Professional Documents
Culture Documents
Abnormal Labor
Abnormal Labor
BY ALEMAYEHU G 1
objective
At the end of this session students should able to know:
Definition of abnormal labor (dystocia)
BY ALEMAYEHU G 2
Definition of Abnormal labor
An abnormal labor is any labor in which the pattern of labor progress is significantly different
from accepted and recognized patterns of labor progress in terms of cervical changes, decent of
fetal presenting part or profile of uterine contractions
Dystocia ( difficult labor) is often used interchangeably to denote an abnormal labor pattern
BY ALEMAYEHU G 3
Classifications of abnormal labor
patterns – Four major groups
Prolongation disorders
Protraction disorders
Arrest Disorders
Precipitate labor
BY ALEMAYEHU G 4
Prolongation Disorders
Only one prolongation disorder recognized
◦ Challenge in diagnosis is often due to the problem in diagnosing the exact time of onset of labor
BY ALEMAYEHU G 5
Protraction Disorders
Two protraction disorders
Protracted descent
Descent of the fetal presentation less than 1 cms per hour in the multigravida and 2 cms per hour in
the primigravida
BY ALEMAYEHU G 6
Arrest Disorders
Three arrest disorders
Arrest of descent
No descent for more than 2 hours
Failure of descent
No descent of fetal presentation for more than 3 hours
BY ALEMAYEHU G 7
Precipitate labor
Precipitate labor means labor that end in expulsion of fetus within less than three hours
Precipitated dilatation :- rate of cervical dilatation 5cm per hour in primigravida and 10 cm per
hour in multigravida
Precipitated descent
BY ALEMAYEHU G 8
Risk factor for abnormal labor
Older maternal age Short stature(less than 150 cm)
Pregnancy complication High station at full dilatation
Non reassuring fetal heart rate Chorioamnionitis
Epidural anesthesia Post term pregnancy
Macrosomia obesity
Pelvic contraction
Occiput posterior position
nulliparity
BY ALEMAYEHU G 9
Etiologies of abnormal labor – related to one of the four
P’s of labor determinants
Abnormalities of the powers
Primary power – uterine contraction
BY ALEMAYEHU G 11
Abnormalities of the passenger (fetus) leading to dystocia
Fetal macrosomia (fetal weight grater than 4000g)
BY ALEMAYEHU G 12
Abnormalities of passages
Bony dystocia
◦ Contracted pelvis: if one of internal diameters of the pelvis are shortned by 0.5 cm or more. Classified
in to:
i. Generaly contracted pelvis – contracture of inlet ,mid cavity and outlet.
ii. Inlet contracture – APD <10 cm or TD <12 cm
iii. Midcavity contracture – APD <11.5cm and TD <9.5 CM
iv. Outlet contracture –BTD <8cm
BY ALEMAYEHU G 13
Causes of contracted pelvis
Abnormal shape of pelvis –android and platypelloid type pelvis
Nutritional deficiency- vitamin D deficiency rickets in child hood and osteomalacia in adult.
Disease or injury in the spines – kyphosis,scoliosis,pelvic tumor, fracture and limbs “
poliomyelitis in childhood”
Congenital disorder of spines, pelvis and limb
BY ALEMAYEHU G 14
Diagnosis of abnormal labor patterns - Steps
Document following parameters against time on partograph
Uterine contraction profile
Cervical dilatation/effacement
Descent of fetal presentation
◦ Prolonged labour is labour which lasts more than twelve hours in the active phase.
BY ALEMAYEHU G 15
contin……
Compare against normal patterns for respective parity, identify
any deviations and then classify into respective abnormal
patterns
Look for specific etiology responsible for the abnormal labor
patterns by carefully assessing the five determinants of labor
progress (P’s of labor)
BY ALEMAYEHU G 16
Evaluation for causes of abnormal labor patterns – Assessment of
the four P’s of labor
Assessment of powers of labor – three ways
Palpation of uterine contractions
External tocodynamometer
Intrauterine pressure catheter monitoring
Maternal exhaustion, vital signs, blood glucose and evidence of dehydration
BY ALEMAYEHU G 17
Management of abnormal labor – depends on specific etiology
diagnosed
In first level facility: Review maternal condition and refer
Volume replacement or maternal hydaration
Amniotomy or ARM
Active monitoring of labor by partograph
Reassess labor progress in 2 hours
BY ALEMAYEHU G 18
In higher level facility:
Power abnormalities
Uterine inertia – Augmentation
Secondary powers failure – Instrumental assistance
Passenger abnormalities
If foetal head >2/5 palpable deliver by CS
If foetal head < 2/5 palpable assist delivery by instrument.
Destructive deliveries in cases of fetal deaths
Abnormalities of the passages
Often Caesarean delivery
Episiotomy for perineal level obstruction
BY ALEMAYEHU G 19
THANK YOU !!!
BY ALEMAYEHU G 20