More than one pacemaker may be initiating contractions or receptor points in the myometrium may be acting independently of the pacemaker.

It May occur so closely together that they do not allow good cotyledon filling.

Apply

fetal & uterine external monitor. Assessing rate, resting tone and fetal response at least 15 minutes. Oxytocin- helpful to stimulate more effective and consistent pattern of contractions with a better, lower resting tone.

Lengths of Phases and Stages of Normal Labor in HoursNulliparaPhase Average Upper Normal

MultiparaAverage Upper Normal

Latent Phase

8.6

20.0

5.3

14.0

Active Phase

5.8

12.0

2.5

6.0

Second Stage

1

1.5

0.25

No limit

Labor DisordersPattern Prolonged latent phase Protracted active phase dilatation Protracted descent Diagnostic Criterion Nulliparas 20 hr or more Multiparas 14 hr or more Nulliparas 1.2 cm/hr or less Nulliparas 1 cm/hr or less Multiparas 2 cm/hr or less

Nulliparas 3 hr or more Prolonged deceleration phase Multiparas 1 hr or more Secondary arrest of dilatation Arrest of descent Failure of descent Arrest 2 hr or more Arrest 1 hr or more No descent in deceleration phase of second stage

Latent phase labor is considered abnormal, if it lasts longer than:

1. 20 hours in a woman having her first baby. 2. More than 14 hours in women who have

already had a baby in the past.

Etiology: This may occur if the cervix is not ripe at the beginning of labor and time must be spent getting truly ready for labor. It

may occur if there is excessive use of an analgesic early in labor.

Outcome: 14% will go into a Protracted Active Phase.

Management: Rest Ambulation Hydration Analgesia

(narcotics such as Demerol 50100 mg IM, Morphine 7.5-15 mg IM, Dilaudid 1-2 mg IM, etc.) Oxytocin stimulation Amniotomy

This phase is prolonged if cervical dilatation does not occur at rate of at least: 1.2 cm/hr in nullipara. 1.5 cm/hr in multipara.

Etiology: Inefficient

uterine contractions. An unfavorable presentation or position of the baby. A small pelvis. Improperly anesthesia Outcome: 39% Po & 13% P1+ will go into Secondary Arrest.

Conservative management. Active intervention with oxytocin.

The phase is prolonged when it extends beyond: 3 hours in nullipara. 1 hour in multipara.

Etiology: Abnormal fetal head position

A caesarian birth is often required.

Occurs if:

There is no progress in cervical dilatation for more than 2 hours.

Cervix becomes edematous. Can occur at 4-7 cm dilatation or as a protracted Deceleration phase.

Outcome

Will require LSCS. If protracted deceleration beware of shoulder impaction.

Occurs if:

The rate of descent is less than 1.0 cm/hour in nullipara or,

2.0 cm/hour in a multipara.

Contractions

have been good quality and

proper duration, and effacement and beginning dilatation have occurred, but then contractions become infrequent and of poor quality and dilatation stops.

If everything is normal except for the suddenly faulty contractions, rest and fluid intake, as advocated for hypertonic contractions also apply.

IV oxytocin may be used to induced to the uterus to contract.

Semi-Fowlers position, suatting, kneeling, or more pushing may speed descent.

failure of the presenting fetal part to continue to descend during the second stage of labor despite uterine contractions and maternal effort.

Results when no descent has occurred for:

1 hour in multipara, or 2 hours in nullipara.

Etiology:

Cephalopelvic Disproportion (CPD) Insufficient maternal effort

Caesarian birth is usually necessary. If there are no contradiction to vaginal birth, oxytocin may be used to assist labor.

Fatigue and anxiety r/t prolonged labor. Risk for deficient fluid volume r/t length and work of labor.