Physiological changes during first stage of labor

The first stage is chiefly concern with the preparation of

the birth canal so as to facilitate expulsion of the fetus in
the 2nd stage. During first stage of labor, following
physiological changes are occurs.

1. Uterine action
I. Contraction and retraction of uterine muscles

Uterine contraction are involuntary, they are controlled

by the nervous system and endocrine influence.
Normally the uterus begins to contract effectively 280
days after the LMP. Contraction consists of regular,
painful with hardening of uterus. The patient experiences
pain, which is situated more on the hypogastric region,
often radiating to the thighs. Probable causes of pain are
myometrial hypoxia during contractions, stretching of
the peritoneum over the fundus, stretching of the cervix
during dilatation and compression of the nerve ganglion.
At earlier the contractions are often week and may be
imperceptible to the mother but it becomes more
powerful at last.

The feature of uterine contraction:

Frequency: It is the interval of each contraction. In the early

stage of labor, the contractions come at intervals of ten to

fifteen

minutes.

The

intervals

gradually

shorten

with

advancement of labor until in the second stage, when it comes

every two or three minutes.
Duration: It is length of each contraction. In the first stage, the

contractions last for about 30 seconds initially but gradually

increase in duration with the progress of labor. Thus in second
stage, the contractions last longer then in the first stage.

Intensity: The intensity of uterine contraction describes the

degree of uterine systole. Or degree of pain e.g. mild moderate

and strong. The intensity gradually increases with advancement
of labor until it becomes maximum in the second stage during
delivery of the baby.
Tonus: It is intrauterine pressure in between contractions. It is

also increases with progress of labor. During pregnancy, as the

uterus is relatively inactive, the tonus is of 2-3 mmHg. During
the first stage of labor, it varies from 8-10 mmHg. The factors,
which govern the tonus, are contractility of uterine muscles,
intra abdominal pressure.

Retraction is a phenomenon of the uterus in labor in which the muscle

fibers are permanently shorted. Contraction is a temporary reduction in
length of the fibers, which attain their full length during relaxation. In
contrast, retraction results in permanent shortening and the fibers are
shorted once and for all. Retraction is a specially a property of upper
uterine segment. It makes upper segment of uterus gradually shorter and
thicker in progressive nature after each contraction and cavity diminishes
which keeps place with the gradual descent of the presenting part.
The effects of retraction which is essential in normal labor are:
Formation of upper and lower uterine segment.
Dilatation and effacement of up of the cervix.
Reduce the surface area of the uterus favoring separation of placenta.
Maintain the advancement of presenting part and help in expulsion of

fetus.

II.

Fundal dominance:

Uterine contraction that is strongest at the top of the

uterus and weakest in the lower uterine segment. Each
uterine contraction starts in the fundus near one of the
cornua and spreads across and downwards. The
contraction lasts longest in the fundus where it is also
most intense, but the peak is reached simultaneously over
the whole uterus and the contraction fades from all parts
together. This pattern permits the cervix to dilate and the
strongly contracting fundus to expel the fetus.

III. Polarity:
Polarity is the term used to describe the neuromuscular
harmony that prevails between the two poles or segments of
the uterus through out the labor. During each uterine
contraction these two pole act harmoniously. The upper pole
contracts strongly and retracts to expel the fetus; the lower
pole contracts slightly and dilates to allow expulsion to take
place. Thus coordination between fundal contraction and
cervical dilatation called Polarity of uterus If the polarity
of uterus disorganized then the progress of labor is inhibited.

IV. Formation of upper and lower segment:

Before onset of labor, there is no complete anatomical and
functional division of the uterus. During labor, the body of uterus
is divided in to two segments. Upper 2/3 rd of the uterus is known
as upper segment, which is formed from the body of the fundus,
is mainly concerned with contraction and retraction: it is thick
and muscular. The lower uterine segment is formed of the isthmus
and the cervix, and is about 8-10 cm in length, that portion of the
non-pregnant uterus lying between the anatomical and the
histological internal os. In early pregnancy, the lower segment is
poorly formed. When labor begins, the retracted longitudinal
fibers in the upper segment pull on the lower segment causing it
to stretch; this is aided by the force applied by the descending
part.

