M PL I C A TI ON S O F L A B O R

CO
AND DE L I V E RY :
PA SS A G E W A Y
MAINE DAL E B . ROB L ES
PREPARED BY: CHAR
COMPONENTS OF LABOR (5 P’S)
•POWER (UTERINE CONTRACTION AND BEARING DOWN EFFORTS)
•PASSENGER (THE FETUS)
•PASSAGEWAY (THE PELVIS)
•PLACENTAL POSITION AND FUNCTIONS
•PSYCHOLOGICAL RESPONSE
CEPHALOPELVIC DISPROPORTION

•3 RD
REASON OF DYSTOCIA:
• CONTRACTION OR NARROWING OF THE PASSAGEWAY OR BIRTH CANAL
•NARROWING CAUSES CPD
CEPHALOPELVIC DISPROPORTION

•DISPROPORTION BETWEEN THE SIZE OF THE

FETAL HEAD AND PELVIC DIAMETER
•RESULTS IN FAILURE TO PROGRESS IN LABOR
INLET CONTRACTION

•NARROWING OF:
•ANTEROPOSTERIOR DIAMETER OF THE PELVIS TO LESS
THAN 11 CM
•TRANSVERSE DIAMETER TO LESS THAN 12 CM
INLET CONTRACTION

•USUALLY IS CAUSED BY:

•RICKETS IN EARLY LIFE
•BY INHERITED SMALL PELVIS
INLET CONTRACTION

•RICKETS
•CAUSED BY LACK OF CALCIUM
•RARE IN DEVELOPED COUNTRIES
INLET CONTRACTION
•PRIMIGRAVIDA
• FETAL HEAD NORMALLY ENGAGES BETWEEN WEEKS 36 TO 38 OF
PREGNANCY
• IF ENGAGEMENT DOES NOT OCCUR IN PRIMI, THE FOLLOWING ARE
SUSPECTED:
• FETAL ABNORMALITY: LARGER THAN USUAL HEAD
• PELVIC ABNORMALITY: SMALLER THAN USUAL PELVIS
INLET CONTRACTION

•MULTIGRAVIDA
• ENGAGEMENT: WHEN LABOR BEGINS
• PREVIOUS VAGINAL BIRTH OF FULL TERM W/O PROBLEM PROOF THAT
BIRTH CANAL IS ADEQUATE
INLET CONTRACTION

•PELVIC MEASUREMENT: PRIMIGRAVIDA

•TAKEN AND RECORDED BEFORE WEEK 24 OF PREGNANCY
INLET CONTRACTION

•IF CPD EXIST

•POSSIBLE CORD PROLAPSE
OUTLET CONTRACTION

•NARROWING OF THE TRANSVERSE DIAMETER, DIAMETER

BETWEEN THE ISCHIAL TUBEROSITIES AT THE OUTLET TO
LESS THAN 11CM
OBSTERICAL PELVIC MEASUREMENT
OBSTERICAL PELVIC MEASUREMENT
OBSTERICAL PELVIC MEASUREMENT
 OBSTERICAL PELVIC MEASUREMENT
TRANSVERSE AP DIAMETER
DIAMETER
INLET 13 CM 11 CM
MID PELVIS 12 CM 12 CM
OUTLET 11 CM 13 CM
VARIATION OF PELVIC SHAPE
VARIATION OF PELVIC SHAPE
TRIAL LABOR
TRIAL LABOR

•INDICATED IF A WOMAN HAS A BORDERLINE (JUST ADEQUATE)

INLET MEASUREMENT AND THE FETAL LIE AND POSITION ARE
GOOD
•TO DETERMINE WHETHER THE LABOR WILL PROGRESS NORMALLY
TRIAL LABOR
•DISCONTINUE (AFTER A DEFINITE PERIOD: 6-12 HOURS)
• IF ADEQUATE PROGRESS IN LABOR CANT BE DOCUMENTED
• FETAL DISTRESS OCCURS
•FOR CS
EXTERNAL CEPHALIC VERSION
EXTERNAL CEPHALIC VERSION
•TURNING A FETUS FROM A BREECH TO A
CEPHALIC POSITION BEFORE BIRTH
•MAY BE DONE AS EARLY AS 34- 35 WEEKS
•USUAL TIME: 37-38 WEEKS
EXTERNAL CEPHALIC VERSION
• CONTRAINDICATION:
• MULTIPLE GESTATION
• SEVERE OLIGOHYDRAMNIOS
• SMALL PELVIC DIAMETER
• CORD THAT WRAPS AROUND THE FETAL NECK
• UNEXPLAINED 3 TRIMESTER BLEEDING
RD
FORCEPS BIRTH
FORCEPS BIRTH

•OBSTERICAL FORCEP
FORCEPS BIRTH

•RARELY USED: CAN LEAD TO WOMAN

•RECTAL SPHINCTER TEAR
•DYSPAREUNIA AND INCONTINENCE
FORCEPS BIRTH
•FORCEPS MAY BE NECESSARY WITH ANY OF THE FOLLOWING
CONDITIONS
• UNABLE TO PUSH WITH CONTRACTIONS
• CESSATION OF DESCENT IN THE 2 STAGE OFE LABOR
ND

• FETUS IN ABNORMAL POSITION

• FETUS IS IN DISTRESS
FORCEPS BIRTH
•BEFORE FORCEPS ARE APPLIED:
• MEMBRANES MUST BE RUPTURED
• CPD MUST NOT BE PRESENT
• CERVIX MUST BE FULLY DILATED
• WOMAN’S BLADDER MUST BE EMPTY
VACUUM EXTRACTION
VACUUM EXTRACTION
•ALSO KNOWN AS VENTOUSE
•METHOD TO ASSIST DELIVERY OF A BABY USING A VACUUM DEVICE
•USED IN THE SECOND STAGE OF LABOR IF IT HAS NOT PROGRESSED
ADEQUATELY
•ALTERNATIVE TO A FORCEPS DELIVERY AND CAESAREAN SECTION
VACUUM EXTRACTION