Abnormal labour broad overview in OBSGYN

All the necessary points to know about abnormal labour

1. Lecture
2023
•6 November 2023 •1

2. Presenter: Dr S Chinkoyo
•6 November 2023 •2

3. prolonged labour
obstructed labour
augmentation of labour
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4. The simple objective of every pregnancy
and intrapartum care is:
To ensure the delivery of a healthy baby
to a healthy fulfilled mother.
1.The fullest possible understanding of the birth process, its
challenges and appropriate management policies is central to
that objective.
2.Failures to reach that objective results in unhappiness,
complaints and litigation, and may even lead to death or
damage of mothers or babies.
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5. labour is the physiological process by
which the fetus, placenta, and
membranes are expelled through the
birth canal.
most women will give birth safely
without any complication.
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6. clinical diagnosis
characterized by
regular painful uterine contractions
+
progressive cervical change
(effacement and dilatation)
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7. ➢singleton pregnancy.
➢term pregnancy: 37-42 weeks.
➢vertex presentation, OA position.
➢spontaneous onset.
➢normal progress.
➢spontaneous vaginal delivery.
➢no complications.
➢healthy baby, healthy fulfilled mother.
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8. labour becomes abnormal when:
1.there is poor progress (as evidenced by
delay in cervical dilatation or descent of
the PP).
2.the fetus shows signs of compromise.
3.there is a fetal malpresentation, a multiple
pregnancy, a uterine scar, or if labour has
been induced.
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9. abnormal labour needs to be managed.
management of labour:
1.is one of the major challenges in
obstetrics and midwifery.
2.it affects the outcome for the mother,
infant and family.
3.aims to prevent rare but serious bad
outcomes.
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10. there is no ideal length of labour for all
women,butmorbidity increases when:
▪labour is too fast (precipitate)–expulsion of the
fetus within less than 3 hrs of the onset of
regular contractions.
▪labour is too slow (prolonged).
there is a greater incidence of fetal hypoxia
and need for operative delivery associated
with longer labours.
•6 November 2023
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11. •6 November 2023 •11

12. astandard duration of the latent first stage
has not been established and can vary
widely from one woman to another.
however, the duration of active first stage
(from 5 cm until full cervical dilatation)
usually does not extend beyond 12 hours in
first labours, and usually does not extend
beyond 10 hours in subsequent labours.
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13. •6 November 2023 •13

14. •6 November 2023 •14

15. ❑4 hours of < 0.5cm/hrdilatation in 1
st
stage
or
❑1 hour with no descent during active pushing in
2
nd
stage.
accepted definition: cervical dilatation of
less than 0.5cm/hr in 4 hours (i.e., <2cm in 4
hours, usually associated with failure of
descent of the fetal head).
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16. dystocia should be diagnosed in the
active phase of labour.
dystocia should notbe diagnosed prior
to the onset of labour or during the
latent phase of labour.
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17. •6 November 2023 •17

18. hypotonic contractions POWERS
cephalopelvic disproportion
▪fetal position
▪presentation PASSENGER
▪fetal size
▪bony pelvis PASSAGE
▪soft tissue
➢progress in labour results from the interaction of 3
factors:Powers, Passages and Passenger.
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19. failure to progress in labour may be due to
faults in Powers, Passenger or Passages
(i.e., physiologically), but the possible
clinical problems are:
1.inefficient uterine action
2.obstructed labour due to CPD
3.obstructed labour due to malpositions of
the vertex (OPP, asynclitism)
4.malpresentations (breech, face, brow)
5.rarely, cervical causes
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20. •6 November 2023 •20

21. contractions that …
▪last 40-60 seconds
▪reach 50-60 mm Hg of pressure
▪occur every 2-3 minutes (3-5 in 10 minutes)
or
▪result in good progress.
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22. •6 November 2023 •22

23. 1.false labour
2.incoordinate uterine activity
3.cervical dystocia
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24. •6 November 2023 •24

