partograph and labor dystocia for undergraduate
DESCRIPTION
undergraduate course lectures in ob&gyne prepared by DR Manal Behery.Professor of OB&GYNE.Faculty of medicine,ZAGAZIG UniversityTRANSCRIPT
Partograph Partograph
PartographPartograph A partograph is a graphical record of the observations made of a women in labor
For progress of labor and conditions of the mother and
the fetus
History Of PartogramHistory Of PartogramFriedmans partogram
Cervical dilatation and fetal station against time in hours from onset of labouryielded the typical sigmoid or S shaped curve
ObjectivesObjectives early detection of abnormal progress of a labour
prevention of prolonged labour
Recognize cephalo pelvic disproportion long before obstructed labour
Assist in early decision on transfer augmentation or termination of labour
Early recognition of maternal or fetal problems
Components of the partographComponents of the partographPart 1 fetal condition ( at top )Part 2 progress of labour ( at middle )Part 3 maternal condition ( at bottom )
Mother information
Fetal well-being bull Fetal heart ratebull Character of liquorbull Moulding
Labour progress bull Dilatation
bull Descent
bull Uterine contraction
Medicationsbull Oxytocinbull Pain relief (eg pethidine)
Maternal well-being bull BP Pulse Temperaturebull Urine ndash albumin glucose acetonebull Urine output
Part 1 Fetal condition Part 1 Fetal condition Recording fetal heart rateRecording fetal heart rate
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
PartographPartograph A partograph is a graphical record of the observations made of a women in labor
For progress of labor and conditions of the mother and
the fetus
History Of PartogramHistory Of PartogramFriedmans partogram
Cervical dilatation and fetal station against time in hours from onset of labouryielded the typical sigmoid or S shaped curve
ObjectivesObjectives early detection of abnormal progress of a labour
prevention of prolonged labour
Recognize cephalo pelvic disproportion long before obstructed labour
Assist in early decision on transfer augmentation or termination of labour
Early recognition of maternal or fetal problems
Components of the partographComponents of the partographPart 1 fetal condition ( at top )Part 2 progress of labour ( at middle )Part 3 maternal condition ( at bottom )
Mother information
Fetal well-being bull Fetal heart ratebull Character of liquorbull Moulding
Labour progress bull Dilatation
bull Descent
bull Uterine contraction
Medicationsbull Oxytocinbull Pain relief (eg pethidine)
Maternal well-being bull BP Pulse Temperaturebull Urine ndash albumin glucose acetonebull Urine output
Part 1 Fetal condition Part 1 Fetal condition Recording fetal heart rateRecording fetal heart rate
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
History Of PartogramHistory Of PartogramFriedmans partogram
Cervical dilatation and fetal station against time in hours from onset of labouryielded the typical sigmoid or S shaped curve
ObjectivesObjectives early detection of abnormal progress of a labour
prevention of prolonged labour
Recognize cephalo pelvic disproportion long before obstructed labour
Assist in early decision on transfer augmentation or termination of labour
Early recognition of maternal or fetal problems
Components of the partographComponents of the partographPart 1 fetal condition ( at top )Part 2 progress of labour ( at middle )Part 3 maternal condition ( at bottom )
Mother information
Fetal well-being bull Fetal heart ratebull Character of liquorbull Moulding
Labour progress bull Dilatation
bull Descent
bull Uterine contraction
Medicationsbull Oxytocinbull Pain relief (eg pethidine)
Maternal well-being bull BP Pulse Temperaturebull Urine ndash albumin glucose acetonebull Urine output
Part 1 Fetal condition Part 1 Fetal condition Recording fetal heart rateRecording fetal heart rate
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
ObjectivesObjectives early detection of abnormal progress of a labour
prevention of prolonged labour
Recognize cephalo pelvic disproportion long before obstructed labour
Assist in early decision on transfer augmentation or termination of labour
Early recognition of maternal or fetal problems
Components of the partographComponents of the partographPart 1 fetal condition ( at top )Part 2 progress of labour ( at middle )Part 3 maternal condition ( at bottom )
Mother information
Fetal well-being bull Fetal heart ratebull Character of liquorbull Moulding
Labour progress bull Dilatation
bull Descent
bull Uterine contraction
Medicationsbull Oxytocinbull Pain relief (eg pethidine)
Maternal well-being bull BP Pulse Temperaturebull Urine ndash albumin glucose acetonebull Urine output
Part 1 Fetal condition Part 1 Fetal condition Recording fetal heart rateRecording fetal heart rate
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Components of the partographComponents of the partographPart 1 fetal condition ( at top )Part 2 progress of labour ( at middle )Part 3 maternal condition ( at bottom )
Mother information
Fetal well-being bull Fetal heart ratebull Character of liquorbull Moulding
Labour progress bull Dilatation
bull Descent
bull Uterine contraction
Medicationsbull Oxytocinbull Pain relief (eg pethidine)
Maternal well-being bull BP Pulse Temperaturebull Urine ndash albumin glucose acetonebull Urine output
Part 1 Fetal condition Part 1 Fetal condition Recording fetal heart rateRecording fetal heart rate
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Mother information
Fetal well-being bull Fetal heart ratebull Character of liquorbull Moulding
Labour progress bull Dilatation
bull Descent
bull Uterine contraction
Medicationsbull Oxytocinbull Pain relief (eg pethidine)
Maternal well-being bull BP Pulse Temperaturebull Urine ndash albumin glucose acetonebull Urine output
Part 1 Fetal condition Part 1 Fetal condition Recording fetal heart rateRecording fetal heart rate
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Part 1 Fetal condition Part 1 Fetal condition Recording fetal heart rateRecording fetal heart rate
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
I intactC clearM muconiumB blood stained
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Molding the fetal skull bonesMolding the fetal skull bones Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion separated bones sutures felt easilyhelliphelliphellipO bones just touching each otherhelliphelliphelliphelliphellip+ overlapping bones helliphelliphelliphelliphellip helliphelliphelliphellip++ severely overlapping bones ( notable ) helliphellip+++
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Part 2 ndash progress of labourPart 2 ndash progress of labour Cervical dilatation it is divided into a latent phase and an
active phase Descent of the fetal head Uterine contractions
