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