8.prolonged labour.pptx

7/23/2019 8.Prolonged labour.pptx

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PROLONGED LABOURAND OBSTRUCTED

LABOUR

COMPLICATIONS


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What isprolonged

lao!r"


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PROLONGED LABOUR

Prolonged lao!r

onset o# tr!e lao!r

rh$th%i&al pain#!l&ontra&tions a&&o%panied

$ &er'i&al dilation (here lao!r is longerthan )* ho!rs


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What are the

&o%ponents o#

prolongedlao!r"


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PROLONGED LABOUR

PROLONGED LABOURIS di'ided as

prolonged latent phaseo# lao!r

prolonged active phaseo# lao!r


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What islatentphase"


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LATENT P+ASE

Latent phase

The onset o# reg!lar

pain#!l &ontra&tions(ith &er'i&al dilation

Dilatation o# , -. &% The d!ration is . ho!rs


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PROLONGED LATENTP+ASE

, to . &% &er'i&al

dilatation islonger than 8

hours


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I# the (o%an re%ains in thelatent phase o# lao!r #or %ore /ho!rs0 progress is not nor%al1

In these &ases the (o%an %a$e in

2#alse lao!r3 or a

prolonged latent phase1


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ACTI4E P+ASE

ACTI4E P+ASE5-

A&&eleration phase

Pri%ipara *16-7718 hrs

%!ltiparo!s )1)-91) hrs

De&eleration Phase

Pri%ipara9* %in-.1. hrs

M!ltiparao!s 7* -9. %in


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SECOND STAGE

SECOND STAGE

Pri%para 98 %in-)19hrs

M!ltiparao!s 7/ -9,%in


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+o( to

di:erentiateet(een #alselao!r and

prolonged


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LATENT P+ASE AND ;ALSELABOUR

In the latent phase there isso%e &hange in &er'i&ale:a&e%ent and


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The diagnosis is !s!all$ %aderetrospe&ti'el$0 either (hen&ontra&tions &ease in &ases o#

#alse lao!r0 or

(hen &er'i&al dilatationprogresses e$ond . &% and

&ontra&tions &ontin!e1 An$ (o%an (ith a latent phase

o# / ho!rs %!st e re#erred1


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In a prolonged latent phase0 the&er'i&al dilatation (ill re%ainet(een 7 &% and . &%1

I# !sing the partograph (ith thelatent phase0 &er'i&al dilatation(hen plotted (ill &ross to the

right o# the alert line a#ter /ho!rs and then the (o%ansho!ld e re#erred1


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I# she has notentered the a&ti'ephase o# lao!r after8 hours of induction0

she sho!ld edeli'ered $

&aesarean se&tion


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What is

a&ti'e phase

o# lao!r"


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ACTI4E P+ASE O;LABOUR

ACTI4E P+ASE O;LABOUR

phase (ith reg!larpain#!l &ontra&tions

Cer'i&al dilatation #ro% *&% 7, &% sho!ld not belonger than 12 hours


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+o( (o!ld

$o! %anage

prolongeda&ti'e phase"


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MANAGEMENT O; PROLONGEDACTI4E P+ASE

Assess !terine &ontra&tions5

I# &ontra&tions are ine>&ient

?less than . &ontra&tions in7, %in!tes0 ea&h lasting lessthan *, se&onds@0

inade!ate !terine a&ti'it$ a!g%ent (ith o=$to&in


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In Prolonged

a&ti'e phase (ithgood !terine

&ontra&tion ho((o!ld $o! %anage"


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PROLONGED ACTI4E P+ASE-CONTD

I# &ontra&tions are e>&ients!spe&t

&ephalopel'i& disproportion0 ostr!&tion0

%alposition

or %alpresentation

LOOK FOR A CAUS


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What are the

&a!ses o#

prolongedlao!r"


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PROLONGED LABOUR

Ca!ses o# prolonged lao!r

It is !s!al to des&rie this as d!e tothe three Ps5

Po(ers5 poor or !n&oordinated !terinea&tion

Passenger5 #etal head too large 0%alposition and dee=ion o# the head

Passage5 s%aller0 t!%o!r orostr!&tion in pel'is0 &er'i&al d$sto&ia


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What isostr!&tedlao!r"


