'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Prevention, Diagnosis and

Treatment of protracted Labor

Dr. Mohammed Abdalla

 Guideline Objective

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

·To prevent unnecessary protracted labor
·To increase the use of procedures that
assist in progress to vaginal birth
 Unsatisfactory progress of labour

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

• Cervix not dilated
• No palpable contractions/infrequent
contractions

False labour
Unsatisfactory Progress of Labour

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Cervix not dilated beyond 4 cm
after 8 hours of regular
contractions

Prolonged latent phase

Unsatisfactory progress of labour

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Less than three contractions in
10 minutes, each lasting less
than 40 seconds

Inadequate uterine
contractions
Unsatisfactory Progress of Labour

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Cervical dilatation to the right
of the alert line on the
partograph

Prolonged active phase

Unsatisfactory progress of labour

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Secondary arrest of cervical
dilatation and descent of presenting
part in presence of good
contractions

Cephalopelvic
disproportion
 Unsatisfactory progress of labour

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Secondary arrest of cervical dilatation and
descent of presenting part with large caput,
third degree moulding, cervix poorly applied to
presenting part, oedematous cervix, ballooning
of lower uterine segment, formation of
retraction band, maternal and fetal distress

Obstruction
1. Confirm Active Labor Before Admitting to
Facility

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Spontaneous contractions at least 2 per 15 minutes,
and two or more of the following :

·Complete effacement of cervix

·Cervical dilation greater than or equal to 3 cm
·Spontaneous rupturing of membranes (SROM)
 2. Perform Amniotomy Early in
Labor

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Perform amniotomy early in labor
unless one or more of the following occurs:

·Spontaneous rupture of membranes

·Presentation unknown, floating or unstable
·Cervix dilated less than 3 cm
·Patient refuses
 3-conduct Frequent Cervical Checks

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

• Cervical checks should indicate at least 1 cm
dilation per hour

Failure to progress is defined as

cervical changes of less than 1 cm per hou
for 2 consecutive hours.
 Partograph and
Criteria for Active
Labor

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

• Label with patient identifying
information
• Note fetal heart rate, color of
amniotic fluid, presence of
moulding, contraction pattern,
medications given
• Plot cervical dilation
• Alert line starts at 4 cm--from
here, expect to dilate at rate of
1 cm/hour
• Action line: if patient does not
progress as above, action is
required
 '‫التنظيم الهيكلي لـ 'اسم الشركة‬
4-Augment with Oxytocin
to achieve adequate labor
for 2 to 4 hours.
 2.5 U Oxytocin in
500 ml. G. 5%

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

15 drops / min In multigravida and
increase infusion rate by 15 drops in previous C.S.
every 30 minutes

When contractions lasting more than 40 seconds

and occurring three times in 10 minutes).
maintain infusion

If good contractions are not established

at 60 drops per minute .
5 units in 500 mL dextrose
30drops / min
increase infusion rate by 15 drops
every 30 minutes
If good contractions are not established at 60 drops per minute do c.s.
 5 units Oxytocin in
500 mL dextrose
In primigravida

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

30 drops / min
increase infusion rate by 15 drops
every 30 minutes
When contractions lasting more than 40 seconds
and occurring three times in 10 minutes). maintain infusion

If good contractions are not established 60 drops per minute .

10 units in 500 mL dextrose

30 drops / min
increase infusion rate by 15 drops
every 30 minutes
If good contractions are not established at 60 drops per minute do c.s.
Uterine Hyperstimulation

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Is defined as contractions lasting longer than 90
seconds, OR more than five contractions in 10
minutes

can be managed by changing the maternal position

and administering oxygen,
shutting off the pitocin until recovery has occurred
and possibly the administration of terbutaline 0.25 mg SC.
Feature Baseline Vari ability (bpm Decelerations Accelerations
(bpm))

Reassuring 110-160 = >5 None Present

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

Non-reassuring 100-109 < 5 for >40 to <90  Early deceleration
minutes  161-180 Variab le
deceleration
 Single p rolonged
deceleration up to 3
minutes
The absence of
accelerations with an
otherwise normal
CTG are of uncertain
significance

abnormal < 100 ,> 180 < 5 for = > 90 Atypical variable decelerations
sinusoidal min.
pattern > = Late decelerations
10 min.
Single p rolonged deceleration
>3 min.
 Category Definition

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

• Normal A CTG where all four features fall into the
reassuring category.
• Suspicious A CTG whose features fall into one of the
non-reassuring categories and the remainder of the
features are reassuring.
• Pathological A CTG whose features fall into two or more
non-reassuring categories or one or more abnormal
categories.
 5-If patient is in Stage II labour
and is not making progress

'‫التنظيم الهيكلي لـ 'اسم الشركة‬

• Positioning.
• Fluid balance.
• Oxytocin augmentation.
• Obstetrical/surgical consult.
 '‫التنظيم الهيكلي لـ 'اسم الشركة‬
6- Consider operative
vaginal delivery or
cesarean delivery