ABNORMAL LABOR AND ITS MANAGEMENT

ABNORMAL LABOR AND ITS MANAGEMENT

I. Uterine over activity

a. palaborum

b. Excessive uterine contraction (obstructed labor)

 II. Uterine Inertia

a. Hypotonic inertia

b. Hypertonic inertia

III. Construction Ring

IV. CERVICAL DYSPLASIA

a. Organic

b. Functional

A. P. LABOUR (less than 3 hours) Definition: Uterine contraction strong, no obstruction in the birth canal, painless except in the last contraction and expulsion of fetus.

Complication:. A. Maternal

1. Laceration cervix vagina 2. p.p Hge 3. inversion of uterus 4. shock due to p. pHge 5. Sepsis laceration

no sterilization

B. Fetala. I C Hg compression and decompression b. Injury of fetusc. Avulsion umbilical cord

Management1. Rare before delivery give anesthesia to slow course of labour

2. After delivery examination Mother Infant

3. For next pregnancy ANC Early admission

C. Excessive uterine Gontraction and retraction

During labor there islline between upper and lower segment

physiological retraction ring.

In obstructed labor marked retraction

Thickening of U. segment

L. S stretched and thinned

The retraction ring up felt in abdomen as transverse groove above

umbiltcus ~ pathological retraction ring or Banuel's ring the uterus rupture

II. HYPOTONIC UTERINE INERTIA Etiology - unknown

a) General factor 1. Primigravida -- old primi 2. Anaemia and Antepartum Hge 3. Toxaemia I. 4. Improper use pf analgesics

b) Local Factor 1. Over distention and uterus 2.Anomalies of uterus 3. Disproportion .4.Full bladder rectum 5. Uterine fibroid 6.Post maturity

Clinical Picture1. Prolonged labour

a. weak uterine ontraction b. slow cervical dilatation c. intact membrane d. retension of placenta e. atonic P.P. Hg

TREATMENT : A. Proper management 4st stage of labour:

1. Rest 2. Sedation 3. I. V. fluid glucose 4. Evacuate b adder and rectum5. Observe F. --- CTG 6. Use Porte aD1 to assess - progress, labour 7. If membrane rupture - antibiotic

B. Uterine stimulus: 1. Syntocinon 2. Close obse ation FH

• Oxytocin contra indicated in: a. Dispr portion b. Malp esentation c. Scar' uterus - relative d. Gran . D1ultipara e. F. Di~tress

C. Operative interference 1.ARM - to accelerate lab. 2.Operative delivery. vaginal delivery forceps Ventous

Abdominal C.S.

Hypertonic Uterine Inertia

1. Common in primigravida 2. If there is dispropdrtion

Malpresentation Malposition

Labour is prolonged uterus contraction irregular and painful cervix slow dilation presenting part high

fetal and maternal distress

Treatment1. Exclude disproportioh 2. Reassurance and I.V 3. Antibiotic 4. Good analgesia I 5. C.S indication disproportion

f. distress

ComplicationA. Mternal

1. Prolonged laboar --- exhaustion and ketoacidosis 2. infection 3. laceration, birth canal 4. p.p Hge 5. Puerperal sepsis

B. Fetal 1. Asphyxia 2. ICHge

III. Contraction Ring Definition

It is localized annular spasm of the uterine muscles It causes prolonged 2nd stage In the 3rd stage hour glass

Contraction of the uterus retain placenta P. P. Hge

Etiology 1. Unknown2. Malpresentatioh + malposition 3. Improper use of Syntocinon

DiagnosisFeeling it with hand

Treatment1. Exclude disproportion 2. If forceps fail on ring below presentingpart C.S. 3. Give anesthesia in the ]"d and 3rd stage of labor

DD between the contraction ring and pathological ring

CERVICAL DYSTOCIADefinition:CX fails to dilate within reasonable time inspite good uterine contraction

I. Organic Rigidity a. Stenosis Cervix -+ due to previous injury, amputation, over cauterizationC. S Indicated

ORGANIC OBST. CX ---» CERVICAL FIBROID ---» CA CX

II. Functional RigidityNo history of

* Trauma * Operative * No evidence of cervical anatomical change

It is manifested by nondilatation of external os although cx effaced and head well applied it.

---» take long time or ---»obstructed labor

TREATMENT: 1. Analgesia 2. F.D ---» C.S