Problems With the Passageway

8/11/2019 Problems With the Passageway

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PROBLEMS WITH THE

PASSAGEWAY


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ABNORMAL SIZE OR SHAPE OF

THE PELVIS

The Android pelvis is so calledbecause it resembles the male pelvis.

The anthropoid pelvis, you will havediscovered, shows very definitefeatures. The fetus commonly

presents as a direct occipito-anterioror occipito-posterior position.


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The distinct shape of the

platypelloid pelvis with the

kidney shaped brim in which the

anteroposterior diameter isreduced and the transverse

increased, means the head

must engage with the sagittalsuture in the transverse

diameter.


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Cephalopelvic disproportion

(CPD)

Occurs when a babys

head or body is too large tofit through the mothers

pelvis.


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It is believed that true CPD israre, but many cases of failureto progress during labor are

given a diagnosis of CPD. Whenan accuratediagnosis of CPDhas been made, the safest type

of delivery for mother and babyis a cesarean.


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The causes of cephalopelvic

disproportion

Possible causes of cephalopelvic

disproportion (CPD) include:

Large baby due to:

Hereditary factors

Diabetes

Postmaturity (still pregnant after

due date has passed)

Multiparity (not the first pregnancy)


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Abnormal fetal positions

Small Pelvis

Abnormally shaped pelvis


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The diagnosis of cephalopelvicdisproportion is often used when

labor progress is not sufficient and

medical therapy such as use ofoxytocin is not successful or not

attempted.


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CPD can rarely be diagnosed

before labor begins even if

the baby is thought to belarge or the mothers pelvis is

known to be small.


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During labor, the babys headmolds and the pelvis joints

spread, creating more room for

the baby to pass through the

pelvis. Ultrasound is used in

estimating fetal size but nottotally reliable for determining

fetal weight.


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A physical examination that

measures pelvic size can oftenbe the most accurate method

for diagnosing CPD. If a truediagnosis of CPD cannot be

made, oxytocin is often

administered to help laborprogresssion or change fetal

postioning.


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Shoulder Dystocia

In a small percentage of births, thebabys shoulder will become locked

under the mothers pubic bone

immediately after delivery of the

head. The doctor or midwife may be

unable to deliver the baby with the

usual hand skills.


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Every doctor and midwife is

trained in the handling of this

emergency, and there areseveral different approaches.


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Occasionally, the baby is injured

during the process to free the

captured shoulder. The mostcommon injury is a stretching and

tearing of the nerves of the babys

arm.


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Although most of the these injuriesresolve without future problems,

occasionally the damage to the

nerve is permanent and results inweakness or paralysis of the arm.

Less frequently, the collarbone

(clavicle) or upper arm bone(humerus) are broken in an attempt

to free the shoulder.


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Shoulder dystocias are almost alwaysassociated with big babies. However,the majority of big babies are bornwithout involving shoulder dystocia.

There is also a relationship betweenshoulder dystocia and laborprotractions and

arrests..especially those whichlengthen the duration of Second Stage(after the cervix is dilated).


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PROBLEMS WITH THE POWERS

Dystocia or Difficult labor

Premature labor

Precipitate labor and birthUterine prolapse

Uterine rupture


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DYSTOCIA

Dystocia may arise due to

incoordinate uterine activity,

abnormal fetal lie or presentation,

absolute or relative cephalopelvic

disproportion, or (rarely) a massive

fetal tumor such as

a sacrococcygeal teratoma.


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PREMATURE LABOR


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Oxytocin is commonly used totreat incoordinate uterine

activity, but pregnanciescomplicated by dystocia oftenend with assisted deliveries,

including forceps, ventouse or,commonly, caesarean section.


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HYPERTONIC UTERINE

DYSFUNCTION

An elevated tone of the uterus that

generally occurs in the latent phase

of labor. The condition causesfrequent and intense contractions,

but they are not effective. This may

be caused by the mid segment of theuterus contracting with such a force

that is greater than the fundus or a

lack of nerve .


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HYPOTONIC UTERINE

DYSFUNTION

The number of contractions is

unusually low or infrequent(notmore two or three occuring in a 10-

minute period).The resting tone of

the uterus remains less than 10mmHg, and the strenght of

contractions does not rise above

25mm Hg.


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ABNORMAL PROGRESS IN

LABOR

Abnormal Labour

Recognition of prolonged 1stand2nd stages

Common causes of prolonged labour

Complications - maternal


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RETRACTION RINGS

Bandl's ring(also known as

pathological retraction ring) is the

abnormal junction between the twosegments of the human uterus, which is

a late sign associated with obstructed

labor. Prior to the onset of labour, thejunction between the lower and upper

uterine segments is a slightly thickened

ring


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In abnormal and obstructed labours,

after the cervix has reached full

dilatation further contractions cause the

upper uterine segment musclefibres myometrium to shorten, so that

the actively contracting upper segment

becomes thicker and shorter.


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The ridge of the pathological ring ofBandl's can be felt or seen rising as far

up as the umbilicus. The lower segment

becomes stretched and thinner and ifneglected may lead to uterine rupture.


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PREMATURE LABOR

Pregnancy is normally a time of

happiness and anticipation, but it can

also be a time of uncertainty. Manywomen have concerns about what is

happening with their baby and wonder

"Is everything okay"? Some womenhave concerns about going into labor

early.


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Premature labor occurs inabout 12% of all pregnancies.

However, by knowing thesymptoms and avoiding

particular risk factors, a woman

can reduce her chance of goinginto labor prematurely.


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PRECIPITATE LABOR AND BIRTH

Occur when uterine contractions

are so strong that a woman gives

birth with only a few, rapidlyoccuring contractions.It is often

defined as a labor that is completed

in fewer than 3 hours.


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Is cervical dilatation thatoccurs at a rate of 5cm or

more per hour in a primiparaor 10cm or more per hour in

a multipara.


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UTERINE PROLAPSE

Is falling or sliding of the womb (uterus)

from its normal position into the vaginal

area. Uterine prolapseis a form of female

genital prolapse. It is also called pelvic

organ prolapseor prolapse of theuterus (womb).


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UTERINE RUPTURE

Rupture of the uterus during

labor,although rare ,is always a

possibility.It is always serious,because itaccounts for as many as 5% of all

material deaths.


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Uterine rapture occurs when a

uterus undergoes more strain

than it is capable of sustaining.


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THANK YOU!!!

SHERYLL B. NELSON

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Problems With the Passageway