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Dr Manal Behery Assistant Professor , Zagazig University 2013

NORMAL & ABNORMAL LABOUR PART 2: Abnormal labor. Dr Manal Behery Assistant Professor , Zagazig University 2013. 1- labor Dystocia 2- Fetal lie and fetal presentation that impair delivery 3-Cephalopelvic disproportion 4- Operative vaginal delivery 5- induction of labor.

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Dr Manal Behery Assistant Professor , Zagazig University 2013

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  1. NORMAL & ABNORMAL LABOUR PART 2: Abnormal labor Dr ManalBehery Assistant Professor , Zagazig University 2013

  2. 1-labor Dystocia2- Fetal lie and fetal presentation that impair delivery 3-Cephalopelvic disproportion4- Operative vaginal delivery5- induction of labor • Part 2: ABNORMAL LABOUR

  3. All of the following cause labor dystocia except A-Hydroceplus B- Occipto –anterior C-Face presenation D- Occipto –Posterior E-Ovarian mass F- Shoulder dystocia Answer B

  4. what is labor dystocia? • Difficult labor, but refers to abnormally slow progress of labor

  5. Failure to progress in labor

  6. what are protraction disorders and arrest disorders? • Things are moving slower than expected • No change occurs

  7. Normal vs.Prolonged latent phase

  8. How is protraction disorder dx? • Nulliparous: dilation <1.2cm/hr, descent <1.0cm/hr • Multiparous: dilation <1.5cm/hr, descent <2.0cm/hr

  9. How is arrest disorder dx? • -Nulliparous: NOdilation >2hr, no descent >1hr • -Multiparous: NO dilation >2hr, no descent >1hr

  10. How long do you let woman push for? • A-1 hr if multi,2hrs if nulli ,add 1hrs if epidural • B-2 hrs if mulli,3 hrs if nulli ,add 1hrs if epidural • C-1.5 hr if multi ,2.5 hrs, add 1 hr if epidural ANSWER A

  11. Effects of labor dystocia includes all except • A-Chorioamnionitis • B-Uterine rupture • C-Reassuring FHR trace • D-Pelvic floor injury ANSWER C

  12. The three P's of labor • A-Power: uterine contractions • B-Passenger: the baby • C-Passage: the patient's pelvis, pelvic floor

  13. Power and stages of labor • During first stage of labor, you are concerned with the power of the uterine contractions • During the second stage of labor, you are concerned with the power of the patient's pushing efforts

  14. How do you measure uterine activity? • -External tocodynamometry or an intrauterine pressure catheter (IUPC) • For IUPC, patient must be ruptured and increased the risk of infection

  15. What are considered adequate contractions? • Strong enough to cause cervical change • Optimal frequency is a minimum of three contractions in a 10 min period (ideal is every 2 min) • Greater than or equal to 200 Montevideo units

  16. What can you do about inadequate power of uterus? • -If contraction pattern is irregular or less than 3 in 10 minutes or if MVU's are less than 200, use Pitocin to increase intensity and frequency of contractions.

  17. What can you do about inadequate power of pushing? • Allow patient to rest through a few contractions to catch her breath. • Try different positions for more effective pushing • If everything fails, operative vaginal delivery or Cesarean section

  18. Characteristics of the passenger • Lie • Presentation • Size • Anomalies

  19. Fetal lie and fetal presentation that impair delivery • -Fetal lie: non-longitudinal presentation-transverse, oblique or shoulder • -Fetal presentation: breech, face (1 in 600), or brow (1 in 3000), compound presentation (1 in 700)-hand or arm prolapses along fetal head • Asynclitism-lateral deflection of the head to a more anterior or posterior position in pelvis

  20. Types of breech presentation • frank breech: legs are piked-complete breech: indian style or curled legs-footling breech: one leg down, monitor for if umbilical cord falls through pelvis

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