Abnormal Labor
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Transcript of Abnormal Labor
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Abnormal LaborProfessor
Abdulrahim Rouzi
MB, ChB, FRCSC
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Abnormal Labor
Dystocia: Slow progress of labor due to Passage Passenger Contraction
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Abnormal Labor
Passage Abnormal birth canal Road traffic accidents
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Abnormal Labor
Passenger Macrosomia Abnormal presentation Abnormal position
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Abnormal Labor
Power Abnormal or ineffective uterine contractions
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Abnormal Labor
Friedman curve One way to divide labor Latent and active phase Normal and abnormal latent phase Primiparous versus multiparous
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Abnormal Labor
Active phase: Cervical dilation rate of 1.0 cm/hr for
nulliparas and 1.2-1.5 cm/hr for parous women
If abnormal rule out obstruction May use oxytocin
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Abnormal Labor
Second Stage: From 10 cm dilated cervix to expulsion of
fetus For primigravidae 2 hours without epidural and to
3 hours with epidural For multigravidae 1 hour without an epidural and
to 2 hours with an epidural
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Abnormal Labor
Before intervention by operative vaginal delivery or cesarean section we must
Make sure 1. Latent phase is passed 2.Efficient contractions achieved How?
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Abnormal Labor
Use of intrauterine pressure devices Unit of measuring contractions Caput and molding
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Cesarean section
Indications can be fetal or maternal: Maternal
Request Exhausation Repeat cesarean section Abnormal pelvis
Transverse lie Placenta previa Non-reassuring fetal heart rate when an operative delivery is not attainable Nonvertex presenting twin Breech Many more indications, including repeat s( decline TOL) ands elective cesarean section
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Cesarean section Fetal indications
Non reassuring fetal heart rate Abnormal presentation Abnormal position Abnormal placentation (previa….etc)
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Vacuum and forceps
Maternal indications
Inadequate expulsive maternal efforts
Fetal indications
Non reassuring FHT
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Requirements for operative vaginal delivery Empty bladder Fully dilated cervix Adequate anesthesia Fetal presentation, position and station well
known Lithotomy position Experience
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Complications of operative vaginal deliveries Maternal and Fetal complications:
Lacerations PPH Anesthesia copmplications Intracranial hemorrhage Cephalhematoma