25. preferred exceptional
prolonged latent phaserest & analgesiaoxytocin
mobilization
reassurance
arrest disorders
-with true CPD caesarean -
-without CPD oxytocin rest if exhausted
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26. ‘primary arrest’: poor progress in the active
1
st
stage of labour (<2 cm cervical dilatation in
4 hours).
‘secondary arrest’: occurs when progress in
the active 1
st
stage is initially good but then
slows or stops altogether, typically after 7 cm
dilatation.
‘arrest in the 2
nd
stage of labour’: occurs
when delivery is not imminent after the usual
interval of pushing in the 2
nd
stage of labour.
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27. ‘arrest in the 2
nd
stage of labour’may
be due to:
▪inefficient uterine activity
▪CPD
▪malposition ormalpresentation
▪resistant perineum
▪maternal exhaustion,fearorpain
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28. 1.antenatal preparation
2.continuous emotional support
3.ambulation and upright posture
4.analgesia
5.adequate hydration and light diet
6.amniotomy (ARM)
7.augmentation of labour
8.use of the Partogram
•6 November 2023 •28

29. can be achieved by:
▪antenatal preparation.
▪continuous emotional support.
▪analgesic drugs.
appears to enhance labour progress.
preserves or enhances fetal well-being.
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30. modest reduction in duration of active
labour.
may improve application of the presenting
part to the cervix.
does not reduce the risk of caesarean
section.
does not improve maternal or fetal
morbidity.
may increase the risk of MTCT of HIV.
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31. when you wish the woman had
strong, regular contractions on her
own and she doesn’t.
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32. a pictorial graphic representation of
labour.
emphasizes the progressive nature of
labour.
identifies delay or arrest of the
progress at an early stage.
includes 3 sets of data: maternal
signs, fetal signs, and progress of
labour.
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33. •Time (hours)
•
Cervical dilatation (cm
)
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34. •6 November 2023 •34

35. slow progress of labour is demonstrated
by crossing the alertand action lineson
the cervicograph.
slow progress of labour is associated
with increases in :
▪maternal stress
▪maternal infection
▪postpartum haemorrhage
▪the need for neonatal resuscitation.
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36. progress of labour
▪uterine contractions
▪descent of the presenting part
▪cervical dilatation
▪moulding and caput formationassess
fetal condition
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37. it is an excellent tool for the monitoring of labour
BUT
it is only as good as the HCP who uses it.
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38. •6 November 2023 •38

39. 1.avoid unnecessary inductions.
2.admit only women in active labour.
3.encourage antenatal education.
4.encourage continuous emotional support.
5.allow ambulation and upright posturing.
6.use appropriate analgesia.
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40. diagnosis of slow progress of labour
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41. ▪findings:
▪cervix not dilated
▪no palpable contractions/infrequent
contractions.
▪diagnosis:
▪false labour.
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42. ▪findings:
▪cervical dilatation to the right of the alert
line on the partogram.
▪secondary arrest of cervical dilatation and
descent of the PP in presence of good
contractions.
▪diagnosis:
▪cephalopelvic disproportion (CPD).
•6 November 2023 •42

43. ▪findings:
▪cervical dilatation to the right of the alert
line on the partogram.
▪secondary arrest of cervical dilatation and
descent of the PP with large caput,
moulding+++, cervix poorly applied to PP,
oedematouscervix, ballooning of lower
uterine segment, formation of retraction
ring (Bandl’sring), maternal and fetal
distress.
▪diagnosis:
▪neglected obstructed labour.
•6 November 2023 •43

44. ▪findings:
▪cervical dilatation to the right of the alert
line on the partogram.
▪less than 3 contractions in 10 minutes, each
lasting less than 40 seconds.
▪diagnosis:
▪inefficient uterine action.
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45. ▪findings:
▪cervical dilatation to the right of the alert
line on the partogram.
▪presentation other than vertex in occipital
anterior position.
▪diagnosis:
▪malpresentation or malposition.
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46. ▪findings:
▪cervix fully dilated and woman has urge to
push, but there is no descent.
▪diagnosis:
▪prolonged active phase of the second stage.
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47. •6 November 2023 •47