Normal Labor and

Delivery

dr. Damayanti Eka, SpOG

Dept of Obstetric and Gynaecology

Raden Mattaher Hospital/Faculty of Medicine,
Jambi University
 Labor, definition
 Labor: All processes from the onset of
contraction to the end of the forth stage (2
hours after delivery of he placenta

 Four stages of labor:

• First: Dilation of the cervix (1-10 cm)
• Second: Expulsion of the fetus, or delivery
• Third: Expulsion of the placenta
• Fourth: Hemostasis period, 2 hours after
expulsion of the placenta
 Delivery
 Definition:
Expulsion of the fetus (second stage)

 Delivery is included in labor.

 Types:
• Spontaneous delivery vs. Assisted delivery
• Operative
• Vaginal vs. abdominal
 Normal labor and delivery
(definition)

 Spontaneous initiation
 Pregnancy age: 37-42 weeks
 Longitudinal lie, occiput presentation
 Duration of labor: 4-18 hours
 Vaginal delivery
 Amount of bleeding: < 500 ml
 Pregnancy outcome: good
 Terminologies
 Normal delivery
 Physiological delivery
 Pathological delivery
 Spontaneous delivery
 Assisted delivery
 Operative delivery
 First stage
 Uterine contraction: frequency, duration, intensity
 Fetal heart rate: every 30 ‘ (uncomplicated) and 15 ‘
for high risk fetus or electronic fetal monitoring
 Maternal vital signs: BP, T, PR every 4 hours
 First vaginal ex: dilatation, thickness, and consistency
of the cervix, presentation, position, station,
membrane, and cephalopelvic balance (clinical
pelvimetry)
 Next vaginal ex: 2-4 hours
 Oral intake: avoid dehydration especially for
prolonged labor
 Intravenous fluid: indicated for potential bleeders
 Analgesia: indicated in certain condition
First stage
Dilatation and descent of fetal
head
Partograph
Station
Delivery room
Handheld Doppler fetal heart rate
monitor
Cardiotocography
Reactive Non-Stress Test (CTG)
Normal Contraction Stress
Test (CTG)
Abnormal Contraction Stress Test
(CTG)
Late deceleration
 Second stage
 Signs and symptoms:
• Bearing down sensation
• Dilated anus
• Vomiting
• Ruptured membrane
 Bimanual (Vaginal) examination
• Check for dilatation
• Determine: station, position of denominator
• Check for cord prolapsed
 Preparation
• Dorsal lithotomy with leg holder
• Supine with flexed, semi-abducted hip and
flexed knee
• Catheterization, if bladder is disturbing
 Delivery the head (1)
 Engagement: Sagital suture fits the
transverse diameter of the inlet (occiput in 3
or 9 o’clock)
 Flexion
 Descent
 Internal rotation (occiput moves to 12 o’clock,
to fits the mid pelvis)
 More descent
 Crowning (distension of the head on the
vaginal opening as wide as 3-4 cm diameter)
 Delivery the head (2)
 Episiotomy (if necessary)
 Extension of the head
 External rotation
 Delivery of the anterior followed by
posterior shoulders
 Delivery of the rest of the body
 Clamp the cord on two points, cut
 Deliver the newborn to baby nurse
 Third stage
 Delivery of the placenta, active management
 Oxytocin 10 IU soon after delivery of the fetus
 Or, 3 tablets of 200 mg misoprostol orally or
rectally
 Catheterization in case of full bladder
 Examine signs of separation of the placenta
 Pressure on the fundus and traction on the
cord
 Examine maternal surface to detect missing
cotyledon
 Methylergonovin maleat 0.3 mg i. m.
 Massage on the fundus
 Forth stage

 Monitor vital sign

 Monitor uterine contraction
 Repair episiotomy
 Monitor bleeding especially for
potential bleeders
Synclitism and asynclitism
Engagement, descent to delivery of the
head
Delivery of the placenta
Repair of episiotomy or perineal rupture
Deflection of the head
 Deflection of the head
(malpresentation)

vertex sinciput brow face

Breech presentation & transverse lie
Transverse lie with subseptate
uterus & low lying placenta
Thank you.....