Você está na página 1de 22


Labor and delivery require a woman to

utilize her coping methods psychologically
and physiologically
Normally, labor begins when the fetus
reaches a mature age (38-42 weeks age of
The mechanism that converts Braxton
Hicks Contractions (painless contractions)
to strong and coordinated uterine
contractions is unknown
In some cases, labor occurs before the
fetus reaches the mature age (preterm birth)
while in others it is delayed (postterm birth).
Although the exact mechanism that
initiates labor is unknown.
Theories have been proposed to
explain how and why labor occurs.

• Hormonal factors
• Mechanical factors
Causes of Onset of Labour
 Hormonal factors
1) Estrogen theory
2) Progesterone withdrawal theory
3) Prostaglandins theory
4) Oxytocin theory
5) Fetal cortisol theory
 Mechanical factors
1) Uterine distension theory
2) Stretch of the lower uterine segment by
the presenting near
Oestrogen theory

During pregnancy, most of the

oestrogens are present in a binding
form. During the last trimester, more
free oestrogen appears increasing the
excitability of the myometrium and
prostaglandins synthesis.
Progesterone withdrawal theory
 Progesterone is the hormone designed to
promote pregnancy. It is believed that presence
of this hormone inhibits uterine motility.
 As pregnancy advances, changes in the
relative effects estrogen and progesterone
encourage the onset of labor.
 A marked increase in estrogen level is noted in
relation to progesterone, making the latter
hormone less effective in controlling rhythmic
uterine contractions.
 Also, in later pregnancy, rising fetal cortisol
levels inhibit progesterone production from the
placenta. Reduce progesterone formation
initiates labor
Prostaglandin theory
 In the latter part of pregnancy, fetal
membranes and uterine decidua increase
prostaglandin levels.
 This hormone is secreted from the lower
area of the fetal membrane (forebag).
 A decrease in progesterone amount also
elevates the prostaglandin level.
 Synthesis of prostaglandin, in return,
causes uterine contraction thus, labor is
Oxytocin theory
 Pressure on the cervix stimulates the
hypophysis to release oxytocin from the
maternal posterior pituitary gland.
 As pregnancy advances, the uterus
becomes more sensitive to oxytocin.
Presence of this hormone causes the
initiation of contraction of the smooth
muscles of the body (uterus is
composed of smooth muscles).
Foetal cortisol theory
 Increased cortisol production from the
foetal adrenal gland before labour may
influence its onset by increasing
oestrogen production from the placenta.
Uterine distension theory

 Like any hollow organ in the body, when

the uterus in distended to a certain limit, it
starts to contract to evacuate its contents.
 This explains the preterm labour in case of
multiple pregnancy and polyhydramnios.
Stretch of the lower uterine segment

 by the presenting part near term