysiology of Normal Labour by Sunil Kumar Daha
Pathophysiology  of Normal Labour by Sunil Kumar DahaPathophysiology  of Normal Labour by Sunil Kumar Daha
Pathophysiology of Normal Labour by Sunil Kumar Dahasunil kumar daha
 
Normal labour and its physiology
Normal labour and its physiologyNormal labour and its physiology
Normal labour and its physiologyAtul Yadav
 
6.Normal Labor,Delivery And The Puerperium
6.Normal Labor,Delivery And The Puerperium6.Normal Labor,Delivery And The Puerperium
6.Normal Labor,Delivery And The PuerperiumDeep Deep
 
NORMAL LABOR. WARDA
NORMAL LABOR.  WARDANORMAL LABOR.  WARDA
NORMAL LABOR. WARDAOsama Warda
 
CBL Management of labour.pdf
CBL Management of labour.pdfCBL Management of labour.pdf
CBL Management of labour.pdfElhadi Miskeen
 
Clinic of the labor obstetric
Clinic of the labor obstetricClinic of the labor obstetric
Clinic of the labor obstetricMuhammad Khadhari
 
NORMAL LABOR (EUTOCIA)
NORMAL LABOR (EUTOCIA)NORMAL LABOR (EUTOCIA)
NORMAL LABOR (EUTOCIA)Rajat Nanda
 
Causes and onset of labour
Causes and onset of labourCauses and onset of labour
Causes and onset of labourDrpawan Jhalta
 
THIRD STAGE OF LABOUR.pptx3rd stage.of labour
THIRD STAGE OF LABOUR.pptx3rd stage.of labourTHIRD STAGE OF LABOUR.pptx3rd stage.of labour
THIRD STAGE OF LABOUR.pptx3rd stage.of laboursunnykharshandi1995
 
Causes and onset of normal labour
Causes and onset of normal labourCauses and onset of normal labour
Causes and onset of normal labourSwati Sugandha
 

Similar a Physiology of normal labour (20)

stagesmanagementoflabour-190204140838.pptx
stagesmanagementoflabour-190204140838.pptxstagesmanagementoflabour-190204140838.pptx
stagesmanagementoflabour-190204140838.pptx
 
Stages of labor
Stages of  laborStages of  labor
Stages of labor
 
Pathophysiology of Normal Labour by Sunil Kumar Daha
Pathophysiology  of Normal Labour by Sunil Kumar DahaPathophysiology  of Normal Labour by Sunil Kumar Daha
Pathophysiology of Normal Labour by Sunil Kumar Daha
 
Normal labour and its physiology
Normal labour and its physiologyNormal labour and its physiology
Normal labour and its physiology
 
Labour : The process of child birth
Labour : The process of child birthLabour : The process of child birth
Labour : The process of child birth
 
Stages of labour
Stages of labourStages of labour
Stages of labour
 
Normal labour
Normal labourNormal labour
Normal labour
 
Labor-5 (2).pptx
Labor-5 (2).pptxLabor-5 (2).pptx
Labor-5 (2).pptx
 
3rd stage of labour.ppt
3rd stage of labour.ppt3rd stage of labour.ppt
3rd stage of labour.ppt
 
6.Normal Labor,Delivery And The Puerperium
6.Normal Labor,Delivery And The Puerperium6.Normal Labor,Delivery And The Puerperium
6.Normal Labor,Delivery And The Puerperium
 
Normal labour and management
Normal labour and managementNormal labour and management
Normal labour and management
 
NORMAL LABOUR
NORMAL LABOURNORMAL LABOUR
NORMAL LABOUR
 
NORMAL LABOR. WARDA
NORMAL LABOR.  WARDANORMAL LABOR.  WARDA
NORMAL LABOR. WARDA
 
CBL Management of labour.pdf
CBL Management of labour.pdfCBL Management of labour.pdf
CBL Management of labour.pdf
 
Clinic of the labor obstetric
Clinic of the labor obstetricClinic of the labor obstetric
Clinic of the labor obstetric
 
