Dysfunctional Labor and Birth

8/3/2019 Dysfunctional Labor and Birth

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Nursing Management ofLabor and Birth at Risk

By: Faith Angeline C. Fernandez


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Dysfunctional labor

Problems with Power, Passenger, Passageand Psyche

Post-term with Labor and Birth

Women requiring Induction & AugmentationIntrauterine Fetal Demise

Obstetric Emergencies

Birth Related Procedures


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Difficult labor --Difficult labor --

DystociaDystocia


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DefinitionDefinition

Difficult labor orchildbirth

Abnormal slowprogress of labor


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IncidenceIncidence The most common

indication for

primary cesarean

section


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Evaluation indexEvaluation index Cervical dilation

Descent of the fetal

presentation


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Classification ofClassification of

DystociaDystocia Abnormalities of the Power

Abnormalities of the Passage

Abnormalities of the

Passenger

Abnormalities of the Psyche


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Characteristics of theCharacteristics of thepowerpower

Intensity is greater in the fundus Average 24mmHg

Well synchronized

Frequency Duration 60s

regular

Rhythm and force

Basal resting pressure 12-15mmHg


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Abnormalities in PowerAbnormalities in Power Inertia is a time honored term to

denote that sluggishness of acontractions, or the force of labor, hasoccurred.

More current term is dysfunctionallabor

Occurring at the onset in labor

Occurring later in labor


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Abnormalities in PowerAbnormalities in Power Prolonged labor appears to

result from several factors.

It is more likely to occur if thefetus is large

Hypotonic, hypertonic anduncoordinated contractions


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Fetal monitoringFetal monitoring


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Uterine dysfunctionUterine dysfunction Hypotonic

Hypertonic

Uncoordinated

Inadequate

expulsive

efforts

i


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HypotonicHypotonic

dysfunctiondysfunction

Insufficien

t

Irregular

Infrequent

Management:

Infusion of oxytocinMembranes may be

artificially ruptured

(amniotomy)

H i


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HypotonicHypotonic

dysfunctiondysfunction

Post Partal Period

Management:

In the 1st hour after birthoPalpate the uterus

oAssess lochia every 15 minutes


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Hypotonic dysfunctioHypotonic dysfunctionnetiologyetiology

Malfunction

Malpresentation

Extrinsic factor


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Hypertonic dysfunctionHypertonic dysfunction

Lack of

resting tone Frequent

intense

contraction

Management :

Morphine

Sulfate/Sedation

I and E monitoring

Darkening the room

lights

Decreasing noise

Cesarean section

iH t i


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HypertonicHypertonic

DysfunctionDysfunction

H iH t i


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HypertonicHypertonic

dysfunctiondysfunction etiologyetiology

Muscle fibers of the myometriumdo not repolarize.

U di dU di t d


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UncoordinatedUncoordinated

ContrationsContrations

Dyssynchronus

Frequent

Management:

I and E

monitoring

Oxytocin


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Comparison of Hypotonic andComparison of Hypotonic and

Hypertonic ContractionsHypertonic ContractionsCriteria Hypertonic Hypotonic

Phase oflabor

Latent Active

Symptoms Painful Painless

Medication

Oxytocin Unfavorable reaction FavorableReaction

Sedation Helpful Little value


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Abnormal patternsAbnormal patterns

Prolonged latent phase

Protraction disorders (activephase)

Arrest disorders (activephase)

Precipitate labor disorders


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Friedmans curveFriedmans curve


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Latent phase

Active phaseI II stage

Partogram


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Prolonged latentProlonged latent

phasephase

Nulliparas

Multiparas

Prolonged

>20 hr

> 14 hr

Normal average

6.4 hr

4.8 hr

P l d l t tP l d l t t


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Prolonged latentProlonged latent

phasephase

Management:

Administration of morphine mayrelax hypertonicity

Administering adequate fluid

AmniotomyOxytocin infusion

Cesarean Birth

P t ti A tiP t ti A ti


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Protraction ActiveProtraction Active

