Normal and abnormal labour pdf
File Name: normal and abnormal labour .zip
- Abnormal Labour
- Predictors of labor abnormalities in university hospital: unmatched case control study
- Obstructed labour
Background: Modified WHO partograph is graphical record of maternal and foetal data during progress of labour entered against time on single paper sheet. Entire labour can be interpreted in a glance on the photograph. It helps to detect abnormal progress of labour. It guides obstetrician to decide about the need for augmentation of labour or termination of pregnancy either by instrumental delivery or LSCS and avoids prolong labour before obstruction.
The anterior wall at the pubic symphysis measures approximately 5 cm, and the posterior wall measures approximately 10 cm. The pelvic inlet is bounded laterally by the iliopectineal lines, which can be traced anteriorly along the pectineal eminence and pubic crest to the symphysis. The posterior boundary is composed of the sacrum at the level of the iliopectineal lines. The anteroposterior diameter obstetric conjugate is the shortest distance between the sacral promontory and the pubic symphysis.
The inlet usually is considered to be contracted if the obstetric conjugate is less than 10 cm or the greatest transverse diameter is less than 12 cm. When both diameters are contracted, the incidence of dystocia is much greater than when only one diameter is contracted. The midpelvis is bounded anteriorly by the posterior aspect of the symphysis and pubis and posteriorly by the sacrum at the level of S3 or S4.
The lateral boundary is the pelvic sidewalls and ischial spines. The distance between the ischial spines is usually the smallest diameter of the pelvis, typically measuring 10 cm or more. The anteroposterior diameter of the midpelvis, which runs from the inferior aspect of the pubic symphysis to the sacral hollow at the level of the ischial spines, averages Midpelvic contraction should be suspected whenever the interspinous diameter is less than 10 cm.
When the diameter is less than 9 cm, the midpelvis is considered definitely contracted. Midpelvic contraction is more common than inlet contraction. The pelvic outlet is composed of two triangular areas that share the same base but are not in the same plane. The anterior triangle is formed by the pubic arch. The apex of the posterior triangle is the tip of the sacrum, and the sides are the sacral sciatic ligaments and ischial tuberosities.
The anteroposterior diameter, from the inferior edge of the pubic symphysis to the tip of the sacrum, usually measures approximately The transverse diameter, the distance between the inner edges of the ischial tuberosities, measures approximately 10 cm. It is rare to find outlet contraction without midplane contraction. Of the four types of pelves, gynecoid, android, anthropoid, and platypelloid, the gynecoid pelvis is most optimal for normal delivery. Other abnormalities also may affect the bony pelvis.
Kyphosis, if it involves the lumbar area, may be associated with a typically funnel-shaped pelvis, which leads to late arrest of labor. Scoliosis, which involves the lower region of the spine, may produce an irregular inlet, leading to obstructed labor.
The pelvis usually is not contracted in cases of unilateral lameness. With bilateral lameness, the pelvis is wide and short, but most women are able to deliver vaginally. In poliomyelitis, now extremely rare, the pelvis may be asymmetric, but most patients can deliver vaginally. In dwarfism, cesarean delivery is generally the rule because of marked fetopelvic disproportion.
Cesarean sections occur more frequently in women with a history of a pelvic fracture, especially bilateral fracture of the pubic rami, before pregnancy. Soft tissue abnormalities in the pelvis occasionally can result in dystocia. Uterine myomas are the most common pelvic masses associated with dystocia. They may obstruct the birth canal or cause malpresentation of the fetus. Other possible causes of upper genital tract dystocia include ovarian tumors, bladder distention, a pelvic kidney, excess adipose tissue, uterine malposition, and cervical stenosis or neoplasm.
Clinical estimation of the adequacy of the pelvis can alert the clinician to the possible risk of pelvic dystocia. A clinically small pelvis is associated with a 2. Several pelvic diameters can be assessed clinically, including the diagonal conjugate measured from the inferior edge of the pubic symphysis to the sacral promontory , prominence of the ischial spines, convergence of pelvic sidewalls, angle of the subpubic arch, and sacral curvature. In general, suspicion of a contracted pelvis is increased with the conditions listed in Table 1.
Table 1: Clinical indices that increase the suspicion of potential for disproportion during labor. The size, presentation, and position of the fetus are important factors in the conduct of labor. Pelvic size and configuration and excessive soft tissue may influence the fetal position and presentation. Although the macrosomic infant is at greater risk for dystocia, most cases of abnormal labor occur among fetuses weighing less than g.
The biparietal diameter BPD , the smallest transverse dimension of the fetal skull, averages approximately 9. The shortest anteroposterior dimension is the suboccipitobregmatic diameter, which also averages approximately 9.
The fetal head can overcome minor degrees of pelvic contracture by molding. The bones of the skull overlap at major suture lines, which can decrease the BPD by 0. Severe molding may lead to tentorial tears and intracranial hemorrhage. Prolonged, severe pressure between the fetus and birth canal may lead to fetal scalp necrosis or skull fracture.
The mother may develop a vesicovaginal, vesicocervical, or rectovaginal fistula. Other risks of fetopelvic disproportion include cord prolapse, prolonged labor with an increase in maternal and fetal infections, uterine rupture, postpartum hemorrhage, abnormal presentation or position, and maternal and neonatal trauma. Fetal malpresentation may be the result of or the cause of dystocia. Nonvertex presentations should alert the clinician to the possibility of pelvic dystocia.
