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Rising level offetal adrenocortical hormones

especially cortisol in late pregnancy are a major

stimulus for the placenta to release a largeamount of estrogens

Rise in estrogens stimulates the

-myomerial cell of

the uterus to form

abundant oxytocin

receptors

-antagonise

progestrones

quieting influence

on uterine muscle.

Result in myometrium becomes increasingly

irritable, weak,

irregular uterine conctraction begins to occur.

( Braxton hicks contraction)

False labor As the birth nears...

Certain fetal

cells begin to

produce

oxytocin

causing the

placenta

release

prostaglandins

Both of this hormones are

powerful uterine muscles

stimulants

frequent and vigorouscontraction happens

at this point, the increasing emotionaland physical stressesactivate the

mothers hypothalamus, which signal

the for oxytocin release by the

posterior pituitary.

True Labourgreater contractile

force

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FALSE LABOR

Braxton Hicks contractions occurring at irregular intervals, sometimes with

some periods of regularity

never becoming any stronger

the intervals between contractions remain always the same

Braxton Hicks may go away after changing your activity

the cervix has not begun to dilate or thin out (efface).

TRUE LABOR

True labor begins with contractions occurring at regular intervals thatbecome stronger as the intervals between them gradually shorten

Sometimes contractions may start in the back and from there radiate

around to the abdomen, while you may feel back pain and/or

menstrual-type cramping instead ofa real contraction.

Contractions during true labor will intensify when walking

and does not go away when you change your activity

normal to notice a mucousy or blood-tinged discharge (Bloody show)

Bag of waters (membranes) may rupture.

Cervix begins to dilate and thin out (efface)

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During the latent phase irregular contractions becomeprogressively better coordinated discomfort is minimal

the cervix effaces and dilates to 4 cmdifficult to time precisely, and durationvaries, averaging 8 h in nulliparas and 5h in multiparas.duration is considered abnormal if itlasts > 20 h in nulliparas or > 12 h in

multiparas

During the active phase the cervix becomes fully dilated, and the presentingpart descends well into the midpelvis

On average, the active phase lasts 5 to 7 h in nulliparasand 2 to 4 h in multiparasThe cervix should dilate 1.2 cm/h in nulliparas and 1.5cm/h in multiparasIf the membranes have not spontaneously ruptured,some clinicians use amniotomy (artificial rupture ofmembranes) routinely during the active phase.

Women may begin to feel the urge to bear down as thepresenting part descends into the pelvis

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The 2nd stage-Expulsion-the time from full cervicaldilation to delivery of the fetusOn average, it lasts 2 h in nulliparas (median 50min) and 1 h in multiparas (median 20 min)Strong contraction occur every 2-3 min and lastabout 1 minCrowning occurs when the largest dimension ofthe babys head distends to the vulva, episiotomy isdone to reduce tissue tearing.The babys neck extends as their head exits fromthe perineum.Once the head is delivered, the rest of the babys

body is delivered much more easily.After birth, the umbilical cord is clamped and cutStage 3placental stageCollectively called afterbirthDelivery of placenta and its attached fetalmembranes

Accomplished within 30 minutesStrong uterine conctractions thatcontinues afterbirth compress the uterineblood vessels, limit bleeding, and shearthe placenta off the uterine wall.It is important that all placental fragments

be removed to continued uterine bleedingafter birth (postpartum bleeding)

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Second pregnancy

Descent 3/5

Descent Hodge 2

Inner pelvic

adequate

No Passage

ProblemFundal height X abdominal

circumferences37 X 95 = 3515g (3.515 kg)

Inner pelvic

adequate

Lowest Part Was head

No Passenger

problem

contraction 4.00-7.00 am

10.00am

Twice/ 10min interval,

Duration 25-30s

Thrice/ 10min interval

Duration 25-30sDescent 3/5

Descent Hodge 2

Inadequate

Power