PhasePhase

Nulliparas

Multiparas

Descent


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Protraction ActiveProtraction Active

PhasePhaseManagement:

OxytocinCesarean Birth


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Arrest disorderArrest disorder

Nulliparas

Multiparas

Descent

>2h

>1h

Dilation

>2h

>1h


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Arrest disorderArrest disorder

Management:

Cesarean Birth

Oxytocin


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PartogramPartogram


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A prolonged latent phase

B prolonged active phase

C arrest active phase

Abnormal partogram


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PartogramPartogram


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Pathological retraction ringPathological retraction ring

Occurs at the junction of the upper and loweruterine segments

2nd stage of labor:

o Severe dysfunction labor is occurring.Formed by excessive retraction of theupper uterine segment; the myometrium is

much thicker above than below the ring

Early stage of labor:

o Caused by uncoordinated contractions.

Pathological retractionPathological retraction


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Pathological retractionPathological retraction

ringringManagement:

Administration of morphine sulfate

Inhalation of amyl nitrite

Tocolytic


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ringring

retraction ringretraction ring


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retraction ringretraction ring

(bandls ring)(bandls ring)


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Precipitate laborPrecipitate labor


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disordersdisorders

Nulliparas

Multiparas

Descent

>5cm/hr

>10cm/hr

Dilation

>5cm/hr

>10cm/hr



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disordersdisorders

Management:

Tocolytic - to reduce the force andfrequency of the contraction

Ab liti f thAb liti f th


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Abnormalities of theAbnormalities of thePassagePassage

Bony pelvic (most

common)

Soft tissue obstruction

Abnormal placentalocation

Bony pelvicBony pelvic


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Bony pelvicBony pelvic

abnormalitiesabnormalities

Inlet Contraction

Generally contracted pelvis

Deformed pelvis

Three level of bonyThree level of bony


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Three level of bonyThree level of bony

pelvispelvis


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Inlet contractionInlet contraction

Contraction of pelvic inlet

AP


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Three anteroposterior diameters of

the pelvic inlet


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Diameter of the inlet and midpelvis

FetopelvicFetopelvic


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FetopelvicFetopelvic

disproportiondisproportion

10.9%


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funnel shaped pelvis

47.3% 5.8%

36.6%10.9%

gynecoid

android

Flat(platypelloid) anthropoid

transverselycontracted

Pelvis


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each pelvic

plane is 2 cmless than

normal

generally contracted pelvis


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osteomalacia oblique pelvis

kyphosis

Deformed

pelvis


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Soft tissue dystociaSoft tissue dystocia

Congenital anomalies

Scarring of birth canal

Pelvic masses


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Pelvic massPelvic mass


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Pelvic massPelvic mass


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Low lying placentaLow lying placenta

Abnormalities of theAbnormalities of the


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Abnormalities of theAbnormalities of thePassengerPassenger

Prolapse of the Umbilical

Cord

Fetal macrosomia

Malpresentation

Shoulder dystocia

Fetal malformation


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13.3

9.5

11.3


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Prolapse of theProlapse of the


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Prolapse of theProlapse of theumbilical cordumbilical cord

A loop cord slips down in front of thepresenting part.

Prolapse may occur at any time afterthe membranes rupture if thepresenting part is not fitted firmly

into the cervix.



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It tends to occur most often withthe ff. conditions:o

Premature rupture of themembrane

oPlacenta previa

o

A small fetusoHydramnious

oMultiple gestation

oCPD preventing firm engagement



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Management:

Administering Oxygen at 10 L/min byfacemask is also helpful to improve the

oxygenation of the fetus

Aimed toward relieving pressure on the cord

Placing a gloved hand in the vagina and

manually elevating the fetal head of the cordKnee chest position or trendelenburg positionwhich causes the fetal head fall back from thecord



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Do not attempt to push back anyexposed cord. This may add to thecompression by causing knotting or

kinking. Cover any exposed portion with

sterile saline compress to prevent

drying Deliver the infant quickly, possibly

with Forcep delivery to prevent fetalanoxia


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Fetal MacrosomiaFetal Macrosomia Size may become a problem in a fetus who weighs

more than 4,000 4,500g (9-10lbs.)