NORMAL LABOR (EUTOCIA)
NORMAL LABOR (EUTOCIA)NORMAL LABOR (EUTOCIA)
NORMAL LABOR (EUTOCIA)
 
Causes and onset of labour
Causes and onset of labourCauses and onset of labour
Causes and onset of labour
 
THIRD STAGE OF LABOUR.pptx3rd stage.of labour
THIRD STAGE OF LABOUR.pptx3rd stage.of labourTHIRD STAGE OF LABOUR.pptx3rd stage.of labour
THIRD STAGE OF LABOUR.pptx3rd stage.of labour
 
Normal labor and physical therapy role
Normal labor and physical therapy role Normal labor and physical therapy role
Normal labor and physical therapy role
 
Causes and onset of normal labour
Causes and onset of normal labourCauses and onset of normal labour
Causes and onset of normal labour
 

Más de rajeev sood

Malignant ovarian tumors
Malignant ovarian tumorsMalignant ovarian tumors
Malignant ovarian tumorsrajeev sood
 
Antepartum and intrapartum foetal monitoring
Antepartum and intrapartum foetal monitoringAntepartum and intrapartum foetal monitoring
Antepartum and intrapartum foetal monitoringrajeev sood
 
Thyroid disease in pregnancy
Thyroid disease in pregnancyThyroid disease in pregnancy
Thyroid disease in pregnancyrajeev sood
 
Third stage labour complication
Third stage labour complicationThird stage labour complication
Third stage labour complicationrajeev sood
 
Tocolysis & fda risk categories
Tocolysis & fda risk categoriesTocolysis & fda risk categories
Tocolysis & fda risk categoriesrajeev sood
 
Gestational trophoblastic neoplasia
Gestational trophoblastic neoplasiaGestational trophoblastic neoplasia
Gestational trophoblastic neoplasiarajeev sood
 
Peripartum convulsions
Peripartum convulsionsPeripartum convulsions
Peripartum convulsionsrajeev sood
 

Más de rajeev sood (8)

Malignant ovarian tumors
Malignant ovarian tumorsMalignant ovarian tumors
Malignant ovarian tumors
 
Antepartum and intrapartum foetal monitoring
Antepartum and intrapartum foetal monitoringAntepartum and intrapartum foetal monitoring
Antepartum and intrapartum foetal monitoring
 
Breast feeding
Breast feedingBreast feeding
Breast feeding
 
Thyroid disease in pregnancy
Thyroid disease in pregnancyThyroid disease in pregnancy
Thyroid disease in pregnancy
 
Third stage labour complication
Third stage labour complicationThird stage labour complication
Third stage labour complication
 
Tocolysis & fda risk categories
Tocolysis & fda risk categoriesTocolysis & fda risk categories
Tocolysis & fda risk categories
 
Gestational trophoblastic neoplasia
Gestational trophoblastic neoplasiaGestational trophoblastic neoplasia
Gestational trophoblastic neoplasia
 
Peripartum convulsions
Peripartum convulsionsPeripartum convulsions
Peripartum convulsions
 

Último

Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
Understanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well essUnderstanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well essAbhishekKumar524514
 
Forensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentationForensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentationKavitha Krishnan
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 

Último (20)

Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
Understanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well essUnderstanding AIDS:a roadmap to well ess
Understanding AIDS:a roadmap to well ess
 
Forensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentationForensic Nursing powerpoint presentation
Forensic Nursing powerpoint presentation
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 

