ABNORMAL LABOR AND ITS MANAGEMENT I Uterine over

ABNORMAL LABOR AND ITS MANAGEMENT

I. Uterine over activity a. palaborum b. Excessive uterine contraction (obstructed labor) II. Uterine Inertia a. Hypotonic inertia b. Hypertonic inertia III. Construction Ring IV. CERVICAL DYSPLASIA a. Organic b. Functional

A. P. LABOUR (less than 3 hours) Definition: Uterine contraction strong, no obstruction in the birth canal, painless except in the last contraction and expulsion of fetus. Complication: . A. Maternal 1. Laceration cervix vagina 2. p. p Hge 3. inversion of uterus 4. shock due to p. p. Hge 5. Sepsis laceration no sterilization B. Fetal a. I C Hg compression and decompression b. Injury of fetus c. Avulsion umbilical cord

Management 1. Rare before delivery give anesthesia to slow course of labour 2. After delivery examination 3. For next pregnancy Mother Infant ANC Early admission

C. Excessive uterine Gontraction and retraction During labor there islline between upper and lower segment physiological retraction ring. In obstructed labor marked retraction Thickening of U. segment L. S stretched and thinned The retraction ring up felt in abdomen as transverse groove above umbiltcus ~ pathological retraction ring or Banuel's ring the uterus rupture

II. HYPOTONIC UTERINE INERTIA Etiology - unknown a) General factor 1. Primigravida -- old primi 2. Anaemia and Antepartum Hge 3. Toxaemia I. 4. Improper use pf analgesics b) Local Factor 1. Over distention and uterus 2. Anomalies of uterus 3. Disproportion. 4. Full bladder rectum 5. Uterine fibroid 6. Post maturity

Clinical Picture 1. Prolonged labour a. weak uterine ontraction b. slow cervical dilatation c. intact membrane d. retension of placenta e. atonic P. P. Hg TREATMENT : A. Proper management 4 st stage of labour: 1. Rest 2. Sedation 3. I. V. fluid glucose 4. Evacuate b adder and rectum 5. Observe F. --- CTG 6. Use Porte a. D 1 to assess - progress, labour 7. If membrane rupture - antibiotic

B. Uterine stimulus: 1. Syntocinon 2. Close obse ation FH • Oxytocin contra indicated in: a. Dispr portion b. Malp esentation c. Scar' uterus - relative d. Gran. D 1 ultipara e. F. Di~tress C. Operative interference 1. ARM - to accelerate lab. 2. Operative delivery. vaginal delivery forceps Ventous Abdominal C. S.

Hypertonic Uterine Inertia

1. Common in primigravida 2. If there is dispropdrtion Malpresentation Malposition Labour is prolonged uterus contraction irregular and painful cervix slow dilation presenting part high fetal and maternal distress

Treatment 1. Exclude disproportioh 2. Reassurance and I. V 3. Antibiotic 4. Good analgesia I 5. C. S indication disproportion f. distress

Complication A. Mternal 1. Prolonged laboar --- exhaustion and ketoacidosis 2. infection 3. laceration, birth canal 4. p. p Hge 5. Puerperal sepsis B. Fetal 1. Asphyxia 2. ICHge

III. Contraction Ring Definition It is localized annular spasm of the uterine muscles It causes prolonged 2 nd stage In the 3 rd stage hour glass Contraction of the uterus retain placenta P. P. Hge Etiology 1. Unknown 2. Malpresentatioh + malposition 3. Improper use of Syntocinon

Diagnosis Feeling it with hand Treatment 1. Exclude disproportion 2. If forceps fail on ring below presentingpart C. S. 3. Give anesthesia in the ]"d and 3 rd stage of labor DD between the contraction ring and pathological ring

CERVICAL DYSTOCIA Definition: CX fails to dilate within reasonable time inspite good uterine contraction I. Organic Rigidity a. Stenosis Cervix -+ due to previous injury, amputation, over cauterization C. S Indicated

ORGANIC OBST. CX ---» CERVICAL FIBROID ---» CA CX II. Functional Rigidity No history of * Trauma * Operative * No evidence of cervical anatomical change It is manifested by nondilatation of external os although cx effaced and head well applied it. ---» take long time or ---» obstructed labor TREATMENT: 1. Analgesia 2. F. D ---» C. S