The Patient in Labour
This section summarises assessment, monitoring, recognition of high‑risk features and immediate management for a woman presenting in labour. It focuses on practical decision making at the emergency department / maternity interface, escalation thresholds and immediate actions for the most common obstetric emergencies.
Recommendations and thresholds follow UK guidance (NICE NG235, NG229) and Resuscitation Council UK where cited. Local maternity protocols and escalation pathways should be followed for operational detail.
Overview
Labour is the coordinated process of uterine contractions, cervical change and descent of the fetus culminating in delivery of baby and placenta. Early recognition of the stage of labour, identification of maternal or fetal risk factors, timely monitoring and prompt escalation to obstetric‑led care when indicated are priorities.
Involve maternity/midwifery and obstetric teams early when labour is suspected, when pregnancy is ≥ 20 weeks, or when any red flag is present (NICE NG235).
Stages of labour - practical summary
- First stage
- Latent: painful contractions, effacement and dilation up to approximately 4 cm.
- Established (active): progressive dilation 4-10 cm. Typical duration for active labour: nulliparous ≈ 8 hours; multiparous ≈ 5 hours (wide variation).
- Second stage
- Passive: full dilation without expulsive effort.
- Active: expulsive contractions and maternal bearing‑down; baby descends and crowns. Usual maximum durations: nulliparous ≈ 3 hours, multiparous ≈ 2 hours (can be longer with...
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