8 abnormal labour

Uterine relaxation limited uterine cavity fetal head obstructed
classification
Frank breech p


the lower extremities are flexed at the hips and extended at the knees, and thus the feet lie in close proximity to the head. It appears most commonly
Clinical manifestation
Coordinate hypotonic uterine dysfunction incoordinate hypotonic uterine dysfunction partogram: World Health Organization
partograph
persistant occipitotransverse or occipitoposterior position fistula formation intrapartum infection threatening rupture or rupture
midpelvis and outlet
differs in that one or both knees are flexed. one or both hips are not flexed and one or both feet or knees lie below the breech, that is, a foot or knee is lowermost in the
Abnormal expulsive force
Uterine dysfunction
hypotonic uterine dysfunction hypertonic uterine dysfunction
Hypotonic uterine dysfunction
Effective contraction:
contractions very rarely, the consequence of painful sensations and thus a lack of awareness of vigorous labor.
Dystocia
Second part: abnormalities of birth canal
Treatment
Enhance the uterine contractibility the goal is to affect uterine activity that is sufficient to produce cervical change and fetal descent while avoiding uterine hyperstimulation and fetal distress.
Pelvic contraction
Birth canal

bony canal soft canal any contraction of the pelvic diameters that diminishes the capacity of the pelvis can creat dystocia during labor
Contracted pelvic outlet
Defination: diminition of the interischial tuberous diameter to 8cm or less. 2 triangles:


baseof both: interischial tuberous diameter anterior triangle posterior triangle
Breech presentation
Incidence


breech presentation is common remote from term. 3-4% of singleton deliveries
Position

LSA, LST LSP. RSA, RST, RAP
Causes
Hypertonic uterine contraction
Localized abnormalities of uterine action

constriction ring pathological retraction ring
localized rings or constrictions of the uterus develop in
Abnormal Labour
page 211
Normal labour
3 elements :

expulsive force birth canal fetus
Abnormal labour
Abnormalities of the expulsive forces
Abnormalities of the fetus Abnormalities of the maternal pelvis
abnormal cephalic posion 6-7% breech presentation others
3-4%
Persistant occipitoposterior (transverse) position
Causes


abnormal pelvis:transverse narrowing of the midpelvis flexion not well hypotonic uterine dysfunction
Generalized abnormalities of uterine action
Precipitate labor:

extremely rapid-labor total duration less than 3 hours
abnormally low resistance abnormally strong uterine and abdominal
World Health Organization partograph
A partogram was designed for use in developing countries (1992).Labour is divided into a latent phase ,which should last no longer than 8hours, and an active phase starting at 3cm dilatation, the rate of which should be no slower than 1cm per hour. A 4hour wait(lag time) is recommended before intervention when the active phase is slow. Labor is graphed and analysis includs use of alert and action lines. The protocol was found to be beneficial in Southeast Asia.(WHO,1994)
abnormal bony canal: pelvic contraction

Classification
Contraction of the pelvic inlet contraction of the midpelvis and pelvic outlet general contraction of the pelvis pelvic deformities
Contracted pelvic inlet
Anteroposterior d<10cm diagonal conjugate d<11.5cm external conjugate d<18cm

simple flat pelvis rickets flat pelvis
Contracted midpelvis
association with prolonged labors, which is often the result of obstructed labor, with marked streching and thinning of the lower uterine segment. The ring may be seen clearly as an abdominal indentationand signifies impending rupture of the lower uterine segment.
7 concepts
Prolonged latent phase:16 hr prolonged active phase:8 hr arrest active phase:0cm/2hr prolonged second-stage labor:2hr/1hr arrest second-stage labor:0cm/1hr delayed descent:<1cm/hr arrest descent:>=0cm/hr
picture1
Outlet contraction without concomitant midplane contraction is rare
Funnel shaped pelvis transversely contracted pelvis
•General contraction of the pelvis

uterine activity is sufficient to make the cervix effacement and dilatation, fetus descent.