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OBSTRUCTED LABOUR

Ostr!&ted lao!r %eans in spite o#strong &ontra&tions o# the !ter!s

the #et!s &annot des&end thro!gh the

pel'is Ostr!&tion !s!all$ o&&!rs at the

pel'i& ri%0 !t o&&asionall$ it %a$o&&!r in the %id&a'it$ or at the o!tlet

o# the pel'is Lao!r (ill not progress (itho!t

assistan&e


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OBSTRUCTED LABOUR-CONTD

Ca!ses o# ostr!&ted lao!r5

&ephalopel'i& disproportion?s%all pel'is or large #et!s@

anor%al presentations0 e1g1ro(0 sho!lder0 a#ter&o%inghead in ree&h presentation

Malposition o&&ipitoposterior0%entoposterior


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OBSTRUCTED LABOUR -CONTD

#etal anor%alities0 e1g1h$dro&ephal!s

anor%alities o# thereprod!&ti'e tra&t0 e1g1pel'i& t!%o!r

stenosis o# &er'i= &er'i&al d$sto&ia


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What (ill e the

partographndings in

ostr!&tedlao!r"


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PARTOGRAP+ RECORDINGS INOBSTRUCTED LABOUR

a prolonged rst or se&ond stageo# lao!r (hi&h is e'ident

e&a!se &er'i&al dilatation (ill

&ross rst the alert line andthen0

i# no a&tion is taFen0 (ill &ross the

a&tion line despite ahistor$ o# strong!terine &ontra&tions1


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Nor%al partograph- 769*


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Prolonged latent phase


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Prolonged a&ti'e phase


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)r$ Arrest o# &er'i&aldilatation


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)r$ arrest in des&ent o#head


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Oxytocin infusion


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What (ill e the

ado%inale=a%ination

ndings inostr!&ted


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OBSTRUCTED LABOUR

On ado%inale=a%ination

Bandls ring

Good !terine

&ontra&tion Presenting part is high


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What isBandlsring"


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BANDLS RING

Bandls ring is the na%e gi'en to thearea et(een the !pper and lo(er!terine seg%ents (hen it e&o%es

'isile and


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BANDLS RING

Bandls ring is a late sign o# ostr!&tedlao!r1 It &an e seen as a depressiona&ross the ado%en at ao!t the le'el o#the !%ili&!s1

Ao'e this is the grossl$ thi&Fened0retra&ted !pper !terine seg%ent1

Belo( the Bandls ring is the distended0dangero!sl$ thinned lo(er !terineseg%ent1

The lo(er ado%en &an e #!rtherdistended $ a #!ll ladder and o(el1


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What (ill e

the 'aginale=a%ination

ndings in

ostr!&ted OBSTRUCTED LABOUR


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OBSTRUCTED LABOUR;INDINGS

4aginal e=a%ination

o:ensi'e %e&oni!%

oede%a o# the '!l'a0espe&iall$ i# the (o%an haseen p!shing #or a long ti%e

4agina- hot and dr$ e&a!seo# deh$dration

OBSTRUCTED LABOUR


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OBSTRUCTED LABOUR-CONTD

oede%a o# the &er'i=

In &ase o# o!tlet ostr!&tion5

a large &ap!t s!&&edane!% &ane #elt

Gross %o!lding

head 0 sho!lder0 ro( orposterior #a&e st!&Fed

Presentation or prolapsed ar%1


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What are the

grades o#

%o!lding"


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MOULDINGS

Mo!lding is re&orded as #ollo(s5

ones are separated and thes!t!res &an

e #elt easil$ ?o@

ones are H!st to!&hing ea&hother ?@

ones are o'erlapping !t &ane separated ?@

ones are o'erlapping se'erel$and &annot e se arated 1


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What are the

&a!ses o#&ephalo pel'i&

disproportion"

