ABNORMAL LABOR NORMAL LABOR PROGRESSION STAGES AND PHASES
ABNORMAL LABOR
NORMAL LABOR PROGRESSION STAGES AND PHASES FIRST STAGE: Time from onset of labor to complete cervical dilation. Second stage: Time from complete cervical dilation to fetal expulsion Third stage: Time between fetl expulsion and placental expulsion
Criteria for normal progress: Emanuel Friedman established criteria for normal progress of labor in the 1950 s, and these criteria were used for assessment and management of labor for decade. based on these data the transition from the latent phase to active phase appeared to occur at 3 to 4 cm cervical dilation and the statistical minimum rate of normal cervical dilation during the active phase was 1. 2 cm/h for nulliparous woman and 1. 5 cm/h for multiparous woman. Aprolonged second stage for nulliparas and muitiparas was defined as 2. 5 hours and 1 hours
Contemporary criteria: The applicentury of the Friedman curve and its established norms tocontemporary obstetric practice was challeneged in the 21 century. Contemporary criteria are different from, and generally slower than, those cited by Friedman. this change hase been attributed to changes in patient characteristics, anesthesia practice
The Friedman curve depicts a relatively slow rate of cervical dilation until 4 cm(latent phase)_>abrupt acceleration in the rate of dilation (active phase) Contemporary data suggest that beyond 6 cm dilation , rates of cervical dilation are more rapid in both nulliparas and multiparas and at 6 cm dilation nearly all woman should be in active phase
DYSTOCIA(POWER/PASSENGER/PASS) CPD & FAILURE TO PROGRESS
Second stage: Friedman: A prolonged second stage for nulliparas was defined as 2. 5 h and multiparus 1 h. Zhang: The median duration of the second stage in nulliparous. 3 hand parous. 2 h
Protraction and arrest disorder: Approximately 20 percent of all labors ending in a live birth involve a protraction and arrest disorder and is the most common reason for primary cesarean delivery.
Risk factor: Hypocontractile uterin activity obesity CPD Bandls ring Non occiput anterior position nulliparity Short stature(less than 150 cm) Neuraxial anesthesia macrosomia chorioamnionitis Older maternal age High station at full dilatation Postterm pregnancy Fetal anomaly resulting in CPD
Protraction: The diagnosis of a protracted active phase is made in woman at>6 cm dilation who are dilating less than approximately 1 to 2 cm/h. Woman with cervical dilation <6 cmare considered to be in latent phase.
Arrest: Active phase arrest is diagnosed at cervical dilation >6 cm in patient with ruptured membranes and: Ø No cervical change for>4 h despite adequate contraction Ø No cervical change for >6 h with inadequate contraction
Active phase arrest: Woman with labor arrest in the active phase of the first stage are managed by cesarean delivery…. Wating at least 4 h before performing a cesarean for labor arrest allowed 88 percent of muitiparas and 56 percent of nulliparas to achieve a vaginal delivery.
Prolonged second stage: The appropriate duration and maximum length of time allowed for the second stage of labor is not clearly defined. ü Parity ü Regional anesthesia ü Delayed pushing …. . all affect the length of the second stage.
For multiparous allow up to 3 h for the second stage or 2 h of pushing prior to diagnosing arrest of labor for nulliparous woman allow up to 4 h for the second stage or 3 h of pushing prior of diagnosing arrest of labor
Management: After 60 to 90 min of pushing we begin oxytocin augmentation if: ü Descent ü Absent ü Uterin 3 min is minimal + contraction are less frequent than every
If a cesarean delivery is necessary a prolonged second stage may result in: q Fetal head trapped deep in the pelvis which delivering the fetus. q Thin the lower uterin segment extension of the hysrerotomy. q Worsen increasing the risk of the neonatal outecome. q Increasing the difficulty of the risk for postpartum hemorrhage
Numerous clinical factore need to be considered : ü Obstetric ü Clinical pelvimetry ü Maternal ü Fetal history height and weight position ü Maternal temperature(chorioamnionitis) ü Estimated fetal weight ü Effectiveness of maternal pushing
PRECIPITOUS LABOR
CPD INLET MID PELVIS OUTLET
ABNORMAL PRESENTATION FACE FOREHEAD TRANSVERESE COMBINED
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