• Cervix fully EFFACED

• Mild, irregular contractions become more rhythmic and stronger

• Cervical dilatation starts

• Can last even up to 12-16 hours

• Cervix dilates rapidly up to 10cm

• At a rate of 1cm/hour or more

• Foetal descent begins

• Lasts for 2 – 6 hours

• Duration shorter in multi

• Considered as prolonged if,

– >12hrs in primi

– >8hrs in multi

• Maternal well-being

• Foetal well-being

• Progression of labour

• Adequate hydration

• Pain relief

• Graphical presentation of the progress of labour

• Monitor active phase of 1st stage

• Instant visual assessment of maternal & fetal well being & progression of labour

– Vital signs

– Urine

– Hydration

– FHR

– Character of liquor

– Moulding

– Cervical dilatation

– Station

– Uterine contractions

– Oxytocin

– Pain relief

• Heart rate auscultation

• Intact membranes

• Ruptured membranes• Liquor colour

• Meconium stained

2 main components

Abdominal examination

PV examination

– Can be felt by palpation

– Maximum expected is

• 3 in 10min

• One lasting >40 sec

• 2min relaxation in between

• Palpate the number of contractions in 10 minutes

and calculate the duration of one contraction

Less than 20sec

Between 20 and 40sec

More than 40sec

Recording of uterine contractions

• If contractions are not satisfactory,

Oxytocin infusion

5U for primi

2U for multi

Starting 15drops/min

Can increase by 15drops/min every ½ hour

Up to max. of 60drops/min

• Palpation of foetus

– To detect progressive descent of head

– Expressed in 1/5th

• Routinely done every 4 hourly

• Important to determine progression

• 4 main things to check

– Cervical dilatation

– Effacement

– Descent

– Moulding

• 2 important indicator lines are marked in Partogram

Alert line - A line drawn at the end of the latentphase demonstrating progress of 1cmdilatation per hour

Action line - A line drawn parallel and 4 hrs to theright of alert line

• Overlapping of skull bones

0 - bones are separated

+ - bones touching , can be separated

++ - bones overlapping

+++ - bones overlapping severely

• Types in 1st stage

1. Prolonged latent phase

2. Primary dysfunctional labour

3. Secondary arrest

• Latent phase > 14-16hrs in primi

> 8-10 hrs in multi

• Poor uterine contractions

• Possibilities

– Occipito posterior position of foetus

– Cephalopelvic disproportion

– Cervical dystocia

– Uterine dysfunction

• Slow progression in active phase

• Falls to right of action line

• Possibilities

–Uterine Inertia (ineffective uterine contraction)

– Malposition (2nd commenest)

– Cephalopelvic disproportion

• Progression normal in latent and early active phase and arrest of cervical dilatation during late active phase.

• No cervical dilatation > 2hrs at any point beyond 6cm dilatation

• Possibilities

–CPD

–OP position

–Inadequate uterine contraction

• Non pharmacological

Psychoprophylaxis

Psycotherapy

Physical methods

• Pharmacological

Pethidine1mg/kg

Primi – 1st when cx is 3cm, 2nd after 4hrs of 1st dose

Multi – single dose when cx is 3cm

Morphine 10mg SC or IM

Preferred in heart disease

Nitrous oxide gas (Entonox)Mixed with oxygen 1:1

Given via face mask