Physiology of normal labour

  • 1. DR RAJEEV SOOD ASTT. PROF. DEPT. OF OBG IGMC SHIMLA
  • 2. PARTURITION is defined as the process of bringing forth of young which comprises of multiple transformations in both uterine and cervical functions There are four phases :  Quiescence  Activation phase  Stimulation phase  Involution phase.
  • 3. QUIESCENCE ACTIVATION STIMULATION INVOLUTION FROM CONCEPTION BEGINNING OF UP TO DELIVERY TILL THE TO INITIATION PARTURITION OF CONCEPTUS TIME PHASES OF PARTURITION OF PARTURITION TO ONSET OF LABOUR FERTILITY IS RESTORED PREDOMIN INHIBITORS UTEROTROPIC UTEROTONICS OXYTOCIN -ANTLY PROGESTRONE , ESTROGEN, OXYTOCIN THROMBINS INFLUENC PROSTACYCLIN, OXYTOCIN , PROSTAGLANDI -ING NITROUSOXIDE, PROSTAGLAND NS FACTOR RELAXIN INS-> INCREASED GAP JUNC. UTERINE CONTRACTILE PREPARATION CONTRAC INVOLUTION ACTIVITY UNRESPONSIVE FOR LABOUR TIONS ALONG NESS. WITH FETAL & PLACENTAL EXPULSION CERVIX SOFTENING RIPENING DILATATION & REPAIR EFFACEMENT
  • 5. LABOUR It is the third phase of parturition, comprising three stages: First stage: from onset of labour pains till cervix is fully dilated. Second stage of labour: from complete dilatation of cervix till the delivery. Third stage of labour: placental separation &expulsion
  • 6. FIRST STAGE OF LABOUR Following are the major events during labour:  Gradually increasing uterine contractions  Retraction  Dilatation of cervix  Effacement of cervix  Lower uterine segment formation
  • 7. UTERINE CONTRACTIONS IN LABOUR Characteristics of normal uterine contractions:  Pace maker: situated in the region of tubal ostia from where wave of contraction spread downwards. Sometimes there is emergence of multiple pace maker foci leading to less efficient contractions and hence causing primary dysfunction labour  Fundal dominance with gradual diminishing contractions towards the lower segment.  Polarity of uterus : when upper segment contracts, retracts and pushes the fetus down the lower uterine segment and cervix dilates in response. Lack of fundal dominance and the reverse polarity leads to spastic lower uterine segment. Here pacemaker does not work in rhythm.
  • 8.  Good synchronization of contraction waves from both sides of uterus.  Regular pattern of contractions  Good relaxation in between the contractions  Intra amniotic pressure during relaxation is 8mm rising beyond 20mm during contraction
  • 10. INTENSITY: describes degree of uterine systole. increases with progress of labour.Maximum during 2nd stage of labour DURATION: initially last for 10-15 seconds gradually increases up to 40-45 sec. FREQUENCY: in the early stage of labour, contractions come at the interval of 10-15min and increases to maximum in 2nd stage of labour. Clinically contractions are said to be good when they come after interval of 3-5minutes and at the height of contractions uterine wall can not be indented by fingers.
  • 11. TONUS : intra uterine pressure in between the contractions. During Quiscent stage- 2-3mm Hg During first stage of labour 8-10mmHg. Factors governing tonus are:  Contractility of uterine muscles  Intra abdominal pressure  Over distension of uterus as in twins and hydramnios.
  • 12. If the intensity diminishes, duration is shortened and period between the increases it leads to hypotonic uterine dysfunction. Here intrauterine pressure during the contractions remains below 25mm of Hg. if there is increased frequency and duration without adequate relaxation in between it leads to inco- ordinate uterine action. It comprises a rise in the base line tone which and hence diminishing the circulation in the intervillous space of placenta
  • 13. LABOUR PAINS Pain during contractions is along the cutaneous nerve distribution of T10 to L1 Pain of cervical dilatation is radiated to back through sacral plexus Causes of pain:  Myometrial hypoxia  Streching of peritonium over the fundus  Streching of cervix during dilatation  Compression of nerve ganglia
  • 14. Retraction Permanent shortening of uterine muscle. net effects are :  Formation of lower uterine segment.  Maintain advancement of presenting part made during contractions  Reduce the surface area of uterus and hence favouring placental separation.  Effective haemostasis after separation of placenta.
  • 15. FRIEDMAN graph of cervical dilation
  • 16. Latent phase : during which there is little dilatation occurs with considerable changes taking place in the connective tissue component of cervix which include:  Breaking down of collagen by collagease and elastases.  Accumulation of fluid between collagen fibres.  Fibro- muscular glandular hypertrophy.  Increased vascularity Acceleration phase with cervical dilatation 2.5-4 cm. Phase of maximum slope: between 4-9cm Phase of decelaration: 9-10cm
