GANGGUAN

INPARTU
-PARTUS LAMA
-PROLAPS TALI PUSAT

DR.CUT RAZIANTI.Z.B, SPOG

PARTUS LAMA/ DISTOSIA
Causes of abnormal labor

– Abnormalities of birth canal

– Abnormalities of expulsive forces
– Abnormalities of presentation & position of fetus
Abnormalities of birth canal

– The morphology and capacity are primary causes of dystocia.

– Pelvic structure: pubis, sacrum and ischium.
– Pelvic plane: inlet, midpelvic and outlet
– Bony marker: ischial spine
Classification of abnormalities of pelvis

– Contracted pelvis
contracted inlet plane
contracted midpelvis
contracted outlet plane
– Pelvic malformation
Abnormalities of fetus
Abnormalities of fetus

– Abnormalities of fetal position

– Macrosomia

– Fetal malformation
Fetal status

 Fetal lie:The relation of the fetal long axis to that of the mother is termed fetal
lie and is either longitudinal or transverse

 Fetal presentation: the foremost part in birth canal.

 Cephalic, breech and should presentation.

Cephalic presentation

– According to degree of fetal head flex, cephalic presentation is divided into

vertex, brow and face presentation.

– Brow and face presentation result in dystocia.

Management

– To assess cephalopelvic relationship by a series of examination.

– Mild cephalic distocia: trial labor

– Obvious cephalic distocia: cesarean section.

Cephalopelvic disproportion ( CPD ) :

Abnormal labour due to disparity between the dimensions of the fetal

head and maternal pelvis, as to preclude vaginal delivery.

It can be due to a large head, small pelvis or a combination of the

two.

Originally describe for overt pelvic contracture due to rickets,

however now such true CPD is rare and most disproportions are due
to malpositions of the fetal head- asynchtisim or extension of the
bony diameters of the fetal head, or to ineffective uterine contraction.
CPD is suspected if there is :
1 – Progress is slow or arrest despite efficient uterine
contraction.
2 – The fetal head is not engaged.
3 – Vaginal examination shows severe moulding and caput
formation.
4 – The head is poorly applied to the cervix.
Risk factors for poor progress in labour :
1 – Small women.
2 – Big baby.
3 – Malpresentation.
4 – Malposition.
5 – Early rupture of membrane.
6 – Soft tissue / pelvic malformation.
7 – Dysfunctional uterine activity.

Failure to progress, this term used to indicate lack of progressive

cervical dilatation or lack of descent. So it is an observation rather
than a diagnosis.
Abnormal uterine contractions
Uterine dysfunction :
This is the most common cause of poor progress in
labour.

It is more common in primigravida and in older women.

Types of uterine contractions :
**Uterine contractions of normal labour are charecterized by
gradient of myometrial activity being greater and lasting longer at
the fundus ( fundal dominant ) and diminished towards the
cervix.

Usually the exciting stimulus starts in one cornue and then several
milliseconds later in the other. The excitation waves then join and
sweeping over the fundus and down the uterus.

** Normal spontaneous contractions often exert pressures of about

60 mm Hg.
There are 3 types of uterine dysfunction :
1 – Hypotonic uterine dysfunction :
No basal hypertonus and uterine contraction is have a normal
gradient pattern ( synchronus ) but the slight rise in pressure
during a contraction is insufficient to dilate the cervix.
Treatment :
1 – Maternal rehydration.
2 – Good pain relief and emotional support.
3 – IV oxytocin ( syntocinon ), continuous EFM is necessary.

**If progress fails to occur despite 4-6 hour of agumentation with

oxytocin, a C/S will usually be recommended.
2 – Hypertonic uterine dysfunction :
Either basal tone is elevated appreciably or pressure gradient is
distorted, perhaps by contraction of the mid – segment of the
uterus with more force than the fundus.

3 – Incoordinated uterine dysfunction :

complete asynchronism of the impulses originating in each
cornue. Sometimes combination of the last 2 types.
Treatment :
Sometimes oxytocin effective in coordinating these contractions.
Management

– Vaginal examination: rule out cephalopelvic disproportion

– Supportive mangement

– augmentation
The Vaginal examination

– To determine fetal presentation, position and station.

– To assess the cephalopelvic relation.

– To consider the route of delivery.

The supportive management

– Sufficient rest

– To relieve anxiety and fear.

– Fluid and food intake.

Augmentation

– Increase the frequency and force of the existing uterine contractions.

– Methods: amniotomy
oxytocin administration
Amniotomy

– If the fetal head is engaged, amniotomy is a choice to facilitate the uterine

activity.

– After amnitomy the fetal head descends , pressing directly on cervix to enforce
uterine contraction. Accelerating labor.
oxytocin

– Capable of inducing uterine contracion in the third trimester.

– Contraindiction: cephalopelvic disproportion and severe fetal malposition.

PROLAPS TALI PUSAT
DEFINITION

– Cord prolapse has been defined as the descent of the umbilical cord through
the cervix alongside (occult) or past the presenting part (overt) in the
presence of ruptured membranes.
– Cord presentation is the presence of the umbilical cord between the fetal
presenting part and the cervix, with or without membrane rupture
INCIDENCE
– The overall incidence of cord prolapse ranges from 0.1% to 0.6%.
– In the case of breech presentation, the incidence is slightly higher than 1%
– Prematurity and congenital malformations account for the majority of adverse
outcomes associated with cord prolapse in hospital settings but birth asphyxia is
also associated with cord prolapse
TERIMA KASIH