1. DR. RAZAQ O. MASHA,FRCOG Asst. Prof. & Consultant

2. FIRST STAGE: Labour is the onset of regular uterine contractions with progressice effacement and dilatation of the cervix and descent of the presenting part. PRE-LABOUR OR LATENT PHASE: Period of increased uterine activity that occurs for a few weeks before active labour. facilitates softening of the cervix some cervical effacement some dilatation expansion of lower uterine segment

3. “Show” OR BLOODY SHOW  Discharge from the vagina of blood tinged mucus (extension of mucus plug from cervical canal). Movements of Labour a.Engagement b.Descent c.Flexion d.Internal rotation e.Extension f.External rotation g.Expulsion

4. ACTIVE MANAGEMENT 1.ARM 2.Use of oxytocin 1.5 cm / hr multipara 1.2 cm / hr nullipara I.O.L. a.Bishop’s Score: - Cx effacement - Position - Dilatation - Station of the presenting post b.PGE2 c.ARM + oxytocin

5. From full dilatation to expulsion of the fetus From full dilatation to expulsion of the fetus ♦ Duration ♦ Intervention ♦ Intervention ♣Forceps ♣Forceps ♣ Ventouse ♣ Shoulder dystocia in macrosomic babies

6. PAIN RELIEF: PAIN RELIEF: 1.Non Pharmacological Methods a.Psychological management – fear potentiates pain. b.Childbirth preparation classes 2.Analgesia -Pethidine and metoclopramide pathilorfan 3.Entonox 50% Nitrous oxide + 50% oxygen – self administered

7. Separation of the placenta Separation of the placenta Retained placenta – duration Retained placenta – duration Manual removal Manual removal Primary dysfunction labour Secondary arrest

8. INDUCTION OF LABOUR Induction Induction Augmentation AugmentationINDICATIONS Fetal Fetal a. Fetal compromise b. Rhesus disease c. Diabetes Melitus

9. Maternal / Fetal Maternal / Fetal a. P I H b. Pre labour rupture of membranes c. Post maturity d. Maternal disease – valvular heart disease, renal disease, PIH Bishop Score 0123 Dilatation (m) Dilatation (m)Closed1-22-35+ Length (cm) Length (cm)3210 Consistency ConsistencyFirmmediumSoft Position PositionPostMiddleAnterior Station Head -3-20

10. METHODS OF INDUCTION METHODS OF INDUCTION 1.Prostaglandins 3mg dinoprostone PGE2 tabs or intra cervical gel. 2.Amniotomy 3.Oxytocin – has ADH action 4.Membrane Sweep 5.Mechanical dilators Latent Phase Active Phase