  • 17. Caused by: (a)Uterine contraction and retraction: bucket handle manner of attachment of longitudinal muscle fibres of upper uterine segment with circular muscle fibres of lower uterine segment and cervix. Thus during contraction of upper segment the canal- shortens, retracts and opens.
  • 19. (b)Bag of membranes : during labour the membranes attached to the lower uterine segment are detached herniation of membranes through the cervical canal due to ball valve action of well flexed head, during uterine contraction hydrostaic pressure in forewaters increases cervical dilatation
  • 21. Fetal axis pressure: contractions of circular muscles of body of uterus Straightening of vertebral column of fetus Fundal contractions transmit through podalic pole in to fetal axis Mechanical streching of lower uterine segment and opening of cervical canal
  • 22. Effacement of cervix Muscular Fibres of cervix are pulled upwards and merge with lower uterine segment. Effacement precedes the dilatation in primegravidae While it occurs simultaneously with dilatation in multiparae
  • 24. Lower uterine segment formation  During labour lower uterine segment is demarcated by physiological retraction ring above and fibromuscular junction of cervix and uterus below.  formed maximally during labour.  7.5-10 cm when fully formed and cylindrical during 2nd stage of labour  Poor retractile property as compared to upper uterine segment.  gradual thinning of lower uterine segment due to relaxation of its muscle fibres to allow elongation and descent of presenting part
  • 25.  1)implantation of placenta of in lower uterine segment leads to placenta praevia.  2)poor decidual reaction in this segment facilitates morbid adherent placenta.  3)lower segment is entirely the passive segment of uterus. Because of poor retractile property,there is chance of post partum haemorrhage if placenta is implanted over the area.
  • 27.  Uterine tetany: when there is no physiological differentiation between upper active and lower passive segment of uterus whole of the uterus goes in to a tonic muscular spasm holding the fetus inside.  Poor decidual reaction in this segments facilitates morbid adherent placenta if implanted here  Poor retractile property leads to post partum haemorrhage.
  • 28. SECOND STAGE OF LABOUR It two phases:  (a)propulsive: from full dilatation until head touches the pelvic floor.  (b)expulsive: since the time there is irresistible maternal desire to bear down until the baby is delivered .
  • 29. Factors leading to expulsion of fetus from uterine cavity are :  Reduced volume due to escape of large amount of amniotic fluid.  Elongation of uterus due to contraction of circular muscle fibers keeping the fetal axis straight.  Reduced transverse or anterioposterior diameter.  Downward thurst offered by uterine contractions supplimented by voluntary contractions of abdominal muscle.  Retraction of uterus which counterbalance the resistance offered by pelvic floor.
  • 30. Third stage of labour It comprises expulsion of placenta with membranes SEPERATION OF PLACENTA: due to shearing force instituted between the placenta and placental site due to marked reduction in the surface area in the placental site and inelasticity of placenta. PLANE OF SEPERATION: runs through spongy layer of decidua basalis.
  • 31. METHODS OF SEPERATION : Marginal separation Of Placenta(Mathew Duncan): more frequent . Separation starts at the margins as it is mostly unsupported. Central separation (Schultze): detachment starts at centre with opening of few uterine sinuses and collection of retroplacental haematoma. Gradually due to weight of placenta and retroplacental blood collection more and more placenta separates.
  • 32.  SEPARATION OF MEMBRANES: The membranes in the upper part are thrown in to folds while those in the lower part are already detached due to stretching.  Expulsion of placenta : After complete separation the placenta is forced in to the lower uterine segment and then in the vagina.  Complete expulsion occures due bearing down efforts of by manual procedure.
  • 33. HAEMOSTASIS  Living ligature : as the arterioles pass tortuously through interlacing intermediate layers of myometrium they are actually clamped during uterine contractions.  Thrombosis: occlude torn sinuses as pregnancy is hypercoagulation state.  Myotamponade: apposition of walls of uterus after expulsion of placenta.