Parturition, Stages of Labour and Partogram

Parturition

Parturition is the act of giving birth to a child. It is a complex procedure that is really painful and long. There are four main phases to parturition. 

Phase I

Phase 1 is the  Quiescent / Dormant phase. 95% of pregnancy is spent in this phase. This phase is a Prelude to labor. Progressive softening of the Cervix occurs in Phase 1.

Phase II

Phase 2 of parturition is the Activation phase / Preparation for delivery. Cervical ripening occurs in this phase.

Phase III 

Phase 3 is the Stimulation phase, which is also known as the Process of delivery. This is further divided into 4 stages of labor. They are:

• Stage 1: From the onset of contractions to full dilation of Cervix
• Stage 2: From full dilation of Cervix to delivery of Fetus
• Stage 3: From delivery of Fetus to delivery of Placenta
• Stage 4: Observation for 1 hour

Phase IV

Phase 4 is the Recovery phase. It is also known as the Involution phase or Puerperium. The Events occurring in Phase IV are: 

• Uterine involution 
• Spontaneous repair of Cervix
• Breastfeeding

Stages Of Labor

First Stage Of Labor

The first stage of labor is from the From onset of true labor pains to full cervical dilatation. This is also known as the Stage of Pain. The first stage of labor is further divided into two stages. 

1. Latent phase: It is the mild irregular contractions till 3 cm of cervical dilatation. The Strength of contractions is  20-25 MVU (Montevideo units)
2. Active phase: This phase is composed of Strong contractions that last 45 seconds long once every 3 minutes. There are 3 contractions in 10 minutes in this phase. In the Accelerated phase/ Phase of maximum slope, the mother experiences Maximum pain in this stage with a dilatation of 4-8 cm. It is followed by a Deceleration phase in which the cervix dilates fully.

Second Stage of Labor

Full dilatation and Delivery happens in the second stage of labor. The latent Phase + Acceleration Phase (of the Active Phase) constitutes the preparatory division of labor. The phase of maximum slope constitutes the Dilatational division of labor. Deceleration Phase + 2^nd stage of labor constitutes Pelvic division of labor. The prolonged second stage of labor is If >1hr in multigravida and >2 hrs in primigravida. The upper limit of the Active Phase is 12 hours.

Third Stage Of Labor

The Delivery of the baby to the delivery of the placenta is the third stage of labor. It is also known as the Stage of placenta delivery.

Fourth stage of Labour

It is also known as the Stage of observation. It lasts for one hour after the placenta is delivered.

Monitoring of Labor

Strong contractions occur during the active phase, which can raise the fetal heart rate. Thus, it is important to monitor the fetal heart rate every half-hour. The mother's Pulse rate, blood pressure, urine output, and temperature also need to be monitored. As the contractions Progress, Oxytocin levels need to be kept in check. Vitals are monitored every half hour. Every 2 hours, per vaginal examination is done to assess the station of the fetal presenting part and cervical dilatation. 

In the latent phase, vaginal examinations are done once in 4 hrs, whereas in the active stage of labor, it is done once in 2 hrs to limit infections. The station of the presenting part is assessed with the Ischial spine as the reference point, which is the narrowest space of the mid-pelvis.

All the monitoring parameters are charted in a Partogram.

Importance of partogram

Partogram is the best tool for monitoring labor progress. It works as an 'Early warning system.'

If labor progression is slow, then labor is augmented with Oxytocin. 

A partogram is also used to decide whether to transfer to a better center if labor progression is not going well. If the center where the female is admitted has poor facilities or the female has developed complications, she is transferred to a higher center for further management.

The termination of labor by performing a cesarean section, if suggestions of obstruction have started in Partograph.

A partograph is plotted to assess all events during labor. Modified WHO partograph does not have a latent phase. Points are only plotted in the active stage of labor. Partograph charting is started at 4 cm Cervical dilatation.

Benefits of Partogram

• ↓ Prolonged labor
• ↓ Chances of Obstructed Labor
• ↓ Chances of Uterine rupture
• ↓ Chances of Sepsis
• ↓ PPH (Postpartum hemorrhage)
• The ultimate goal of Partogram is to reduce the Maternal mortality rate
• The best method to monitor the progress of labor is a Partogram.

Also Read: NEET PG High Yield Questions For OBS-GYN

Frequently Asked Questions

Question: Cervical dilatation of 4 to 9 cm constitutes what phase of the first stage of labor?

Answer: Active stage of labor

Question: What is the best tool for monitoring progress in active labor?

Answer: Partogram

Question: What is the Stage of labor where the Delivery of the fetus happens?

Answer: Second Stage of Labor

Previous Year's Question: The midwife was plotting a partograph. After how much dilatation, she must start plotting the partograph? (INI CET 2020)

Answer:  4 cm

Previous Year Question: A primigravida presents with labor pains for 4 hours. On examination, the cervix is 5 cm dilated and well-effaced. She is now in which stage of labor? (NEET 2020) 

Answer: The active phase of the first stage

Question: What is the upper limit of the combined duration of stages I & II in a Primigravida?

Answer: 18.5 hrs

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