Abnormal labour
dr.mesfin(GP)
• Labor abnormality is the most common indication
for primary caesarean birth.
• Normal labor refers to the presence of regular
uterine contractions that cause progressive
dilatation and effacement of the cervix and fetal
descent.
• Adequate uterine contraction is achieved when
there are 3-5 strong uterine contractions in 10
minutes each lasting for 45-60seconds (maximum
90 seconds).
Types of labor abnormalities:
1.1st stage of labour
a. Prolonged latent phase of 1st stage of labor
b. Prolonged active phase of 1st stage of labor
- Either slower-than-normal progress
(protraction) or
- Complete cessation of progress (arrest) of
cervical dilatation
A.Prolonged latent phase of 1st stage of labor
• Commonest cause of labor abnormalities
Diagnosis;
• Cervix not dilated beyond 4 cm /active phase not
achieved after 20 hrs for nulliparous & 14 hrs for
multiparous women after the mother perceived regular
contractions.
Causes;
1, False labor
2. Uterine dysfunction
3. Premature sedation or administration of conduction
analgesia
Management
• If there is no change in cervical effacement
or dilatation and there is no FHB
abnormality:
- May not be in labor / suspect false labour
- Give her pethidine 50 mg IM initially & repeat
the same dose if inadequate
- No improvement or uterine contraction
continued despite the above treatment - true
latent phase
• If there is a change in cervical effacement & dilation
(but not sufficient):
- Therapeutic rest with narcotics as above if no
maternal or fetal heart beat abnormality or
- Rupture the fetal membrane (not in HIV infected
mother) & augment with oxytocin according to the
protocol if indicted
- Reassess every 4 hrs more frequently for progress of
labor
- If failed augmentation, do C/S
b. Active phase disorders:
• To diagnose either protraction and arrest,
labor should be in the active phase with
cervical dilation of at least 3-4 cm
1.Protraction disorder: < 1cm/hr cervical dilation
over a minimum of 4 hrs duration
2· Active phase arrest: no cervical dilation over >
2 hrs duration
Causes.
1.Passenger
-incresed fetal size
-Abnormalities from fetal presentations, positions
2. Passage(Abnormalities of maternal pelvis)
-pelvic contracture
-soft tissues of reproductive tract that forms an
obstacle for fetal descent
3.Power
-inadequate uterine contraction
4. maternal Psychology
management
• Mangement dependens on the tonicity of
contraction
1.hypotonic-iv oxytocin
2.hypertonic-iv morphine sedation
3.eutonic-emergent C/S.
2. Prolonged 2nd stage of labor
• Patient is 10cm dilated and fails to deliver infant in <
2hrs(Nullipara) and <1 hr(multipar)
-add one hour if the patient take spinal anesthesia.
• Causes;
-the 4 ps
• Management;assess contraction
-adequate-iv oxytocin
-Inadequate-assess engagement of fetal head
Engaged-consider forceps and vaccum
Not engaged-C/S
3. Precipitate labor
• Precipitous labor is a labor which terminates in
expulsion of the fetus in less than 3 hours.
• Characterized by uterine contractions more
frequently than every 2 minutes
Importance:
• The uterus that contracts with unusual vigour before
delivery is likely to be hypotonic after delivery
• Hemorrhage from the placental implantation site as
the consequence
• Unwanted effect for the mother & the foetus
Maternal:
- PPH secondary to birth canal soft tissue laceration,
uterine atony
- Increased risk of amniotic fluid embolism
Fetal: Risk of fetal morbidity & mortality increases
- Increased risk of placental abruption, hypoxia, birth
injury
- Delivery most likely unattended →birth injury
UMBILICAL CORD PROLAPSE (UCP)
• UCP is obstetric emergrncy that occurs when the
umbilical cord(UC) descends alongside or beyond the
fetal presenting part.
• Cord prolapse can be overt, being felt inside the cervix,
the vagina or even hanging outside the introitus.
“Occult” cord prolapse with the cord anterior to the
presenting part in the lower segment but not felt on
digital vaginal exam has also been described
• Cord prolapse can occur in vertex and frank breech
presentations(0.5%); complete breech (5%); footling
breech (15%) and shoulder presentation ( 20%).
Etiology of Cord Prolapse
• Malpresentations in labor
• PROM
• Amniotomy with a high fetal station
• Polyhydramnios with sudden membrane
rupture
• Second twin delivery
• Cepalopelvic disproportion in labor
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diagnosis
Vaginal exam- cord hanging outside the
introitus; felt in the vagina or inside the cervix
anterior to the presenting part
– Check for pulsation and its rate
– Replace the cord immediately into the vaginal
( not inside the uterus) canal if outside the
introitus
management
• Put mother in knee-chest position
• Initiate oxygen administration by face mask 5L/min
• Insert bladder catheter and infuse the bladder with
0.5L of saline
• Replace the cord into the vaginal canal ( not into the
uterus)
• Push fetal presenting part upwards via the examining
hand in the vagina to relieve compression of the cord
by the presentation
• prompt delivery is recommended when fetus is alive
Thank you