V. Formation of retraction rings

The ridge forms between the upper and lower uterine
segment; this is known as retraction or Bandls ring.
The contraction and retraction of the upper segment cause
the uterine thicker, shorter or smaller, so it attempts to
push the fetus out into the birth canal and according to
distend, stretch and thinner. During this processes, a
distinct ridge is produced at the junction of the two
segments, which is called retraction or physiological ring
and moves up to the level of symphysis pubis as the lower
segment is distended and it is perfectly normal if it does
not move beyond the symphysis pubis.

In normal labor, retraction ring gradually rises as the upper

segment contracts and retracts and lower uterine segment thins out
to accommodate the descending fetus. Once the cervix is fully
dilated and delivery takes place, so the retraction ring rises no
further and ceases spontaneously.
VI. Taking up of the cervix (Cervical effacement):
Cervical effacement is the process by which the muscular fibers

of the cervix are pulled upward and merges with the fibers of the
lower uterine segment. Or it is process of thinning and shorting out
of the cervix.
Effacement may occur late in pregnancy or it may not take place

until labor begins. In the primigravida, the cervix will not dilate
until effacement is complete, whereas in the multigravida
effacement and dilatation may occur simultaneously.

VII. Cervical dilatation:

Dilatation of cervix is the process of enlargement of the
os uteri from a tightly closed aperture to an opening
large enough to permit passage of the fetal head.
Dilatation is measured in centimeters and full dilatation
at equates to about 10cm.
Dilatation occurs as a result of uterine action and the
counter pressure applied by the bag of membranes and
the presenting part. A well -flexed fetal head closely
applied to the cervix favors efficient dilatation. Pressure
applied evenly to the cervix causes the uterine fundus to
respond by contraction.

VIII. Presentation of Show:

It is the bloodstain mucoid discharged seen a few hours
before, or with in a few hours after labor has started.
During pregnancy a woman's cervix produces thick
mucus, filling the opening to act as a plug to seal the
uterus. Towards the end of pregnancy, the cervix may start
to thin and soften, sometimes releasing this mucus plug,
known as a show. The blood comes from ruptured
capillaries in the parietal deciduas where the chorion has
become detached and from the dilating cervix.

2. Mechanical Factor
I. Formation of the fore waters
As the lower uterine segment forms and stretches, the
chorion becomes detached from it and the increased
intrauterine pressure causes this loosened part of the sac of
fluid to bulge downwards in to the dilating internal os, to
the depth of 6-12 mm and forms bag of membranes. The
well-flexed head fits snugly in to the cervix and cuts off
the fluid in front of the head from that which surrounds the
body. The part above the girdle of contact contain the fetus
with bulk of the liquor called hind water and the part of
water in front of the presenting part is called fore water.

II. General fluid pressure

While the membranes remain intact, the pressure of
uterine contractions is exerted on the fluid and as fluid is
not compressible, the pressure is equalized through out the
uterus and over the fetal body and is known as general
fluid pressure. When the membrane ruptures and quantity
of fluid emerges, the placenta is compressed between the
uterine wall and the fetus during contractions and the
oxygen supply to the fetus is thereby diminished and there
is risk of fetal hypoxia during uterine contraction.

III.

Rupture

of

membranes

ROM is a term used during pregnancy to describe a rupture

of the amniotic sac at the onset of, or during, labor. This is
colloquially known as "breaking water". A premature
rupture of membranes (PROM) is a rupture that occurs
prior to the onset labor. The physiological moment for the
membranes to rupture is at the end of the first stage of labor
when the cervix becomes fully dilated and no longer
supports the bag of fore waters. The uterine contractions are
also applying increasing force at this time.

IV. Fetal axis pressure

During each contraction the uterus rears forward
and the force of the fundal contraction is
transmitted to the upper pole of the uterus, down
the long axis of the fetus and is applied by the
presenting part to the cervix. This is known as fetal
axis pressure and becomes much more significant
after rupture of the membranes and during the
second stage of labor.