In compound presentations, a fetal hand beside the head may be encouraged to withdraw by a gentle pinch. A fetal foot beside the head is more unusual; vaginal delivery still may be possible if the pelvis is adequate. In a brow presentation, the partially extended head presents with the occipitomental diameter of Brow presentations are associated with pelvic contraction, small or large fetuses, and nuchal masses. Two thirds spontaneously convert to either a face or an occipital presentation.
Manual or forceps conversion is no longer advocated. Cesarean birth is recommended if the brow presentation persists except in cases of a small fetus.
The fetal head is completely hyperextended in a face presentation. The incidence is about deliveries. Associated factors include anencephaly and brow presentations. If the mentum chin persists posteriorly, cesarean delivery is necessary because the fetal neck cannot hyperextend further to accommodate the pelvic curve. A vaginal delivery is possible with mentum anterior presentations. Manual or forceps conversion of face presentations is no longer advocated. The anthropoid-type pelvis predisposes to this position.
Clinical signs of occiput posterior position include accentuated maternal backache, persistent anterior cervical lip, ineffective contractions, and a prolonged second stage. Ultrasound is invaluable to confirm an occiput posterior position when the diagnosis by clinical examination is questionable.
Spontaneous rotation to occiput anterior may be impeded by regional anesthesia and poor voluntary effort. If the posterior triangle of the pelvic outlet is roomy, the infant can deliver spontaneously from the occiput posterior position, but an episiotomy may be needed. Other options include manual or forceps rotation. Kielland forceps, which do not have a pelvic curve, are ideal.
Classic forceps can be used to rotate the vertex by the Scanzoni maneuver. Forceps rotations are seldom performed in current clinical practice, and require training and expertise. The primary factor associated with success in manual rotation attempts is multiparity. The occiput transverse position is normally transitory because of the process of internal rotation.
Platypelloid and android pelves have narrow anteroposterior diameters, which may not allow normal rotation. If the transverse arrest is believed to be due to a contracted pelvis, cesarean delivery is necessary.
If the pelvis is thought to be adequate, a forceps rotation may be attempted. Oxytocin may be of benefit in causes of transverse arrest, which include uterine inertia and compromise of the pelvic floor muscles. If the pelvis has a prominent sacral promontory, asynclitism may develop; the vertex does not orient the sagittal suture in the midplane of descent.
Asynclitism of the fetal head may overcome small degrees of pelvic inlet contraction. In anterior asynclitism, in which the sagittal suture is nearer the sacrum, the outcome is more favorable than in posterior asynclitism, in which the sagittal suture is closer to the pubic symphysis. If the asynclitism does not overcome the contracted anteroposterior diameter, a deep transverse arrest results. With the common use of ultrasound, most anomalies capable of producing disproportion are diagnosed before the onset of labor.
Hydrocephalus is a frequently encountered developmental abnormality that causes dystocia. A biparietal diameter greater than mm has been associated with true cephalopelvic disproportion. If the fetus has a lethal condition, cerebrospinal fluid can be removed to allow a vaginal delivery; this is a rare procedure in modern obstetrics.
Craniosynostosis, premature closure of the cranial sutures, may cause distortion but rarely leads to dystocia. Encephaloceles, which carry a poor prognosis, are usually fragile and may rupture during delivery. Potentially viable conjoined twins require delivery by cesarean section. Ascitic fluid and other cystic masses can be drained percutaneously in labor to allow vaginal delivery. Ascitic fluid can reaccumulate rapidly, however.
Meningomyeloceles, omphaloceles, and gastroschisis usually do not obstruct labor, but the optimal obstetric management of these conditions is controversial. A sudden inability to deliver the fetus beyond the abdomen can be due to an undiagnosed sacrococcygeal teratoma. In such cases, it may be possible to flex and deliver the legs to allow more room for the mass to deliver. Another option is resuscitation and stabilization of the infant on the perineum then replacement with cesarean delivery.
There is no consistent definition of fetal macrosomia in the literature. The most commonly cited definition is birth weight greater than g. The incidence of birth weight greater than g has been increasing. Macrosomic infants have a threefold increase in morbidity.
Predictors of labor abnormalities in university hospital: unmatched case control study
Metrics details. Abnormal labor is one of the common emergency obstetric problems contributing for more than two-thirds of the unplanned cesarean section. In Ethiopia, although labor abnormality and its complications like obstetric fistula are highly prevalent, there is no published study that determines the predictors of labor abnormalities. The study design was an unmatched case control which included women cases and controls. Cases were identified when a woman was diagnosed to have one of the labor abnormalities at term prolonged latent stage, active phase disorder, prolonged second stage, descent disorder and obstructed labor. Subgroup logistic regression analyses were done taking the different type of labor abnormalities as the dependent variable. Nearly half of the cases
Obstetrics Simplified - Diaa M. Labour is the process by which a viable foetus i. The phase of maximum slope is the most detectable and the two other phases are of shorter duration and can be detected only by frequent vaginal examination. The normal rate of cervical dilatation in active phase is 1.
This means your cervix has opened completely in preparation for childbirth. The second stage is the active stage, during which you begin to push downward. It starts with complete dilation of the cervix and ends with the birth of your baby. The third stage is also known as the placental stage.
If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Labor is a sequence of uterine contractions that results in effacement and dilatation of the cervix and voluntary bearing-down efforts, leading to the expulsion per vagina of the products of conception. Delivery is the mode of expulsion of the fetus and placenta. Labor and delivery is a normal physiologic process that most women experience without complications.
Physicians, advanced practice nurses, nursing personnel, and midwives must be aware of what constitutes normal versus abnormal labor. Without proper skills and strategies, appropriate management cannot occur, and poor outcomes become likely for birthing mothers and their neonates.