Weakness of labor. Adnan zaaba 75hg.pptx

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1. Weakness of labor

2. Primary uterine inertia means weak, ineffective contraction from the onset of labor and during the entire latent phase (until cervical dilation 4cm ) Diagnosis of primary uterine inertia is confirmed by observing the patient: absence of structural changes in the cervix (dilation and effacement) while contractions are regular; vaginal examination is done at an interval of 3–4 hours. Primary uterine inertia is often accompanied by premature membrane rupture /A prolonged time period after membrane rupture can result in chorioamnionitis, hypoxia and intrauterine fetal demise.

3. If labor is ineffective and primary uterine inertia is diagnosed, labor induction methods are resorted to There are two ways to enhance labor activity. The first way is non-pharmaceutical: amniotomy. The second way is pharmaceutical: administration of oxytocin

4. Contraindications for labor stimulation: • threatening uterine rupture • transverse and oblique lie of the fetus • cephalopelvic disproportion • engagement of extended fetal head • fetal hypoxia • premature detachment of normally situated placenta

5. Secondary uterine inertia Secondary uterine inertia is decrease in the vigor of uterine contractions (after normal contractions in the latent phase) during the active phase of labor (the frequency of contractions less than 3 in 10 minutes)

6. Hypotonic pushing efforts means a decrease in the vigor of labor during the second stage of labor emerging due to muscle weakness in the anterior abdominal wall or general exhaustion of the patient. When there is secondary uterine inertia, both the first and second stages of labor become longe r

7. If the fetus shows signs of hypoxia while the mother has secondary uterine inertia in the second stage, or hypotonic pushing efforts when the head is in the pelvic cavity or at the pelvic outlet : obstetric forceps or vacuum extraction to the fetal head.