A 27yo lady has had an uncomplicated pregnancy so far. She came to the hospital 2h ago after
her water broke. The midwife is looking at her now. She has regular contractions. P.V exam
revealed 2cm dilated cervix. Vital signs are normal. What stage of labour is she in?
a. Second stage
b. First stage
c. Latent stage
d. Third stage
e. Active phase
answer: tricky as it could be described as the latent phase of the 1st stage and also the 1st stage, probably the correct answer is the 1st stage of labour.
First Stage of Labor
• latent phase
ƒ uterine contractions typically infrequent and irregular
ƒ slow cervical dilatation (usually to 3-4 cm) and effacement
• active phase
ƒ rapid cervical dilatation to full dilatation (nulliparous ~1.2 cm/h, multiparous ~1.5 cm/h)
ƒ phase of maximum slope on cervical dilatation curve
ƒ painful, regular contractions q2-3min, lasting 45-60 s
ƒ contractions strongest at fundus, weakest at lower segment
• dilatation: latent phase: 0-3 cm; active phase: 4-10 cm
Second Stage of Labor
• from full dilatation to delivery of the baby
• mother feels a desire to bear down and push with each contraction
• women may choose a comfortable position that enhances pushing efforts and delivery
ƒ upright (semi-sitting, squatting) and LLDP are supported in the literature
• progress measured by descent
Third Stage of Labor
• separation and expulsion of the placenta
• can last up to 30 min before intervention indicated
• start oxytocin IV drip, or give 10 U IM or 5 mg IV push after delivery of anterior shoulder in
anticipation of placental delivery, otherwise give after delivery of placenta
• routine oxytocin administration in third stage of labor can reduce the risk of PPH by >40%
Fourth Stage of Labor
• first postpartum hour
• monitor vital signs and bleeding
• repair lacerations
• ensure uterus is contracted (palpate uterus and monitor uterine bleeding)
• inspect placenta for completeness and umbilical cord for presence of 2 arteries and 1 vein
• 3rd and 4th stages of labor most dangerous to the mother (i.e. hemorrhage)
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