Abnormal Labor
description
Transcript of Abnormal Labor
Abnormal LaborProfessor
Abdulrahim Rouzi
MB, ChB, FRCSC
Abnormal Labor
Dystocia: Slow progress of labor due to Passage Passenger Contraction
Abnormal Labor
Passage Abnormal birth canal Road traffic accidents
Abnormal Labor
Passenger Macrosomia Abnormal presentation Abnormal position
Abnormal Labor
Power Abnormal or ineffective uterine contractions
Abnormal Labor
Friedman curve One way to divide labor Latent and active phase Normal and abnormal latent phase Primiparous versus multiparous
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
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
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?
Abnormal Labor
Use of intrauterine pressure devices Unit of measuring contractions Caput and molding
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
Cesarean section Fetal indications
Non reassuring fetal heart rate Abnormal presentation Abnormal position Abnormal placentation (previa….etc)
Vacuum and forceps
Maternal indications
Inadequate expulsive maternal efforts
Fetal indications
Non reassuring FHT
Requirements for operative vaginal delivery Empty bladder Fully dilated cervix Adequate anesthesia Fetal presentation, position and station well
known Lithotomy position Experience
Complications of operative vaginal deliveries Maternal and Fetal complications:
Lacerations PPH Anesthesia copmplications Intracranial hemorrhage Cephalhematoma