NORMAL ABNORMAL LABOUR PART 2 Abnormal labor Dr

NORMAL & ABNORMAL LABOUR PART 2: Abnormal labor Dr Manal Behery Assistant Professor , Zagazig University 2013

Part 2: ABNORMAL LABOUR 1 -labor Dystocia 2 - Fetal lie and fetal presentation that impair delivery 3 -Cephalopelvic disproportion 4 - Operative vaginal delivery 5 - induction of labor

All of the following cause labor dystocia except A-Hydroceplus B- Occipto –anterior C-Face presenation D- Occipto –Posterior E-Ovarian mass F- Shoulder dystocia Answer B

what is labor dystocia? Difficult labor, but refers to abnormally slow progress of labor

Failure to progress in labor

what are protraction disorders and arrest disorders? Things are moving slower than expected No change occurs

Normal vs. Prolonged latent phase

How is protraction disorder dx? Nulliparous: dilation <1. 2 cm/hr, descent <1. 0 cm/hr Multiparous: dilation <1. 5 cm/hr, descent <2. 0 cm/hr

How is arrest disorder dx? -Nulliparous: NOdilation >2 hr, no descent >1 hr -Multiparous: NO dilation >2 hr, no descent >1 hr

How long do you let woman push for? A-1 hr if multi, 2 hrs if nulli , add 1 hrs if epidural B-2 hrs if mulli, 3 hrs if nulli , add 1 hrs if epidural C-1. 5 hr if multi , 2. 5 hrs, add 1 hr if epidural ANSWER A

Effects of labor dystocia includes all except A-Chorioamnionitis B-Uterine rupture C-Reassuring FHR trace D-Pelvic floor injury ANSWER C

The three P's of labor A-Power: uterine contractions B-Passenger: the baby C-Passage: the patient's pelvis, pelvic floor

Power and stages of labor During first stage of labor, you are concerned with the power of the uterine contractions During the second stage of labor, you are concerned with the power of the patient's pushing efforts

How do you measure uterine activity? -External tocodynamometry or an intrauterine pressure catheter (IUPC) For IUPC, patient must be ruptured and increased the risk of infection

What are considered adequate contractions? Strong enough to cause cervical change Optimal frequency is a minimum of three contractions in a 10 min period (ideal is every 2 min) Greater than or equal to 200 Montevideo units

What can you do about inadequate power of uterus? -If contraction pattern is irregular or less than 3 in 10 minutes or if MVU's are less than 200, use Pitocin to increase intensity and frequency of contractions.

What can you do about inadequate power of pushing? 1) Allow patient to rest through a few contractions to catch her breath. 2) Try different positions for more effective pushing 3) If everything fails, operative vaginal delivery or Cesarean section •

Characteristics of the passenger Lie Presentation Size Anomalies

Fetal lie and fetal presentation that impair delivery Ø-Fetal lie: non-longitudinal presentationtransverse, oblique or shoulder Ø-Fetal presentation: breech, face (1 in 600), or brow (1 in 3000), compound presentation (1 in 700)-hand or arm prolapses along fetal head ØAsynclitism-lateral deflection of the head to a more anterior or posterior position in pelvis •

Types of breech presentation frank breech: legs are piked -complete breech: indian style or curled legs -footling breech: one leg down, monitor for if umbilical cord falls through pelvis

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