URDANETA CITY UNIVERSITY

San Vicente West, Urdaneta City, Philippines-2428

COLLEGE OF HEALTH SCIENCES
Bachelor of Science in Nursing Program

Name: Bernaldo M. Antenor Jr. Course and Year: BSN 2

Date: December 20, 2020 Block: Blk. 1
Subject: Care of Mother, Child, Adolescents Code: N001

Therapeutic management of problems or potential problems in labor and birth

Dysfunctional Labor and Associated Stages of Labor:
a. Dysfunction at the First Stage
Prolonged Latent Phase
Latent phase begins with regular contractions that efface and dilate the cervix and ends with the onset of
active labor. The length of latent phase is a function of several factors. Generally, latent phase is
inversely related to cervical dilation at the time of onset of labor. Similarly, the lower in the pelvis the fetal
presenting part is at the onset of labor, the shorter the latent phase. A potential for producing prolonged
latent phase with sedation must be remembered. In most sedated patients, labor resumes when
sedation has worn off.

Protracted Active Phase Dilation

Protracted active phase dilation is a common dysfunctional labor pattern. It seems to be associated with
mild cephalopelvic disproportion. Clinical experience with intrauterine pressure catheters suggests that
many cases of protracted active phase dilation might have been termed primary uterine
inertia or hypertonic uterine inertia  previously, suggesting some type of uterine dysfunction. There also
may be an iatrogenic contribution to this labor abnormality, with the possibility that supine position may
decrease uterine contractility, leading to slowed cervical dilation. Also, although active labor is relatively
insensitive to analgesia, the use of narcotics may be associated in some cases with precipitating slow
dilation in active phase. Early epidural anesthesia, particularly if the station of the presenting part is
higher than −1, also is associated with an increased risk for this labor abnormality.

Secondary Arrest of Dilation

Secondary arrest of dilation is diagnosed when there has been no change in cervical dilation for at least
2 hours. This time criterion is the same for nulliparas and multiparas and is based in part on the certainty
with which cervical dilation can be determined on digital examination. Secondary arrest, which occurs in
5% to 10% of labors in most series, is more frequent with term than preterm and with larger than smaller
fetuses. This abnormality occurs more frequently than prolonged latent phase but less frequently than
protracted active phase dilation. It has been recognized as being the most severe of dilation
abnormalities because of its association with increased fetal morbidity and mortality and with a
considerably increased risk of cesarean birth.

Prolonged Deceleration Phase

The deceleration phase is the third phase of active labor, after the phase of maximum slope. The onset
 of deceleration phase begins at 9 cm for nulliparous and multiparous labor. Active descent should start
by the beginning of deceleration phase, although in many labors active descent begins earlier in active
labor. Engagement that does not occur by the beginning of deceleration phase (i.e., 9 cm) in nulliparas
and by the end of deceleration phase in multiparas is abnormal. Prolonged deceleration phase requires
at least 3 hours for diagnosis in nulliparous labor and 1 hour for diagnosis in multiparous labor. Because
descent should be active by this time in normal labor and because the intervals for diagnosis of descent
abnormalities are shorter than those necessary for the diagnosis of prolonged deceleration phase, the
clinician’s attention should focus more on descent than on dilation at this time in labor.

b. Dysfunction at the Second Stage

Protracted Descent
Protracted descent should be diagnosed in nulliparous labor when descent is proceeding at less than l
cm/hr and in multiparous labor when descent is proceeding at less than 2 cm/hr. Although it is true that
station of the fetal presenting part is more difficult to estimate reliably than is dilation, it is possible to
make this diagnosis within 1 hour for the nullipara and within 0.5 hour for the multipara. A careful
balance should be sought between overdiagnosis and failure to diagnose protracted descent as promptly
as possible because treatment may entail substantial intervention. The cause of protracted descent often
includes malposition and relatively mild degrees of fetopelvic disproportion; absolute fetopelvic
disproportion is unusual. Slow descent frequently is associated with the use of epidural anesthesia.

Arrest of Descent
The diagnosis of arrest of descent should be made when descent has stopped entirely for at least 1 hour
in the nullipara and 0.5 hour in the multipara. It frequently is preceded by and has the same causative
factors as protracted descent. When arrest of descent has not been preceded by other dysfunctional
labor patterns, experience suggests that, similar to secondary arrest of dilation, it is extremely sensitive
to oxytocin augmentation. Low-dose intravenous oxytocin frequently is associated with spontaneous
vaginal delivery. As with the case of augmentation for other labor abnormalities, electronic monitoring is
appropriate.

When labor contractions are ineffective, several interventions, such as induction and augmentation of labor
with oxytocin or amniotomy maybe initiated to strengthen them.
 Prepare the Scoring of Cervix for readiness for Elective Induction
Scoring Factor 0 1 2 3
Dilation (cm) Closed 1-2 cm 3-4 cm 5 cm or more
Effacement (%) 0% to 30% 40% to 50% 60% to 70% 80% or more
Station -3 -2 -1,0 +1, or lower
Consistency Firm Moderate Soft
Position Posterior Midposition Anterior

Assessment of the Woman for Danger Signs of Oxytocin Administration:

1. Nausea
2. Vomiting
3. Severe allergic reactions
4. Bleeding after child birth
5. Abnormal heart beats
6. High blood pressure
7. Rupture of the uterus