An oversized infant may cause uterine dysfunctionduring labor or at birth because of over stretching

of the fibers of the myometrium. A large infant born vaginally has a higher than

normal risk of:

o Cervical nerve palsy

o Diaphragmatic nerve injury

o Fractured clavicle because of shoulder dystocia

o Hemorrhage

F l i


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Fetal macrosomiaFetal macrosomialarge for gestational age(LGA)

4000g


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Fetal macrosomiaFetal macrosomia

Management:

Pelvimetry or Sonography can be

used to compare the size of the fetuswith the womans pelvic capacity

Cesarean section

M l t tiM l t ti


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MalpresentationMalpresentation

In approximately 1/10

th

of all labors, thefetal position is posterior rather thananterior.

Posterior position tend to occur in women

with android, anthropoid or contractedpelvis.

A posterior position is suggested by adysfunctional labor pattern such as aprolonged active phase, arrested descentor fetal heart sounds best heard at thelateral sides of the abdomen.


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MalpresentationMalpresentation Breech presentation

Face presentation

Brow presentationTransverse Lie


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Cepholic position and the diameter through pelvis

occiput

presentation

parietal

presentation

brow

presentation

face

presentation

M l t tiM l t ti


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MalpresentationMalpresentation


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Breech presentation

Sh ld d t iSh ld d t i


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Shoulder dystociaShoulder dystocia

Is a birth problem that is increasing inincidence along with the increasingaverage of new born.

The problem occurs at the second stage oflabor, when the fetal head is born but theshoulders are too broad to enter and bornthrough the pelvic inlet.

The force of birth can result in a fracturedclavicle or a brachial plexus in jury for thefetus.


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Shoulder dystociaShoulder dystocia


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presentationpresentation


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presentationpresentation


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Brachial Plexus InjuryBrachial Plexus Injury


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Fetal malformationFetal malformation

P hP h


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PsychePsyche

The fourth P refers to the psychologicalfeelings that a woman brings into labor.

For many women, this feeling ofapprehension or fright.

Women who manage best in labor

typically are those who have a strongsense of self-esteem and a meaningfulsupport person with them.

P hPsyche


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PsychePsyche Women without adequate support can

have an experience so frightening andstressful they can develop a posttraumatic stress syndrome.

P hPsyche


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PsychePsyche

Management:Encouraging women to ask questions atprenatal visits and to attend preparation forchildbirth classes helps prepare them forlabor.

Encouraging them to share their experience

after labor serves as debriefing time andhelps them integrate the experience intotheir total life


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Induction andInduction and

Augmentation of LaborAugmentation of Labor

LaborLabor


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LaborLabor Induction of Labor means that labor is started

artificially

Augmentation refers to assisting labor that hasstarted spontaneously to be more effective.

Induction may be necessary to initiate labor beforethe time when it would have occurredspontaneously because the fetus is in danger or

labor does not occur spontaneously and the fetusappears to be at term.

I di ti f i d ti f l bIndication for induction of labor


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Indication for induction of laborIndication for induction of labor Primary reason for induction of labor

include the presence of:o Preeclampsia/Eclampsia

oDiabetes mellitus

o Prolonged rupture of the membraneso Postterm pregnancy

oRh incompatibility

o

Intrauterine fetal demise (iufd)o Intrauterine growth retardation

Indication for augmentationIndication for augmentation


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Indication for augmentationIndication for augmentation

Or assistance to make uterine contractions

stronger may be necessary if the contractionsare hypotonic or too weak or infrequent to beeffective.

