Prolonged labour
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Prolonged labor is the inability of a woman to proceed with childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time mothers, and over 14 hours for women that have already had children.
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This presentation discusses prolonged labor, which occurs when labor lasts over 20 hours for first-time mothers or 14 hours for women who have given birth before. Prolonged labor can happen in the latent or active phases of the first stage, or the second stage. Causes include problems with uterine contractions, the birth canal, or the baby. Prolonged labor can endanger the baby through hypoxia or infection and endanger the mother through hemorrhage, trauma, or infection. Management involves identifying the cause, monitoring for effects, and treating any issues through techniques like amniotomy, oxytocin infusion, pain relief, or cesarean delivery if needed to deliver the baby safely.Prolonged labour -gihs
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The document defines prolonged labour as when the first and second stages of labour last more than 18 hours total. It then discusses the phases of labour and outlines causes of prolonged labour including issues with uterine contractions, the cervix, pelvis, or baby. Diagnosis involves assessing cervical dilation and descent rates. Dangers to the mother and baby include hypoxia, infection, and trauma. Treatments include preventing issues with early monitoring, changing positions, hydration, and pain relief or interventions like amniotomy, oxytocin, or c-section depending on the stage and severity.Manual removal of placenta
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This document describes the procedure for manual removal of the placenta (MRP). MRP is performed when the placenta fails to deliver within 30 minutes of childbirth. It involves inserting fingers into the uterus to locate and detach the placenta from the uterine wall while supporting the fundus. Once detached, the placenta is withdrawn from the uterus while continuing to provide counter-traction. Oxytocin is administered to encourage uterine contraction and prevent hemorrhage. The placenta is examined for completeness and the uterus is checked for contraction to ensure the procedure was successful. Potential complications include shock, postpartum hemorrhage, puerperal sepsis, and inversion or hysterectomy.Precipitate labour
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Precipitate labor is defined as labor with a combined duration of the first and second stages of less than two hours. It is more common in multiparous women and occurs due to hyperactive uterine contractions and diminished soft tissue resistance, allowing a dilation rate of 5 cm per hour or more. Risks for both mother and baby include lacerations, postpartum hemorrhage, uterine inversion or rupture, intracranial hemorrhage in the baby from rapid delivery without time for molding. Treatment involves hospitalizing women with a history of precipitate labor prior to delivery, suppressing contractions during labor, controlling delivery of the head, liberal episiotomy use, and inducing labor through membrane rupture and controlled deliveryVacuum delivery
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VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
Cord prolapse & cord presentation
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Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord precedes the fetus through the birth canal. It can be diagnosed by feeling the cord or detecting fetal heart abnormalities. Management involves manually lifting the presenting part off the cord, placing the mother in a position to relieve pressure on the cord, considering tocolysis to stop contractions, and delivering via the fastest route, typically an emergency c-section.Disorders of uterine contraction, precipitate labor, premature labor and prol...
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1. Abnormal uterine contractions can cause prolonged and difficult labor and include conditions like uterine inertia with weak contractions, tetanic contractions with strong and frequent contractions, and uterine constriction rings.
2. Precipitate labor is characterized by very rapid labor progressing in less than 3 hours from the start of contractions and can risk maternal and neonatal complications without proper medical care and monitoring.
3. Preterm labor is defined as contractions strong enough to dilate the cervix occurring between 20-37 weeks gestation and can be predicted by fetal fibronectin levels in cervical secretions and ultrasound measurement of cervical length.Prolonged labour
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subject: Obstetrics and Gynaecological Nursing. This topic contains Detail information about prolonged labour and it's managementProlonged labour
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Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
油In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
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Intrauterine growth restriction (IUGR) refers to poor growth of a baby in the womb. It can be caused by poor maternal nutrition, lack of oxygen to the fetus, or other maternal/placental/fetal factors. IUGR babies are small for their gestational age and classified as symmetrical or asymmetrical. Symmetrical IUGR involves reduced cell number and affects all organs, while asymmetrical IUGR involves cellular hypertrophy and disproportionately affects the body. IUGR increases risks for the baby including hypoglycemia, respiratory issues, and long term health problems. Management depends on severity and includes improving nutrition, bed rest, and timing of delivery.Hyperemesis Gravidarum - Disorder of Pregnancy
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This document discusses prolonged labor, obstructed labor, and dystocia caused by fetal anomalies. Prolonged labor is defined as the combined first and second stage of labor exceeding 18 hours. It can be caused by issues with cervical dilation, fetal descent, uterine contractions, or pelvic and fetal factors. Obstructed labor occurs when descent is arrested due to a mechanical obstruction in the birth canal or fetus. This can lead to exhaustion, dehydration, acidosis, and infection for the mother. Fetal risks include hypoxia, infection, head molding issues, and increased need for operative delivery. Prevention focuses on identifying risk factors. Treatment involves evaluating the cause and deciding between augmentation, assisted delivery, or C-More Related Content
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Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
油In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
INTRA UTERINE GROWTH RETARDATION
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油
This document summarizes information about intrauterine growth restriction (IUGR). It discusses normal fetal growth occurring in three stages: hyperplasia, hyperplasia and hypertrophy, and hypertrophy. Causes of IUGR include maternal, fetal, placental, and environmental factors. Maternal causes include medical conditions, malnutrition, smoking, and infections. Fetal causes include genetic abnormalities and infections. Placental causes include improper placentation and reduced blood flow. Clinical features of IUGR infants include a large head, thin skin, and scaphoid abdomen. Risk prediction methods include ultrasound and Doppler. Problems for IUGR infants include hypoxia, hypoglycemia, and immunological and metabolic issues. Management$ Breast engorgement $
