Normal Labor and Delivery

Labor, whether preterm or term, is defined as the presence of sufficient uterine contractions in frequency, intensity, and duration to bring about effacement and dilation of the cervix. Control of normal labor is complex and, despite advances in medical science, poorly understood. Evidence supports prostaglandin (PG) involvement, in particular PGE2 and PGF2a, as well as other mediators (Ulmsten, 1997).

Before the onset of labor, the fetal head may descend into the pelvis, and the height of the fundus will diminish. This lightening may occur acutely and may be very obvious to the pregnant woman, or it may occur over several weeks. An increase in pelvic pressure is experienced at this time. False labor, or irregular, short contractions that occur often before true labor, may in fact aid in cervical effacement and shortening of the cervical canal that begins as funneling at the internal cervical os. With impending true labor, cervical effacement and early dilation may allow the passage of a blood-tinged mucous termed "bloody show." Most women go into true labor within 3 days of a bloody show. Bleeding described as "heavy as the beginning of a menstrual period" may be pathologic, and the pregnant woman should be evaluated for placenta previa, abruptio placentae, or other causes of vaginal bleeding.

Contractions of active labor most often occur every 2 to 3 minutes, last about 1 minute, and have a mean of 40 mm Hg in intensity. However, some women successfully deliver babies with less frequent and intense uterine contractions. Frequent contractions of 1 to 2 minutes apart may be a sign of the increased intrauterine pressure associated with abruptio placentae. Adequate relaxation between contractions is imperative to allow oxygenated blood to enter the intravillous spaces and transfer to the fetal compartment. During the course of labor, uterine contractions cause cervical effacement and then dilation to a full 10 cm to allow passage of the fetal head, the largest diameter of the fetus to pass through the birth canal.

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