Prolonged labor Dysfunctional labor

Poor progress of cervical dilatation

o Fetus is estimated to be mature by date demonstrated by a

lecithin sphingomyelin or sonogram to rule out preterm

Induction and Augmentation ofInduction and Augmentation of


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Induction and Augmentation ofInduction and Augmentation of

LaborLabor Before induction of labor is begun, the ff.

conditions should be present:

o Fetus is in longitudinal lie

oCervix is ripe, or ready for birtho Presenting part is engaged

oNo CPD


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Learning OutcomeLearning OutcomeCompare the methods for inducing labor,

explaining their advantages and disadvantages in

determining the nursing management for womenduring labor induction.

C i l Ri iC i l Ri i


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Cervical RipeningCervical Ripening

Consists of effacement and softening of the cervix

May be used at or near term to enhance success ofand reduce time needed for labor induction whencontinuing pregnancy is undesirable

May hasten beginning of labor or shorten course oflabor

C i l Ri iC i l Ri i


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Cervical RipeningCervical Ripening

May cause hyperstimulation of uterus

Pharmacologic agents includeCytotec and prostaglandin agents

can cause uterine stimulation afterinsertion

iscoring


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scoringscoringScoringfactor

0 1 2 3

Dilatation(cm)

0 1-2 3-4 3-4

Effacement(%) 0-30 40-50 60-70 80

Station -3 -2 -1-0 +1-+2

Consistency Firm Medium Soft

Position Posterior Mid-position

Anterior

St i i f th M bSt i i f th M b


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Stripping of the MembranesStripping of the Membranes

Mechanical method: Gloved fingerinserted into internal os and rotated360 degrees twice separating

amniotic membranes lying againstlower uterine segment

St i i f th M bSt i i f th M b


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Stripping of the MembranesStripping of the Membranes

Disadvantages:

Does not require monitoring or other

assessments often done asoutpatient service

May not induce labor if labor is

initiated, it typically begins within 48hours

May cause bleeding

Oxytocin inductionOxytocin induction


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Oxytocin inductionOxytocin induction

Administration of oxytocin initiatescontraction in a uterus at pregnancyterm.

Oxytocin is always administeredintravenously, so, hyperstimulationshould occur. It can be quicklydiscontinued.

Pit i I f iPitocin Infusion


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Pitocin InfusionPitocin Infusion

Usually effective at producingcontractions may causehyperstimulation of the uterus

Requires small, precise dosage 10 IU in1,000 mL of Ringers Lactate.

An alternative dilution method is to add

15 IU of oxytocin to 250 mL of an IVsolutio; this yields of concentration of 60mU/1mL.



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Maximum rate and dosing interval based

on facility protocol, clinician order,individual situation, and maternal-fetalresponse

Infusion are usually begun at a rate of 0.5to 1 mU/min until contraction begin.

Do not increase the rate to more than 20

mU/min without checking furtherinstructions, due to an administration rategreater than this is likely to cause tetaniccontractions.



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Management:

Take the womans pulse and BP every 15minutes

Monitor uterine contractions conscientiously

Contractions should occur no more oftenthan every 2 minutes, should not bestronger than 50 mmHg preassure andshould not lst longer than 70 seconds.



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Pitocin InfusionPitocin Infusion B-adrenergic receptor drug such as terbutaline

sulfate (Brethine)or Magnesium Sulfate mayprescribed to decrease myometrial activity.

Anti diuretic effect:o Decreased urine flow

o

Headache and vomitingo Keep accurate record of I and O

oTest and record urine specific gravity

o Limit the amount of fluid (150mL/hr) by ensuring that the main IV fluidline is infusing at a rate not greater than 2.5 mL/min.

Augmentation by oxytocinAugmentation by oxytocin


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Augmentation by oxytocinAugmentation by oxytocin

Is required if labor contractions begins

spontaneously but then become so weak,irregular, or ineffective (hypotonic) thatassistance is needed to strengthen them.

Precautions regarding oxytocinaugmentation are the same as for primaryinduction of labor.

Be certain that the drug is increased in

small increments only and that fetal heartsounds are well monitored duringprocedure.

