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m 

§ §

c Conventionaly the stages of labour


are devided into 3 stages.
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§  It begins after
expulsion of the foetus & ends with the
expulsion of the placenta & memb
[after birth] . Its average duration is
about 15 mins in both primigravida &
multipara The duration is however
reduces to 5 mins in active
management.
c In addition to the ¶premonitory
stage previously mention , there is
another stage called the 

§  stages of observation for at
least 1 hour after expulsion of the after
birth . During this pd , general condition
of the patient & the behavior of the
uterus are to be carefully watched
§



c during pregnancy there is marked


hypertrophy & hyperplasia of the uterine
muscle leading to enlargement of the
uterus . At term, the length of the uterus
is 30 cm (including cervix) . Fundus is
much wider than the lower segment . The
uterus assume ovoid shape . The cervical
canal is occluded by a thick , mucus plug
.
c      
 
there is good synchronisation of the
contraction waves of both halves of the
uterus .the waves of contration follows
a regular pattern . Good relaxation
occurs in between contraction to bring
down the intra- amniotic pressure . The
cause of pain during contraction is due
to streching of the structure adjacent
to the uterus
c Thus pain is distributed along the cutaneous
nerve distribution of T10 to L1
c
  is a phenomenan of the
uterus in labour in which the muscle fibres
are permanently shortened . Contraction is
a temporary reduction in length of the fibres
, which attain their full length after the
contraction passes off
In contrast,retraction results in
shortening of the fibes once & for all.
Retraction is specially a property of
upper uterine seg.
Effects of retraction are ²
1.Dilataton & taking up of the cervix
2.Effective homostasis after sepration of
placenta .
 §
§ § 

c 1.dilatation &taking up of the cervix.


c .full formation of the lower uterine seg.
c      
redisposing factors are-
c 1.softning of the cervix

c .fibro muscular glandular hypertrophy.

c 3.incresed vascularity.

c 4.accumulation of fluid in between


collagen fibres.
6

6

c These occur d/t action of harmones


ostreogen,progesteron,relaxin.actual
factor responsible as
c î        
the longitudnal ms fibres of the upper
seg are attached with the circular ms
fibres of the lower seg. Thus with each
uterine contraction,not only the canal is
§ 

   


  

   


  
c Mpened up from above down .but it also
become s shortenened and
retractated.while the upper seg.
contracts.,retracts and expels the
foetus,the lower seg. & cervix dilate in
resonse to the contraction of the upper
seg.
   

The memb. [amnoin &chorion]are
attached loosly to the decidual lining of
the uterine cavity except over the
internal os
The liquor in the lower part of the
amnoitic cavity is less in amt &is called
forewaters.the bulk of the amnoitic fluid
c [in upper part,along the with foetus ]
c Is called hind water.with the onset of
labour the memb attached to the lower
uterine seg.are detached &with the rise
of intrauterine press.turning uterine
contraction,there is herniation of the
memb. Through the cervical canal.
à 
 
 
when the foetus lies longutudnally,in
flexed attitude.there is mechanical
stretching of the lower seg.&opening up
of the cervical canal.
Ñ  "  the final phase of
dilatation & retraction of the cervix is
c Isachived by downward press. Mf the
foetus & upward pull of the cervix over it.
c        
   it is a process of thinning out
which is accomplished during first stage
of labour.
 
 
 
§

c 6efore the onset of labour,there is no


complete anatomical or functional
devision of the uterus.during labour
demarcation of an active upper seg & a
relatively passively more
pronounced.the wall of the upper seg.
More pronounced.becomes
thickend,with thinning of lower seg
ca distict ridge is produced at the jxn of
two,called physiological retraction ring.
 §§§ 

c The second stage begins with the complete
dilatation of the cervix & ends with the
expultation of the foetus.this stage is
concerned with the descent & delivery of the
foetus through the birth canal.
c After the full dilatation of cervix,the memb.
Usually rapture & escape of good amt of
liquor amnii.
c Delivery of the foetus is accomplished by the
downward thrust offered by uterine
contraction,supplemented by voluntry
c Contraction of abdominal ms ,against the
resistanced offered by bony & soft tissue of
birth canal.
c Due to the power of retractionthe foetus is
expelled from the uterus against the resistance
offered by the pelvic floor.
 §  
§ 

c Third stage comprises the phase of placental


sepration,its descent of the lower seg. & finally
its expulsion with the memb.
c lacental sepration;- at the bigning of labour
the placenta is attached to an area 0 cm
[8µ]in diamet.
c In second stage it decreases..of the area
following succesive retraction.
c These retractin leada to sheering force ,b/w the
placenta & placental site,wich brings abt ultimate
sepration.
c §      
 "
c §epration is faccilitated by utereine contraction &
mostly by wgt of the placenta.
c  "   
c After complete sepration of placenta,its forced
down into the flabby lower uterine seg.thereafter it
is expelled out by either voluntry contraction of
abdominal ms[bearing down effort]or by
manipulative procedure