Labor Dystocia 1 First Stage of Labor Latent
Labor Dystocia (1) First Stage of Labor Latent phase ● Contractions every 3 -5 minutes. ● Officially ends at 6 cm dilation, although some women may be in active labor before 6 cm. ● Rate of change can be slow, sometimes < 1 cm per hour. ● If no progression for 2 -4 hours and inadequate contractions, can consider discharge home to wait with therapeutic rest if desired ● Prolonged latent labor: > 20 hours in nulliparous > 14 hours in multiparous > 24 hours in induction Is not be an indication for cesarean. Active phase Begins when the rate of cervical change increases. At 6 cm in nullip. At 4 cm with active contractions for multip. Management of active labor Evaluate every 2 -4 hours. If the cervix is not dilating at least 1 cm in 4 hours, consider the 6 Ps: The Six P’s Power consider IUPC. Start oxytocin to keep contractions > 200 MVUs. AROM seems to shorten labor only if combined with oxytocin. Passenger: Reassess EFW, check fetal position (OP may need manual rotation), change maternal position Passageway: Assess for full bladder or rectum, assess for fibroids Pain: Ensure pain is adequately managed; do not avoid epidural for the sake of labor progress. Psyche: Decrease stressors in the room, increase support. Patience Remember active phase arrest is diagnosed when cervix is dilated > 6 cm, with membranes ruptured and: - No change > 4 hours with contractions > 200 MVUs - No change > 6 hours with inadequate contractions Treatment of active arrest is cesarean delivery. Updated 4/20
Labor Dystocia (2) Second Stage of Labor Begins once the cervix is fully dilated and ends with delivery of the neonate. The length of the second stage is affected by: - Parity - Delayed pushing - Epidural analgesia - Fetal station at complete dilation - Diabetes - Pre-eclampsia - Maternal BMI - Chorioamnionitis - Fetal size - Position (OP/OT/OA) Oxytocin augmentation - After 60 -90 minutes pushing with minimal descent, or contractions > 3 minutes apart - After evaluating for physical issues (fetal position & presentation, small pelvis, macrosomia) Arrest of the second stage of labor Before diagnosing arrest of labor, if maternal and fetal conditions permit, allow at least: - 2 hours pushing for multip - 3 hours pushing if nullip - An additional hour with epidural anesthesia Factors favoring expectant management: previous vaginal delivery, normal BMI, OA position, afebrile, EFW is AGA, effective pushing, category 1 tracing, and a desire to keep pushing, progress with pushing. Other options: Manual rotation of fetal occiput: For OP and OT positions, after confirming with ultrasound. Operative vaginal delivery: Vacuum or forceps deliveries have the best outcomes if fetus is at +2 station or greater and OA.
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