LaborLabor


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It include the aggressiveadministration of oxytocin to shortenlabor to 12 hours, which presumablyreduces the incidence of CS birth and

post partal infection.

The Maximum dosage may be as

high as 36 40 mU/min.


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Birth-Related Procedures

External VersionExternal Version


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May be done 37 to 38 weeks gestation tochange breech presentation to cephalicpresentation before birth

Physician applies external manipulation to

maternal abdomen. gentle pressure is then exerted to rotate

the fetus in a forward direction to cephalic

lie Fetal part must not be engaged.



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Management before theprocedure:

NST performed to establish fetal well-being

Tocolytic given during procedure to

relax the uterus


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Transverse fetal lieTransverse fetal lie

Internal VersionInternal Version


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Podalic version used to turn second twinduring vaginal birth

Used only if second fetus does not

descend readily and heartbeat is notassuring

Physician reaches into uterus and grabsfeet of fetus and pulls them down through

cervix



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Management before theprocedure:

Tocolytic given during procedure torelax the uterus

Purpose of AmniotomyPurpose of Amniotomy


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Purpose of AmniotomyPurpose of Amniotomy

Stimulate or induce labor Apply internal fetal or contraction monitors

Obtain fetal scalp blood sample for pH

monitoring Assess color and composition of amniotic

fluid

Episiotomy TypesEpisiotomy Types


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Surgical incision of perineal body toenlarge outlet commonly used toavoid spontaneous laceration



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Two typesoMidline: Incision begins at bottom

center of perineal body and extends

straight down midline to fibers

oMediolateral: Incision begins in

midline of posterior fourchette andextends at 45 degree angle downwardto right or left


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Episiotomy TypesEpisiotomy Types Episiotomy usually performed with

regional or local anesthesia

Types of EpisiotomyTypes of Episiotomy


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Types of EpisiotomyTypes of Episiotomy

Nursing CareNursing Care


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During procedure, provide mother withsupport and comfort

Use distraction if needed if procedure is

uncomfortable, act as advocate for mother Document type of episiotomy in records

and report to subsequent caregivers

After procedure, provide comfort and

apply ice pack



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Assess perineal area frequently inspect every 15minutes during first hour after birth for redness,edema, tenderness, ecchymosis, and hematomas

Apply ice pack immediately in fourth stage

Instruct mother in perineal hygiene and comfortmeasures

Inadequate expulsiveInadequate expulsiveff tff t


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effortsefforts

Second stage

Assisted delivery might be needed

Analgesic / anesthetic agents wear

off

Operative deliveryOperative delivery


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Operative deliveryOperative delivery

1)forceps

operations

IndicationsIndications


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Maternal heart disease Maternal pulmonary edema

Maternal infection

Maternal exhaustion

Fetal stress



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Premature placental separation Need for shorter second stage of

labor

Heavy regional block with ineffectivepushing

Applications of ForcepsApplications of Forceps


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RisksRisks


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RisksRisks

Newborn may experienceoBruising

oEdema

oFacial lacerations

oCephalhematoma

o

Transient facial paralysisoCerebral hemorrhage

RisksRisks


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RisksRisks

Woman may experienceoVaginal or perineal lacerations

o Infection secondary to lacerations

o Increased bleeding

oBruising

o

Perineal edema


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Learning OutcomeLearning OutcomeDescribe the use of and risk of vacuum extraction

use to assist birth.

Operative deliveryVacuum


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Vacuum ExtractorVacuum Extractor


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Assists birth by applying suction to fetalhead

Should be progressive descent with firsttwo pulls, procedure should be limited toprevent cephalhematoma risk increasesif birth not within six minutes

Increases risk for jaundice due to

reabsorption of bruising at cup attachmentsite



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Learning OutcomeLearning OutcomeExplain the indications for cesarean birth, impact onthe family unit, preparation and teaching needs, and

associated nursing care.