CEP+ALOPEL4IC


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CEP+ALOPEL4ICDISPROPORTION

Cephalopel'i&disproportion o&&!rs (hen

there is a %istet(eenthe #etal headand the pel'is1

This %eans it is di>&!ltor i%possile #or the #et!s

to pass sa#el$ thro!gh the


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CPD

s%all pel'is (ith anor%al siJe head0 or

a nor%al pel'is (ith alarge #et!s0 or

&o%ination o# a largea$ and s%all pel'is1


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What is

orderline

?%arginal@

pel'is"


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Cephalopel'i& disproportion %a$ e5

?a@orderline5

In these &ases the prole% %a$ e

o'er&o%e d!ring lao!r1 Strong!terine &ontra&tions0 rela=ation o#the pel'i& Hoints and %o!lding o# the#etal sF!ll %a$ enale the #et!s to

pass thro!gh the pel'is #or 'aginaldeli'er$


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What isdenite

CPD"


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?@Denite5 This o&&!rse&a!se the pel'is is too

s%all0 is anor%al inshape0 or e&a!se the#et!s is anor%al or too

large #or the pel'isthro!gh (hi&h it has to

pass1 Operati'e deli'er$


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There#ore thediagnosis o# &ephalo-pel'i& disproportionis a#ter the trial o#

lao!r


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+o( todiagnose

CPD"

DIAGNOSIS O; CEP+ALOPEL4IC


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DIAGNOSIS O; CEP+ALOPEL4ICDISPROPORTION

Se&ondar$ arrest o# &er'i&aldilatation

La&F o# des&ent o# presenting part

large &ap!t0 third degree %o!lding0

Cer'i= #!ll$ dilated and (o%an has

!rge to p!sh0 !t there is nodes&ent1 Prolonged e=p!lsi'ephase


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+o( to

diagnose

CPD in

lao!r" CPD ;EATURES IN


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CPD- ;EATURES INLABOUR

&er'i= poorl$ applied topresenting part0

oede%ato!s &er'i=0 allooning o# lo(er !terine

seg%ent0

#or%ation o# Bandls ring0 %aternal and #etal distress1


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+o( to dete&t

poor progress

o# lao!r"

DIAGNOSIS O; UNSATIS;ACTORK


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DIAGNOSIS O; UNSATIS;ACTORKPROGRESS O; LABOUR

Cer'i= not dilated e$ond *&% a#ter / ho!rs in spite o#

reg!lar !terine &ontra&tions-Prolonged latent phase

Cer'i&al dilatation to the

right o# the alert line on thepartograph


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What are the

predisposing#a&tors #or

r!pt!re o# !ter!s"

Danger o# !terine


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Danger o# !teriner!pt!re

When the %e%ranes r!pt!re and thea%nioti& !id drains

the #et!s is #or&ed into the lo(er

seg%ent o# the !ter!s $ &ontra&tions I# the &ontra&tions &ontin!e0 the lo(er

seg%ent stret&hes0 e&o%esdangero!sl$ thin and is liFel$ to

r!pt!re NE4ER add o=$to&in (itho!t e=&l!ding

ostr!&tion

RUPTURE O; T+E


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RUPTURE O; T+EUTERUS

%a$ e &o%plete or in&o%plete1I# it is &o%plete ?i1e1

the !ter!s &o%%!ni&ates dire&tl$

(ith the peritoneal &a'it$@0 leeding(ill o&&!r (ithin the peritone!%1

I# it is in&o%plete ?i1e1 the r!pt!redoes not rea&h the 'is&eral

peritone!%@0 leeding (ill o&&!rehind the 'is&eral peritone!%-diagnosis is di>&!lt

RUPTURE O; T+E


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RUPTURE O; T+EUTERUS

is %ore liFel$ to o&&!rin %!ltipara

Espe&iall$ in highparo!s %others

s&ar o# a pre'io!s&aesarean se&tion


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What are the

&o%pli&ations

o# prolongedlao!r"

PROLONGED AND OBSTRUCTED


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PROLONGED AND OBSTRUCTEDLABOUR

Maternal and #etal distress

In#e&tion0 sept&ae%ia

Potpart!% hae%orrhage ;ist!la #or%ation is&hae%i&

ne&rosis

Genital tra&t prolapse Ps$&hologi&al tra!%a

8.prolonged labour.pptx

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