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Cervical dilatationCervical dilatation It is the surest way to assess progress of labour
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
latent phase latent phase
Starts from onset of labour until the cervix reaches 3 cm dilatation
lasts 8 hours or less
Contractions at least 210 min contractions
each lasting lt 20 seconds
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Active phase Active phase
The cervix should dilate at a rate of 1 cm hour or faster
Contractions at least 3 10 min each lasting lt 40 seconds
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm hour
Moving to the right or the alert line means referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Action line ( hospital line )Action line ( hospital line )The action line is drawn 4 hour to the right
of the alert line and parallel to itThis is the critical line at which specific
management decisions must be made at the hospital
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
When labor goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase area to the alert line
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Abnormal labor progress Abnormal labor progress
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Descent of the fetal headDescent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Assessing descent of the fetal PVAssessing descent of the fetal PV 0 station is at the level of the ischial spine 0 station is at the level of the ischial spine
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Recording uterine contractionRecording uterine contraction
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
PART 3Recording of maternal PART 3Recording of maternal conditioncondition
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
--
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Abnormal labor and DystociaAbnormal labor and Dystocia
One of the main functions of the partograph is to detect early deviation from normal progress of labor
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
0
2
4
6
8
10
12
2 4 6 8 10 12 14 16
Latent phase Active phase
2nd stage1st stage
max slope
acceleration
dec
Time (hours)
Cervical dilatation (cm)
Friedman labor curve in nulliparous
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Normal progress in labor Normal progress in labor
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
A prolonged latent phaseB prolonged active phaseC arrest active phase
Abnormal progress in labor
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Prolonged latent phaseProlonged latent phase
1048698 Nulliparas
Multiparas
prolonged
gt20 hr
gt 14 hr
Normal average
64 hr
48 hr
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Management Management Prolong Latent Phase Prolong Latent Phase
ndash Simple analgesiandash Encourage mobilizati on ndash Reassurancendash ARM and oxytocin will cause poor progress
later
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Protraction disordersProtraction disorders
1048698 Nulliparas
Multiparas
Descent
lt10 cmh
lt20 cmh
Dilation
lt12 cmh
lt15 cmh
Average
8hr
5hr
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Arrest disorderArrest disorder
1048698 Nulliparas
Multiparas
Descent
gt2h
gt1h
Dilation
gt2h
gt1h
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Causes of Protraction disordersCauses of Protraction disorders
1048698
minor malpositions such as occiput posterior
improperly administered conduction anesthesia excessive sedation
Fetopelvic disproportion
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Treatment of protraction and Treatment of protraction and arrest disorderarrest disorder
Cesarean section is indicated in the presence of confirmed fetopelvic disproportion
In the absence of fetopelvic disproportion support and close observationoxytocin augmentation
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Critical Factors
Psyche Powers
Passenger
Passageway
Dysfunctional Labor is related to Abnormalities of the Critical Factors
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Psychology of birthPsychology of birth
The progress of labor and birth can be adversely affected maternal fear and tension
Norepinephrine and epinephrine may stimulate both alpha and beta receptors of the myometrium and interfere with the rhythmic nature of labor
Anxiety can also increase pain perception and lead to an increased need for analgesia amp anesthesia
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Fetal monitoringFetal monitoring
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Friedmanrsquos GraphFriedmanrsquos GraphHypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Normal Curve
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Therapeutic InterventionsTherapeutic Interventions
ndash Ambulation
ndash Nipple Stimulation --release of endogenous Pitocin
ndash Enema--warmth of enema may stimulate contractions
ndash Amniotomy--artificial rupture of the membranesndash Augmentation of labor with Pitocin
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
AmniotomyAmniotomy Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook 1-Check the fetal heart tones
ndash Assess color odor amountndash Provide with perineal carendash Monitor contractionsndash Check temperature every 2 hours
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Hypertonic and uncoordinated Hypertonic and uncoordinated dysfunctiondysfunction
Resting tone
Dyssynchronous
Frequent intense contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Friedmanrsquos GraphFriedmanrsquos GraphHypertonic Uterine ContractionsHypertonic Uterine Contractions
Prolonged latent phase
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
Causesndash Large baby or small pelvisndash Usually diagnosed when there is an arrest in descent
Symptomsndash Station remains the same does not descend
Treatmentndash Usually do a cesarean delivery if cause is pelvisndash Utilize other measures such as forceps vacuum
extraction episiotomy
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the sacral promontory
The distance from the sacral promontory to the exterior portion of the symphysis is the diagonal conjugate and should be greater than 115 cm
Unengaged fetal head
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
bull Feel the ischial spines for their relative prominence or flatness
bull Ischial prominence narrows the transverse diameter of the pelvis
bull Feel the pelvic sidewalls to determine whether they are parallel (OK) diverging (even better) or converging (bad)
bull Narrow sacrosciatic notch
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90
Measure the bony outlet by pressing your closed fist against the perineum
Greater than 8 cm bituberous ( or transverse outlet) is considered normal
Narrow pubic archlt90