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Most common indications forcesarean birtho Fetal distress

oActive genital herpes

oMultiple gestation (three or morefetuses)

oUmbilical cord prolapseoTumors that obstruct birth canal

o Lack of labor progression



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Most common indications forcesarean birtho Maternal infection

o

Pelvic size disproportiono Placenta previa

o Abruptio Placenta

o Previous cesarean section

o Eclampsia

TeachingTeaching


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TeachingTeaching

Teaching needs includeoWhat to expect before, during, and

after delivery

oWhy it is being doneoWhat sensations the woman will

experience

oRole of significant others

o Interaction with newborn

Cesarean Section


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Performed when

mom or fetus in

danger

If in moms history,ask why section

done. May give you

clues as to pastdelivery

complications

Cesarean Section

PreparationPreparation


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PreparationPreparation

Preparation for cesarean birthrequiresoEstablishing IV lines

oPlacing indwelling catheter

oPerforming abdominal prep

Cesarean SectionCesarean Section


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er ne nc s ons orer ne nc s ons orCesarean BirthCesarean Birth


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Cesarean BirthCesarean Birth



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Nursing Careg

Routine postpartal care including:o Fundal checks

oCare of incision

oMonitoring Intake & Output andmaintaining IV access

oAdminister and teach about post-op

medicationsoAssessment of respiratory system

oAssessment of bowel sounds


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Learning OutcomeLearning OutcomeExamine the risks, guidelines, and

nursing care of the woman undergoing

vaginal birth following cesarean birth.

Vaginal Birth After Cesarean BirthVaginal Birth After Cesarean Birth


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Vaginal Birth After Cesarean Birthag a t te Cesa ea t

Can occur after trial of labor in cases ofnonrecurring indications for cesareanbirth

Most common risks areoHemorrhage

o Surgical injuries

o

Uterine ruptureo Infant death or neurological

complications

Vaginal DeliveryVaginal DeliveryWhen crowning apply gentle pressure to infants head


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When crowning, apply gentle pressure to infant s head

Vaginal DeliveryVaginal Delivery


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Examine neck for looped umbilical cord

Vaginal DeliveryVaginal Delivery


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Support infants head as it rotates for shoulder

presentation



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gg

Continuous EFM Internal Monitoring

IV fluids

Avoid Pitocin if at all possible Classic or T uterine incision is

contraindication to VBAC



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gg

Important for nurse to supportcouple, explore their feelings, andprovide information throughout labor


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Obstetric Emergencies

Nuchal Cord


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Occurs inroughly 25% of

all deliveries Cord wrapped

around neck Can lead to

decreased

blood flow of

infant

Preeclampsia


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p

Unknown cause Often healthy, normotensive

primigravida

After twentieth week, oftennear term

Diagnosis of preeclampsia Hypertension


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HypertensionBlood pressure >140/90 mm Hg

Acute rise of 20 mm Hg in systolic pressure or 10mm Hg rise in diastolic pressure over pre-pregnancy levels

Proteinuria

Excessive weight gain with edema

Management

Treat hypertension, prevent seizures

Eclampsia


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Same signs and symptoms plus seizures orcoma

Tonic-clonic activity

Often begins as oral twitching

Often apnea during seizure

Can initiate labor

p

Management


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Left lateral recumbent position

Minimize stimulation

Oxygen and ventilation assistance

If seizures:

Monitor vital signs Safety of the patient

Gestational Diabetes Mellitus


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Mother cant metabolize carbohydrates

Excess glucose goes to fetus Stored as fat

Management Glucose monitoring

Diet Exercise Insulin

Vaginal Bleeding


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Abortion (miscarriage)

Ectopic pregnancy

Abruptio placenta

Placenta previa

Uterine rupture

Postpartum hemorrhage

Abortion


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Termination of pregnancy from any cause

before 20th week of gestationLater is known aspreterm birth

Common classifications of abortion

Determine:Onset of pain and bleedingAmount of blood lossIf any tissue passed with blood

Management

Third-Trimester Bleeding


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3% of pregnancies

Never normal

Most often due to: Abruptio placentae Placenta previa Uterine rupture

Abruptio Placenta


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Partial or complete detachment of normallyimplanted placenta at more than 20 weeksgestation

