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The first stage (stage leveling and cervical dilatation): there is a uterine contraction frequency,
intensity, and duration sufficient to produce leveling and cervical dilatation. Ends when the cervix has
opened a full (10 cm) fetal head can pass.
uterine contractions hydrostatic pressure throughout the membranes of the cervix and lower
uterine segment leveling and dilatation. If the membranes have ruptured bottom urgent direct
fetal cervical and lower segment leveling and cervical dilatation.
The upper segment of the uterus to contract active, become thicker during childbirth. Lower uterine
segment is more passive, into thin-walled birth canal. Segments on contract, retraction, and push the
fetus out while the lower segment and soft cervical canal is dilated to form a slender muscular and
fibromuscular fetus can stand out.
When the first stage of labor, the amniotic membrane and the lower part of the fetus opening of the
vagina. If it has ruptured, pelvic floor changes happened because of the given pressure by the lowest
part of the fetus. The changes are stretching of mm.levator ani and thinning of central part of the
Second stage (stage expulsion of the fetus): starts when cervical dilatation is complete and ends when
the fetus is born. The progress of labor was assessed through a progression of decline in the lowest
part of the fetus.
At the presentation of the head, if his is strong enough head down into the pelvic cavity.
* His is the mother force that causes cervical opening and push the fetus down. Straining is a force
that is formed by the contraction of the abdominal muscles simultaneously through the forced
respiratory effort with closed glottis.
The state of the entry of the head to the PAP:
a. Sinklitismus: fetal head axis perpendicular to the field of PAP
b. Asinklitismus: fetal head tilted axis field PAP
- A. Anterior: the direction of the axis of the head makes an acute angle with PAP
This situation is more favorable, because the pelvic space in the posterior region more broadly.
- A. Posterior: the opposite situation of the anterior.
In nulliparous, fetal head into the PAP occur before labor begins and there is no decline further before
labor begins. In multiparous, the entry of the fetal head to the PAP is not so perfect and further decline
occurred in stage I.
The axis of the fetal head is not symmetric detention by the underlying tissues of the head will
decrease head flexion in the pelvic cavity head enters the pelvic area with the smallest size.
Head down to the pelvic diaphragm which runs from the behind top to the front bottom. Due to a
combination of elasticity pelvic diaphragm and intrauterine pressure caused by repeats his head
rotation (axis in), occiput rotates to the front side in the pelvic floor, occiput under the symphysis,
then head deflection to be able to delivery.

The vulva opens in each his and the fetus become more visible, the perineum become wider and thin,
and anus the rectum wall. His Strength + straining strength bregma, forehead, face and finally the
chin are visibled. After the head is born, head rotate again (outer axis), which is a movement back to
the position before the in axis.
Shoulder across the pelvis in a tilted position, when the head has been born shoulder will be in a
position behind and front, front shoulder borns first, and followed by the behind shoulder. Similarly,
the trochanter, front trochanter borns first. Then the baby is born entirely.
Third stage (stage separation and expulsion of the placenta): starts after the fetus is born and ends
with the birth of the placenta and fetal membranes.
After the baby is borned, his still at same amplitude but the frequency is reduced resulting in
shrinking the size of the uterus and placenta implantation sites reduction to accommodate
themselves to the surface that tapers, plasenta increases the but limited elasticity placenta bend.
Embossed strain causing decidua spongiosa experiencing separation delivery of the placenta and
the site of implantation decreases. The placental separation occurred a few minutes after delivery. As
a result of the separation, hematoma formed between separate placental and the remaining decidua.
Once the placenta is detached, the pressure exerted by the wall of the uterus causing the placenta
gliding down towards the lower segment of the uterus or the upper part of the vagina. Extrusion
mechanism placenta:
a. Schultze mechanism: there is a separation of the placenta hematoma retroplasenta push the
placenta to the uterine cavity placenta undergo inversion and burdened by hematoma
godown, but the sticked rigidly of membrane around to the decidua placental membranes down
slowly while drag the membrane peripheral part peeled inversion of pouch which formed by
membrane shiny amniotic on the surface of the placenta or in the inversion pouch appears on
vulva. Blood from the placental site poured into the pockets of inversion blood does not flow out to
until the placenta extrusion.
b. Duncan mechanism: the first separation of the placenta is in the peripheral side
between uterine wall membrane and flow out from the placenta.

blood collects

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