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PHASES OF PARTURITION
10
PHASES of
PARTURITION
OBJECTIVES
1 Discuss the physiologic processes that take place during labor
2 Discuss the clinical aspects of Phases of Parturition
LABOR
Bringing forth of the young
Uterine contractions and cervical changes
Fetal cardinal movements
PROCESSES
Passage of the baby thru the birth canal
PHASES OF PARTURITION
Labor
Uterine quiescence
Cervical Softening
PHASE 4
PHASE 2
PHASE 1
PHASE 3
Puerperium
Uterine awakening or activation
PHASE 1
PHASE 1
UTERINE QUIESCENCE
UTERINE QUIESCENCE
Characterized by uterine smooth muscle tranquility with maintenance of cervical structural integrity.
Begins even before implantation.
This continues until near the end of pregnancy.
UTERINE QUIESCENCE
BRAXTON-HICKS CONTRACTIONS
low-intensity myometrial contractions are felt during the quiescent phase, but they do not normally cause cervical dilatation
CERVICAL SOFTENING
CERVICAL SOFTENING
Structural changes
- increased vascularity
- stromal hypertrophy
- glandular hypertrophy
- hyperplasia
- slow, progressive compositional or structural changes of the extracellular matrix
PHASE 2
Uterine Awakening/ Activation
PHASE 2
MYOMETRIAL CHANGES
MYOMETRIAL CHANGES
Key proteins that control contractility or Contraction associated proteins (CAPs) include oxytocin receptor, prostaglandin F receptor, and connexin 43
They lead to increased uterine irritability and responsiveness to uteronins, hence stimulating contractions
MYOMETRIAL CHANGES
LIGHTENING
Formation of the lower uterine segment from the isthmus
“the baby dropped”
CERVICAL RIPENING
CERVICAL RIPENING
- Cervical yielding and dilatation
- Begins weeks or days before the onset of contractions
- Total amount and composition of proteoglycans and glycosaminoglycans within the matrix is altered
- The uterine corpus is mainly smooth muscle
- The cervix is mainly connective tissue
CERVICAL RIPENING
- Cervical yielding and dilatation
- Begins weeks or days before the onset of contractions
- Total amount and composition of proteoglycans and glycosaminoglycans within the matrix is altered
- The uterine corpus is mainly smooth muscle
- The cervix is mainly connective tissue
Dynamic changes in collagen structure
CERVICAL RIPENING
collagen fibril diameter is increased
increased spacing between fibrils
loss of tissue integrity
increased tissue compliance
PHASE 3
Labor/
Active Labor
PHASE 3
Stage 1
STAGE 1
Stage of Cervical Effacement and Dilatation
start of uterine contractions up to full cervical dilatation
STAGE 1
Stage of Cervical Effacement and Dilatation
start of uterine contractions up to full cervical dilatation
Stage 2
STAGE 2
Stage of Fetal Expulsion
From full cervical dilatation up to fetal expulsion
Stage 3
STAGE 3
Delivery of Placenta and Membrane
Stage 4
STAGE 4
1st hour following delivery
PHASE 4
PHASE 4
Puerperium
PARTURIENT RECOVERY
INVOLUTION / PURPERIUM