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The Biology of labor
makmur sitepu
Divisi Feto-Maternal
Departemen Obgin FK-USU/RS.HAM
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Parturition
Normal Pregnancy Uterine quiescence
Closed cervix
Parturition
Coordinated uterine activity
Maturation of the fetus
Maternal lactation
Progressive cervical dilation
Fetus
MotherPlacenta
Membranes
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Initiation of Labor Fetus
Sheep Fetal ACTH and cortisol
Placental 17 hydroxylase
Estradiol
Progesterone Placental production of oxytocin, PGF2
Humans
Fetal increased DHEA
Placental conversion to estradiol
Increased decidual PGF2and gap junctions
Increased oxytocin and PG receptors
Decreased progesterone receptors
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Initiation of labor Oxytocin
Peptide hormone Hypothalamus-posterior pituitary
Fetal production
Maternal serum increase in second stage of labor Oxytocin receptors
Fundal location
100-200 x during pregnancy
Actions
Stimulate uterine contractions
Stimulate PG production from amnion/decidua
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Theories of labor
Progesteron withdrawal.
Has quieting effect on uterus
Counterbalance estrogen.
Oxytocin production
Posterior pituitaryAs pregnancy progresses oxytocin receptor
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Prostaglandin production
Endothelin production Contraction smooth muscle. High level in amniotic fluid.
Estrogen stimulation > 3435 weeks. Promotes oxytocin production in myometrium.
Fetal cortisol.
Distention of uterus.
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Exact couse of onset labor not clear.
Most current belief is that of
A PROSTAGLANDIN CASCADE.
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Maternal and Fetal Endocrine Systems Involved in
Increased Placental Production of CRH.
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Calcium channel
Ca store+ Oxytocin
+ Prostaglandin
Ca+ MLCK
Extracellular
Intracellular
Uterine contractions
cAMP
Oxytocin receptor
Phospholipase C
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Fetal membranes
Contraction
Rupture
Prostaglandin
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Partogram
11/19/2013
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KASUS
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Ny. DL, usia 28 tahun, G1P0A0
HPHT = 20 November 2009
Pemeriksaan 4 jamkemudian diperoleh :
Status present : dalam batas normal
Status obstetricus : His = 3x30 detik/10 menit
DJJ = 148x/i, regular
Dilatasi servik : 6 cm
Penurunan kepala : 2/5
Penyusupan : +2
Ketuban masih utuh
Dua jamkemudian Ny.DL mengalami pembukaan lengkap.
Penurunan Kepala : 1/5
Penyusupan : +2
His : 4 x 50 detik/ 10 menit
Djj : 150x/1, regular.
ketuban pecah dan timbul rasa ingin mengedan.
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Kasus dengan TFU 34 cm
Kepala 3/5minus station-13
EBW : 155 x (34 - 13) = 3255 gram.
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HPHT: 20 November 2009
TTP: 27 agustus 2010
Usia Kehamilan saat ini 39 minggu.
Kepala Sudah memasuki PAP
Taksiran berat janin JT : 3255 gram.
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