Precipitate Labour.pptx

beneficial

1. PRECIPITATE
LABOUR

2. Definition

_ Precipitate labour refers to a labour pattern that
progresses rapidly and ends with delivery occurring in less
than 3 hours is typically less than 5 hours after the onset
of uterine activity.

_ Jt is due to strong coordinate uterine contractions in
absence of obstruction in the birth canal, and resistance
of the soft tissues.

- The patient does not feel contractions except the last

contractions during the expulsion of the fetus.

3. Contributor Factors

Maternal multi parous status.
Small fetus
Relaxed pelvic and vaginal musculature

History of rapid labors with previous deliveries

A particularly efficient uterus which contracts
with great strength

4. Signs

+ À sudden onset of intense, closely timed contractions
with little opportunity for recovery between
contractions.

+The sensation of pressure including an urge to push
that comes on quickly and without warning.

Often times this symptom is not accompanied by

contractions as the cervix dilates very quickly.

5. Diagnosis

It is a retrospective diagnosis as the patient is usually
seen in the 2nd or 3rdstages of labor.

If seen during the first stage of the labor, the
Partograph will show rapid progress of cervical
dilatation and effacement.

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6. Risks of Precipitate Labour and Delivery

FOR MOTHER
_ Increased risk of tearing and laceration of the cervix and
vagina
_ Predisposing to postpartum hemorrhage and sepsis
_ Atonic Uterus: due to uterine exhaustion

- Hemorrhaging from the uterus or vagina

Shock following birth which increases recovery time

Delivery in an unsterilized environment such as the car or

bathroom

7. Continued...
FOR BABY

Risk of infection from unsterilized delivery

Potential aspiration of amniotic fluid

_ Intracranial hemorrhage: due to rapid compression

and decompression of the fetal head during delivery.

e

Fetal injuries

Avulsion (forcible separation) of the cord

- Neonatal sepsis

8. Management

BEFORE DELIVERY

A patient with past history of precipitate labor should be admitted to
the hospital at the first perception of labor pains.

DURING DELIVERY

Rarely, if the patient is seen during delivery, general anesthesia
(inhalation by nitrous oxide and oxygen or sedation) may be given to
slow down the course of delivery to prevent forcible bearing down.

AFTER DELIVERY

e If the patient is seen after delivery: exploration of the birth canal for
any injury and manage accordingly.

© Prophylactic antibiotics if delivery occurred in unsuitable
conditions.

9. PROLONGED
LABOUR

10. Definition

+ The labour is said to be prolonged when the combined
duration of the first and second stage is more than the
arbitrary time limit of 18 hrs.

«+ Latent Phase: Latent phase is the preparatory phase of the
uterus and the cervix before the actual onset of labour.

Normal latent phase is about 8 hours in primi gravida € 4

hours in multi gravida.

11. Causes

Unripe cervix

Malposition and malpresentation

Abnormal uterine contraction

Contracted pelvis

12. Be: @SESTAGE: First stage of
L ur is consid dsred 8

Haba LONE ARR oF ET in

d<1.5
= Deen multi.
© The rate of descent if the presenting part
is a cm/hrin primiand < 2 cm/hrin
multi.

i = SECOND STAGE: The 2nd stage is considered prolonged
if it lasts for more than 2 hrs in primi, and a hr in multi.
The diagnostic features are:

© Sluggish or non descent of the presenting

13. Dangers

Hypoxia
Intrauterine
infection
Intracranial stress
or hemorrhage
Increased operative
delivery

Distress
Postpartum
hemorrhage
Trauma to the
genital tract
Increased operative
delivery

Puerperal sepsis
Sub-involution

14. Prevention

® Antenatal or early intranatal detection of the factors likely to
produce prolonged labour (big baby, malpresentation or position).

© Use of partograph helps early detection.

e Selective and judicious augmentation of labour by low rupture of
membranes followed by oxytocin drip.

+ Change of posture in labour other than supine to increase the

uterine contractions.

15. Treatment

First Stage Delay
e Vaginal examination is done to verify the fetal presentation,

position and station.

e Clinical pelvimetry is done, if only uterine activity is sub-

optimal.

© Amniotomy and/ or oxytocin infusion is adequate.

© Effective pain relief is given by IM Inj: Pethidine or by regional

16. Continued....

Second Stage Delay

e Short period of expectant management is reasonable
provided the FHR is reassuring and vaginal delivery is
imminent.

© Otherwise appropriate assisted delivery vaginal
(forceps,ventouse) or abdominal (caesarean) should

be done.

17. PRECIPITATE LABOR

+ Precipitate delivery refers to a
delivery which results after an
unusually rapid labor (combined 1st
stage and second stage duration is
<2hrs) and culminates in the rapid,
spontaneous expulsion of the infant.

18. Precipitate labor disorders

Dilation Descent
P Nulliparas >5cm/hr >5cm/hr

Multiparas >10cm/hr >10cm/hr

19. CAN BE HAPPEN?

PERINEAL TEAR UTERINE RUPTURE |
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PPH ¢ INVERSION
a a =
INFECTION 7 AMNIOTIC

FLUID EMBOLISM

20. ET HEMMORHAGE

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SKULL INJURY CORD TORN