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Premature labor is defined as labor that begins before 37 weeks of gestation. Approximately 10% of deliveries occur prematurely. While the exact cause is unknown in many cases, risk factors include previous preterm births, infections, chronic illnesses, multiple pregnancies, and short cervical length. Management involves attempts to delay labor with bed rest and tocolytic drugs to allow for corticosteroid administration to improve fetal lung maturity. After delivery, neonatal care focuses on preventing complications like respiratory distress through gentle resuscitation measures.Retained placenta
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A retained placenta occurs when the placenta is not expelled from the uterus within 30 minutes of childbirth. Risk factors include previous retained placentas, uterine injuries or surgeries, preterm births, induced labor, and multiple pregnancies. Causes can include failure of the placenta to separate fully from the uterine wall or abnormal placenta attachments like placenta accreta. Treatment involves controlled cord traction, manual removal in the operating room if needed, or hysterectomy for deeply embedded placentas. Complications can be life-threatening bleeding, infections, or shock if not properly managed.Abnormal placenta
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油
Forceps are the instrument which are used to extract the fetal head. There are different types of instrument shown in this slide. Indications and contraindications to use this Instrument.Abnormalities of placenta and cord obg
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油
Has a velamentous insertion of the cord (the umbilical cord inserts abnormally into the fetal membranes, instead of the center of the placenta) Has placenta previa (a low-lying placenta that covers part or all of the cervix) or certain other placental abnormalities.Physiology and Mangement of 2nd stage labour
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油
This document discusses the physiology and management of the second stage of labor. It defines the second stage as beginning with full cervical dilation and ending with delivery of the fetus. Key points include: the second stage has two phases - propulsive and expulsive; normal duration is 2 hours for primiparous and 30 minutes for multiparous women; physiological changes include descent, uterine contractions, membrane rupture, and soft tissue displacement; management aims for a normal delivery with minimal maternal effects and early detection of abnormalities. Assessment includes monitoring contractions, descent, fetal heart rate, and progressing through the mechanisms of labor.Iugr
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Intrauterine growth restriction (IUGR) refers to poor growth of a baby in the womb. It can be caused by poor maternal nutrition, lack of oxygen to the fetus, or other maternal/placental/fetal factors. IUGR babies are small for their gestational age and classified as symmetrical or asymmetrical. Symmetrical IUGR involves reduced cell number and affects all organs, while asymmetrical IUGR involves cellular hypertrophy and disproportionately affects the body. IUGR increases risks for the baby including hypoglycemia, respiratory issues, and long term health problems. Management depends on severity and includes improving nutrition, bed rest, and timing of delivery.Hyperemesis Gravidarum - Disorder of Pregnancy
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油
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This document discusses prolonged labor, obstructed labor, and dystocia caused by fetal anomalies. Prolonged labor is defined as the combined first and second stage of labor exceeding 18 hours. It can be caused by issues with cervical dilation, fetal descent, uterine contractions, or pelvic and fetal factors. Obstructed labor occurs when descent is arrested due to a mechanical obstruction in the birth canal or fetus. This can lead to exhaustion, dehydration, acidosis, and infection for the mother. Fetal risks include hypoxia, infection, head molding issues, and increased need for operative delivery. Prevention focuses on identifying risk factors. Treatment involves evaluating the cause and deciding between augmentation, assisted delivery, or C-Prolonged and obstructed labour
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This document describes prolonged and obstructed labor. It defines prolonged labor as when the first and second stages of labor last more than 18 hours total. Obstructed labor occurs when there is poor or no progress despite strong contractions, usually due to issues with the fetus (fault in passenger) or birth canal (fault in passage). Causes include cephalopelvic disproportion, malpositions, big baby, or contracted pelvis. Diagnosis involves assessing cervical dilation rate and fetal descent rate with a partograph. Treatment depends on the stage of labor affected and may include oxytocics, analgesics, assisted delivery, or C-section. Complications can be serious for both mother and baby if not resolved.
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This document discusses abnormal labor and its management. It defines normal labor and describes abnormalities such as dystocia. Abnormal labor can be caused by issues with the cervix, uterus, maternal pelvis, or fetus. Types of abnormal labor include protraction disorders, arrest disorders, and dysfunctional labor. Management depends on the type and stage of abnormality and may include amniotomy, oxytocin administration, operative vaginal delivery, or cesarean section. Close monitoring of labor progress is important to diagnose abnormalities early to guide management.
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I. Prolonged labor is defined as labor lasting longer than 18-24 hours. It can occur when there are issues with uterine contractions (fault in power), the size and shape of the pelvis (fault in passage), or position of the baby (fault in passenger).
II. Precipitate labor is when the first and second stages are less than two hours. It is more common in multiparous women and can be caused by factors like a small baby in a favorable position or strong uterine contractions.
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This document discusses abnormal labor and its management. It defines normal labor and describes abnormal labor as a difficult labor pattern that deviates from typical progression. Abnormal labor can be caused by issues with the cervix, uterus, maternal pelvis, or fetus. It further outlines the stages of labor and describes factors that can contribute to prolonged latent phase, dysfunctional labor, and dystocia. The management of abnormal labor may include amniotomy, oxytocin administration, operative vaginal delivery, or cesarean section depending on the specific issues present and labor progression. Close monitoring of labor and timely interventions are important to properly manage abnormal labor.
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1) Prolonged labor is defined as labor lasting over 20 hours for first time mothers and over 14 hours for mothers who have previously given birth. It can be caused by issues like malpresentation, cephalopelvic disproportion, or problems with uterine contractions.
2) Signs of prolonged labor include exhaustion, dehydration, high pulse rate, and potential fetal distress. It increases risks for both mother and baby.
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