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Stages of Labour
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Fetal axis pressure: Normally, the fetal axis through the spine coincides with the longitudinal axis of the uterus. During labour, the fetus aligns itself so that the contraction force passing through the fetal spine pushes it along the curve of Carus. The well-fitting descending head stretches and thrusts itself over the os of the cervix and, along with the uterine force propelling it downwards, acts as a cervical dilator. The shortening myofibril of the upper segment gives an upward pull. These three working in synchrony bring about the dilation of the cervix. The absence of this alignment and emptiness of the lower segment in the transverse lie brings out the reason why the cervix appears like a hanging loose, thick, and incompletely dilated organ. This also explains the delay in dilation when the presenting part is ill-fitting, like the footling breech, or when the fetus is misaligned due to the pendulous abdomen.
Causes and risk factors
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Also termed cervical insufficiency, cervical incompetence is well recognised as a potential cause of mid-trimester miscarriage, and although some cases involve mechanical weakness, in the majority of cases there is normal cervical anatomy, but evidence of subclinical intrauterine infection. However, whether infection is the result or cause of premature cervical dilation remains unknown.10 In addition to being a congenital problem, cervical incompetence may follow mechanical trauma such as excessive dilation at the time of curettage, cervical biopsy or occasionally a difficult vaginal delivery. Preterm labour (PTL) has been linked to cervical incompetence in single and multiple pregnancies. In the case of the latter, the risk is higher, and as PTL is the major cause of neonatal death in multiple pregnancies, cervical screening is useful for identifying those at risk, although there is uncertainty as to whether the standard treatment of inserting a stitch (cerclage) improves pregnancy outcome.12,13
Labour and birth care
Published in Helen Baston, Midwifery, 2020
Delay in the first stage of labour is usually suspected if cervical dilatation is less than 2 cm in four hours when the woman is in the established labour (NICE 2014). The midwife has a role in trying to prevent such delay by ensuring that the woman is hydrated, supported and has one-to-one care. Amniotomy (ARM) may be considered and discussed with the woman where progress is slow and the membranes are intact. The midwife should explain that whilst the length of labour may be reduced, she may experience more painful contractions and other options for pain relief should be thought through. If delay is confirmed, the midwife should refer the woman to the care of an obstetrician who will undertake a full assessment of her progress before considering intervention, such as the use of intravenous oxytocin.
Prediction model for labour dystocia occurring in the active phase
Published in Journal of Obstetrics and Gynaecology, 2023
Yanqing Liu, Qingquan Gong, Yuhong Yuan, Qi Shi
The following classes of primiparas were excluded from the study:Women with psychological and mental disorders.Women with cervical dilation > 6 cm at admission, epidural analgesia, CS in latent phase and second stage of labour, CS because of foetal distress and elective CS during the active phase, operative vaginal delivery (vacuum or forceps), shoulder dystocia and induction of labour because of severe malformations such as full-term stillbirth, hydrocephalus and anencephaly.Those with incomplete demographic data.
Foetal Pillow associated uterine and bladder rupture
Published in Journal of Obstetrics and Gynaecology, 2022
Adelle Jordan, Nelson Herbert, Dayle Rundle-Thiele, Sean Holland, Audris Wong
When she presented in spontaneous labour, cardiotocograph (CTG) was normal. Clinical assessment demonstrated 4 cm cervical dilatation, 4:10 strong regular uterine contractions and intact amniotic membranes. Artificial rupture of membranes (ARM) was performed 6 hours after presentation at 9 cm cervical dilatation and revealed meconium stained liquor. Oxytocin was not used in her labour at any stage. Stage 1 labour lasted 9 hours and 30 minutes. Stage 2 labour lasted 3 hours and 5 minutes. At full dilatation of the cervix, 1 hour was allowed for passive head descent. Reassessment after 2 hours of active pushing revealed an obstructed labour with the foetal head at station-1. A decision was made to proceed with an emergency caesarean section. After injection of a spinal anaesthetic a FP was placed as per the manufacturer’s guidelines. As soon as the FP was inserted frank blood was seen in the catheter and the urinary bag. A foetal bradycardia was immediately audible on doppler at 70 beats per minute. Intraoperatively, extensive adhesions and a Bandl’s ring were encountered. Entry to the peritoneal cavity revealed that the lower segment of the uterus had ruptured into the bladder, with foetal parts present within the bladder cavity and abdomen. The uterus was incised transversely below the Bandl’s ring and extended with a midline inverted T-incision. A left lateral inferior angle extension was noted towards the cervix and a forked lateral extension was noted on the right lateral angle.
Progression of the first stage of labour, in low risk nulliparas in a South Asian population: a prospective observational study
Published in Journal of Obstetrics and Gynaecology, 2021
Roli Purwar, Sunita Malik, Zeba Khanam, Archana Mishra
The upper limit of normal, i.e. mean + 2SD is nine hours and six hours respectively in progression from 4 cm to 6 cm to full dilatation. Similarly to our findings, other recent studies like Jones et al., also reporting that low-risk nulliparous women who are delivering vaginally and undergoing spontaneous delivery without oxytocin, epidurals and operative deliveries have duration between 6.2 and 7.7 hours at the mean and up to 13.4–19.4 hours at the mean + 2SD (Jones and Larson 2003). Friedman’s upper limit of normal (mean + 2SD) was 11.7 hours and his active phase began from 2.5 cm cervical dilatation and his 45–53% of active phase duration was passed in the acceleration phase when only dilatation changes from 2.5 cm to 4 cm. The mean duration in progressing from 6 cm to 10 cm cervical dilatation (i.e. almost similar to phase of maximum slope according to Friedman) in our study was 2.57 ± 1.31 hours in group A and 2.79 ± 1. 72 hours in group B. The mean duration of phase of maximum slope, i.e. from 4 cm to 9 cm, of Friedman study was found to be 1.67 ± 1.25 hours (Friedman 1954, 1955, 1978).