Mechanism of labour plus abnormalities in labour
- 1. ABNORMAL LABOUR ALI HASSAN 20083 MAAZ HAMEED 20088 SAMI UL HASAN 20089 YOUSAF KHAN 20093
- 2. 02/27/2025 2 LABOUR • The process by which regular painful contractions bring about effacement and dilatation of the cervix and descent of the presenting part, ultimately leading to expulsion of the fetus and the placenta from the mother
- 3. 02/27/2025 3 STAGES OF NORMAL LABOUR STAGE 1: STAGE 2 STAGE 3 • From Onset of labour to full dilatation of cervix (10mm) Divided into 2 stages : • LATENT PHASE : b.w onset of regular painful contraction and 3-4 cm cervical dilation(3-8 hrs) • ACTIVE PHASE : b.w end of latent phase till full cervical dilation , i.e. 10cm. (2-6 hrs) • • From full dilatation to delivery of baby. • 2 hrs in nulliparous and 1 hr in multiparous women • Divided into 2 phases" • Passive (No maternal urge to push) and Active (maternal urge to push) • From delivery of baby until delivery of placenta . • Normal Duration is 5-10 minutes • Considered prolonged after 30 minutes
- 4. 02/27/2025 4 ABNORMAL LABOUR IT OCCURS WHEN THERE IS: Poor progression in labour Signs of compromise shown by fetus Fetal malpresentation Uterine Scar Combined duration of 1st and 2nd stage is more than 18 hours(arbitrary time) Uterine Bleeding
- 5. 02/27/2025 5 POOR PROGRESS IN 1ST STAGE • It is cervical dilation of less than 2cm in 4 hrs (primary arrest). • May be related to power , passages or passengers. • Dysfunctional Uterine Activiy: Refers to 3 contraction/ 10 minutes ≤ Uterine hyperstimulation : > 5 contractions / minute. • Prolonged Latent Phase : Latent phase greater than arbitrary time managed by Artificial Rupture of Membrane and I/V oxytocin. • Secondary Arrest: progress is initially normal , then slows after 7cm dilation
- 6. 02/27/2025 6
- 7. 02/27/2025 7 CEPHALOPELVIC DISPROPORTION • Progress is slow arrested despite efficient uterine contractions • Fetal head is not engaged • Vaginal examination shows severe molding and caput formation • Head is poorly applied to cervix • Hematuria • Clinically assessed and uterine topography can be done
- 8. 02/27/2025 8 ABNORMALITIES OF BIRTH CANAL (PASSAGE) • Small pelvis. • unsuspected fibroids • Cervical dystocia (non compliant cervix which effaces but fails to dilate) • Cervical distocia because of severe scarring usually result of previous cone biopsy.
- 9. 02/27/2025 9 MALPRESENTATION (PASSENGER) + FACE PRESENTATION: Due to complete extension of fetal head presenting diameter is submental pragmatic with diameter of 9.5 CM if chin is mentro-anterior the delivery can be vaginal however mentro-posterior chin requires C-section • BROW PRESENTATION: Associated with occipital mental diameter presenting of 13 centimeter Mode of delivery is C-section • SHOULDER PRESENTATION: As a result of transverse or oblique lie of fetus due to placenta previa pelvic tumour or uterine abnormalities delivery should be done by C-section.
- 10. 02/27/2025 10 MANAGEMENT OF DELAY IN 1ST STAGE LABOUR 1. mobilize the patient 2. rehydration by IV fluids 3. analgesia with vaginal examination two hourly 4. continuous fetal monitoring 5. oxytocin infusion after two hours of AROM 6. C-section if progress fails to occur after four to six hours of oxytocin.
- 11. 02/27/2025 11 POOR PROGRESS IN 2ND STAGE OF LABOUR CAUSES: POWER: Secondary dusfunctional uterine activity PASSAGE: Narrow mid-pelvis (android pelvis) PASSENGER: Persistent OP position of fetal head
- 12. 02/27/2025 12 MANAGEMENT OPTION OF 2ND STAGE LABOUR: • Continue pushing with encouragement • Regular reviews of progress and fetal well-being • On the thing here oxytocin to augment contraction • If persistent OP position, the head will either have to undergo long rotation to OA or be delivered in OP position (i.e faces to pubis) • Epiostomy for resistance perineum • Instrumental vaginal birth. • Cesarean section.
- 13. 02/27/2025 13 FETAL COMPROMISE RISK FACTORS: • Placental Insufficency • Prematurity • Post-maturity • Multiple Pregnancy • Prolonged Labour • Augmentation with oxytocin • Cord Prolapse • Maternal Diabetes • Oligohydramnios
- 14. 02/27/2025 14 MANAGEMENT OF FETAL COMPROMISE • Maternal Diabetes and Ketosis by IV fluids • Maternal hypotension secondary to epidural by Fluid Bolus, however, a vasoconstrictor such as ephiidrine may be needed • Uterine hyperstimulation from excess oxytocin by turning off infusion nand using terbutaline. • Venocaval compression can be eased by turning woman to left lateral position.
- 15. 02/27/2025 15 OBSTRUCTIVE LABOUR • SIGNS: Exhausted anxious mother , unable to relax. Derranged vital signs Dehydration and foetid breath. • CAUSES: Contracted Pelvis Pelvic Mass Fetal Macrosomia Malposition
- 16. 02/27/2025 16 MANAGEMENT OF OBSTRUCTED LABOUR • Initial Management: Admission Resuscitation I/V line Monitor Vitals Fetal CTG and USG Prophylactic Antibiotic • Definitive Management: C-section