Predisposing factors Trauma Maternal hypertension Preeclampsia

Multiparity Previous abruption

Placenta Previa


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Sudden vaginal bleeding in 3rd trimester

PainAbdomen may be tender or rigid

May be minimal bleeding with shockMost of hemorrhage may be hidden

Contractions may be present

If fetal heart tones absent, fetal death islikely

Pl t l i l t ti i l t i

Placenta Previa


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Placental implantation in lower uterine

segment, encroaching on or coveringcervical os

1 in 300 deliveries

More common in preterm birth

Painless, bright red bleedingIncreases if labor beginsFetal compromise

Placenta Previa


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More common with:

Increased maternal age

Multiparity

Previous cesarean section

Previous placenta previa

Uterine Rupture


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p

Spontaneous or traumatic rupture ofuterine wall

Causes Previous scar opens Trauma Prolonged or obstructed labor

Rare but accounts for 5%-15% maternal

deaths

50% of fetal deaths

Uterine Rupture


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Sudden abdominal painTearing

Active labor

Early signs of shock

Vaginal bleedingMay be hidden

Management of 3rd Trimester Bleeding


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Management of 3 Trimester Bleeding

Prevent shock

Do not examine patient vaginally

May increase bleeding and startlabor

Emergency careABCsLeft lateral recumbent positionCheck fundal height


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Post-termPost-termPregnancyPregnancy

www.freelivedoctor.com

DefinitionDefinition


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DefinitionDefinition A pregnancy that persists for 42 weeks or

more from the onset of the last menstrualperiod. Sometimes called postmaturity orpostdate.

Incidence:

5-10%. It is more common in

primigravidae.

EtiologyEtiology


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EtiologyEtiology

Unknown, but hereditary, hormonaland non-engagement of the

presenting part are suspected factors.

Risk of Post-termRisk of Post-term


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Risk of Post termRisk of Post termA. Placental insufficiency: which may lead to

fetal hypoxia or even death.

B. Oligohydramnios: with its sequelparticularly cord compression during labor.

C. Obstructed labor: due to;

* oversized baby,

* no molding of the skull due to more

calcification.

D. Increased incidence of operative delivery.

DiagnosisDiagnosis Antenatal


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> History: calculation of gestational age.

> Examination: larger baby size.

> X-ray: large ossification center in the upper endof the tibia.

> Ultrasonography: can detect, Biparietal diameter more than 9.6 cm.

Increased foetal weight.

Oligohydramnios. Increased placental calcification.

>Tests for placental function.

DiagnosisDiagnosis


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Postnatala. Baby length: more than 54 cm.

b. Baby weight: more than 4.5 kg.

c. Skull: well ossified with smallerfontanels.

d. Finger nails: project beyond finger

tips.

ManagementManagement


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ManagementManagement

Induction of labor if the condition isfavorable for vaginal delivery using:

> amniotomy oxytocin, or

> prostaglandins oxytocin.

Caesarean section: if conditions are not

favorable for vaginal delivery, or ifinduction of labor failed.


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Intrauterine Fetal Demise

Intrauterine Fetal DemiseIntrauterine Fetal Demise


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A stillbirth occurs when a fetus has died in theuterus. The Australian definition specifies thatfetal death is termed a stillbirth after 20weeks gestation or the fetus weighs more than

400 grams (14 oz).

Once the fetus has died the mother still hascontractions and remains undelivered.

The term is often used in distinction to live birthor miscarriage. Most stillbirths occur in full termpregnancies.

Intrauterine FetalIntrauterine FetalDemiseDemise


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Demisee se

Risk factors:Alcohol abuse, drug use and smoking

due to inadequate prenatal care

unmanaged diabetes or high blood pressureWomen over 35 are more likely toexperience stillborn births

Maternal Obesity; Obesity raises stillbirthrisks

Dysfunctional Labor and Birth

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Transcript of Dysfunctional Labor and Birth