II. Definitions
- Spontaneous Labor
- Regular uterine contractions result in cervical dilation and effacement
-
Premature Rupture of Membranes
- Amniotic membrane rupture before the onset of labor
- Spontaneous labor typically begins within 12 to 24 hours of membrane rupture
- Early Labor Induction is typically initiated within hours of PROM (except in preterm cases)
III. Stages: Three Stages of Labor
- Stage 1
- Divided into two phases (assuming regular contractions in both phases)
- Latent Phase (<6 cm cervical dilation)
- Active Phase (6 to 10 cm cervical dilation)
- Progresses until complete cervical dilation and effacement
- Expected progress is based on Friedman Curve
- Assumes regular, frequent palpable contractions
- Divided into two phases (assuming regular contractions in both phases)
- Stage 2
- See Second Stage of Labor
- Starts with complete cervical dilation and effacement
- Ends with newborn delivery
- Stage 3
- See Third Stage of Labor
- Starts with newborn delivery
- Ends with delivery of the placenta and fetal membranes
IV. Phase: Latent First Stage of Labor
- Latent Phase Definition
- Cervical dilation <6 cm and
- Regular contractions
- Normal Progress
- Nulliparous women
- Maximum normal duration <20 hours
- Multiparous women
- Maximum normal duration <14 hours
- Nulliparous women
- Management
- Avoid hospitalization in latent labor (<4-5 cm dilated, <80% effaced, non-painful contractions)
- Exception: Maternal or Neonatal high risk conditions
- Maximize hydration
- Facilitate rest and supportive environment
- Consider latent phase sedation (e.g. Hydroxyzine)
- See Non-Pharmacologic Pain Control in Labor
- Avoid hospitalization in latent labor (<4-5 cm dilated, <80% effaced, non-painful contractions)
V. Phase: Active First Stage of Labor
- Definition
- Cervical dilation >6 cm and
- Regular contractions
- Normal Progress
- Nulliparous women
- Cervical Dilation: >1.2 cm/hour
- Fetal Descent: >1 cm/hour
- Duration <8.6 hours
- Multiparous women
- Cervical Dilation: >1.5 cm/hour
- Fetal Descent: >2 cm/hour
- Duration <7.5 hours
- Nulliparous women
- Management
- Progress
- See Prevention of Labor Dystocia
- See Labor Dystocia
- Consider Amniotomy
- Consider Active Management of Labor
- Monitoring
- See Fetal Heart Tracing
- Avoid too frequent cervical examinations (dilation, effacement, Fetal Station)
- Focus on examinations that will change management (e.g. Labor Augmentation, Amniotomy)
- Frequent cervical exams increase the risk of Chorioamnionitis
- Labor Pain Management
- Group B Streptococcus Prophylaxis
- See Group B Streptococcus Prophylaxis for indications
- GBS is screened universally in U.S. at 36 weeks gestation
- When indicated, GBS Prophylaxis is started in active labor or at PROM
- Continued GBS Prophylaxis through newborn delivery
- Less restrictive diet in the First Stage of Labor appears safe
- Does not appear to increase the aspiration risk, and may decrease First Stage of Labor duration
- Ciardulli (2017) Obstet Gynecol 129(3):473-80 +PMID: 28178059 [PubMed]
- Progress
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| Definition (NCI) | The stage of the labor and childbirth process when the uterine contractions become strong and regular with cervical effacement and complete dilation of the cervix. |
| Definition (MSH) | Period from the onset of true OBSTETRIC LABOR to the complete dilatation of the CERVIX UTERI. |
| Concepts | Temporal Concept (T079) |
| MSH | D007747 |
| SnomedCT | 6893006, 289210008 |
| English | First Labor Stage, First Stage Labor, Labor Stage, First, Labor, First Stage, Obs first stage labor, Obs first stage labour, first labour stage, labor first stage, first stage of labor, first stage of labour, First Stage of Labor, Dilating Stage, labor stage first (physical finding), labor stage first, First stage of labor, First stage of labour, Observation of first stage of labor, Observation of first stage of labour, Finding of first stage of labor (finding), Finding of first stage of labor, Finding of first stage of labour, First stage of labor (finding) |
| Portuguese | Primeiro Estágio do Trabalho de Parto, Primeiro Período do Trabalho de Parto, Dilatação do Colo do Útero, Dilatação Cervical, Primeira Fase do Trabalho de Parto |
| Swedish | Förlossningens öppningsskede |
| Czech | porodní doba první |
| Finnish | Avautumisvaihe |
| French | Premier stade du travail |
| Russian | RODY, PERVAIA STADIIA, PERIOD RASKRYTIIA, PERIOD REGULIARNYKH SKHVATOK, ПЕРИОД РАСКРЫТИЯ, ПЕРИОД РЕГУЛЯРНЫХ СХВАТОК, РОДЫ, ПЕРВАЯ СТАДИЯ |
| Spanish | primera etapa del trabajo de parto - hallazgo (hallazgo), hallazgo relacionado con la primera etapa del trabajo de parto, hallazgo relacionado con la primera etapa del trabajo de parto (hallazgo), primera etapa del trabajo de parto - hallazgo, Dilatación Cervical, Dilatación del Cuello Uterino, período dilatante (hallazgo), período dilatante, primer período del parto, primer período del trabajo de parto, Primer Periodo del Trabajo de Parto |
| Polish | Okres porodu pierwszy |
| Japanese | 開口期-分娩, 分娩第1期, 分娩開口期, 開口陣痛 |
| German | Geburt, erste Phase, Geburtsphase, erste, Eröffnungsperiode |
| Italian | Primo stadio del travaglio di parto |
| Dutch | Bevalling, eerste fase van de, Eerste fase van de bevalling |
Ontology: labor stage (C2985268)
| Definition (NCI) | The various distinct periods of the labor and childbirth process. It involves uterine contractions and cervical dilation to expel the fetus and for the baby to be born. |
| Concepts | Finding (T033) |
| English | Stage of Labor, Stages of Labor, labor stage, labor stage (physical finding) |
Ontology: labor stage first early (C3836975)
| Concepts | Temporal Concept (T079) |
| English | labor stage first early, labor stage first early (physical finding) |
Ontology: labor stage first active (C3836976)
| Concepts | Temporal Concept (T079) |
| English | labor stage first active, labor stage first active (physical finding) |
