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§ §

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
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
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
  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.
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.


c These occur d/t action of harmones

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

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.
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.
   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
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