CH02 Management of Labor

8/2/2019 CH02 Management of Labor

1/27

Management of

LaborInternational

Management of

Labor


2/27

Management of

LaborInternational

Objectives

Definition and diagnosis of labor

Definition and diagnosis of dystocia

Causes of dystocia

Prevention and management of dystocia

Appropriate use of oxytocin


3/27

Management of

LaborInternational

First Stage

Latent Phase

Active Phase

Second Stage Passive

Active

Third Stage

Fourth Stage


4/27

Management of

LaborInternational

Labor

is

regular frequent uterine contractions

and

cervical change (dilatation and effacement)


5/27

Management of

LaborInternational

Philpotts Partogram

0

6

4

2

0

10

8

2 4 6 8 10

Cervicaldilatation(cm)

Time (hours)

Alert

line

Actio

nlin

e


6/27

Management of

LaborInternational

Source: WHO/UNFPA/UNICEF/WORLD BANK. IMPAC-Managing Complications in Pregnancy and Childbirth: A

Guide for Midwives and Doctors. WHO 2000 (WHO/RHR/ 00.7)


7/27

Management of

LaborInternational

Etiology of Dystocia

Power

Passenger

Passage


8/27

Management of

LaborInternational

Adequate Powers Contractions that

last 60 seconds

reach 50 - 60 mm Hg of pressure

occur every 2 - 3 minutes

or

result in good progress


9/27

Management of

LaborInternational

Preventing Dystocia

Accurate diagnosis of labor

Management of prolonged latent phase

Labor preparation

Birth companion


10/27

Management of

LaborInternational

Preventing Dystocia(cont.)

Ambulation

Analgesia

Amniotomy (ARM)

Fetal size


11/27

Management of

LaborInternational

Management of Dystocia

Arrest without CPD

- amniotomy

- consider oxytocin augmentation if contractions

are inadequate

Arrest with true CPD

- C-Section


12/27

Management of

LaborInternational

Active Management of Labor

Rigorous diagnosis of labor

Close surveillance of progress of labor by partogram Continuous support in labor


13/27

Management of

LaborInternational

Active Management of Labor (cont.)

Early intervention to correct inadequate progress of

labor- ARM

- Oxytocin


14/27

Management of

LaborInternational

Augmentation of Labor

Initial dose of oxytocin 1 - 2 mU / min

Increase interval every 30 min.

Dosage increment 1 - 2 mU

Usual dose for good labor 8 - 10 mU / min.


15/27

Management of

LaborInternational

Contraction Strength with Oxytocin

Depends on:

the dose of oxytocinand

the uterine sensitivity to oxytocin


16/27

Management of

LaborInternational

Adverse Effects of OxytocinAdverse Effect Mechanism Prevention

Fetal compromise Hyperstimulation Correct dose

Uterine rupture Hyperstimulation Correct dose

Water intoxication ADH effect Limit free

water

Hypotension Vasodilatation Low dose


17/27

Management of

LaborInternational

Summary - Prevention of DystociaAvoid unnecessary induction

Admit women in active labor

Encourage ambulation / upright posture

Encourage the use of prenatal education

Continuous support of laboring women

Use of appropriate analgesia


18/27

Management of

LaborInternational

Summary - Management ofDystocia

Appropriate assessment of adequate progress in

labor Appropriate intervention when necessary

- Amniotomy - Ambulation

- Analgesia - Augmentation

- Rest - C-sections


19/27

Management of

LaborInternational

Obstructed Labor


20/27

Management of

LaborInternational

Definition and Incidenceefinition and IncidenceFailure of descent of the fetus in

the birth canal for mechanical

reasons in spite of good uterinecontractions. (Philpott, 1982)

Incidence: 1-3%


21/27

Management of

LaborInternational

Risks Associated withRisks Associated with

neglected obstructed laborneglected obstructed labor

Fetal:

Asphyxia, sepsis, death

Maternal:

Sepsis, uterine rupture,hemorrhage, fistula, death


22/27

Management of

LaborInternational

Etiology of Obstructed LaborEtiology of Obstructed LaborFetal: Pelvic disproportion:

Malpresentations, malposition,malformations

Maternal: Small pelvis, soft tissuetumors of the pelvis


23/27

Management of

LaborInternational

Clinical Presentation of a Patient withClinical Presentation of a Patient withObstructed LaborObstructed Labor

Dehydration

Oliguria

Keto-acidosis

Sepsis


24/27

Management of

LaborInternational

Clinical Presentation of a Patient withClinical Presentation of a Patient with

Obstructed LaborObstructed Labor

State of the Uterus:

Ruptured Uterus

State of the Bladder:

Vaginal FindingsCervical Findings


25/27

Management of

LaborInternational

Complications of Obstructed Labor

Maternal: Ruptured uterus

Vsico-Vaginal Fistulae

Recto-vaginal Fistulae Pueperal Sepsis

Fetal:

Asphyxia/ cerebral palsy Neonatal sepsis

Death


26/27

Management of

LaborInternational

TreatmentTreatment

Prevention- Good nutrition in childhood

- Promotion of antenatal care

- Use of partogram in the health unit

- Development of appropriate and timely referral systems

Cesarean section


27/27

Management of

LaborInternational

Prolonged or neglected obstructed labor

Ruptured Uterus

Documents

CH02 Management of Labor