Prolonged pregnancy and abnormal uterine contractions (4) (1).pdf
- 1. Prolonged pregnancy and abnormal uterine action Post term or prolonged pregnancy is defined as one that exceeds 294 days of pregnancy from the first day of the last menses Post maturity or post mature are terms used for the neonate and refer to fetuses or the condition of the baby.
- 2. Incidence and date The incidence of post term pregnancy is 10% Primigravids have mean duration of 288 days Multigravidas have mean duration of 283 days Pregnancy cannot be said is prolonged without accurate date Abdominal exam and fundal height is not certain Quickening can be felt at different weeks Ultrasound scan in early pregnancy is used to assess the duration of pregnancy and the fetal age.
- 3. Risks of post term pregnancy Increased perinatal mortality and morbidity rates Fetal malnutrition Absence of vernix and lanugo Meconium staining Macrosomia Oligohydramnios Fetal distress
- 4. Management of post term pregnancy Antenatal CTG Amniotic fluid measurement
- 5. Induction of labor It is the stimulation of uterine contractions before the onset of spontaneous labor. It should be associated with ripe cervix and adequate contractions which will bring progressive dilatation of the cervix.
- 6. Maternal indications for induction Prolonged or post term pregnancy Hypertension and preeclampsia Medical problems Placental abruption Previous still birth Unstable lie PROM & SROM Maternal request
- 7. Fetal indication IUGR Decreased fetal movements Rh isoimmunization
- 8. Contraindication of induction of labor Placenta previa Transverse and compound presentations Cord presentation and cord prolapse CPD Severe fetal compromise
- 9. Methods of induction 1) prostaglandins An objective method of assessing whether the cx. Is favorable for induction is Bishop's score Prostaglandins is administered by intravaginal route. Prostaglandin E2 Is available in gel or pessary form They are inserted in the posterior cervical fornix Labor starts 30%- 50% of mothers 2) sweeping or striping of the membranes Prostaglandins in the fetal membrane stimulate the cx to start labor
- 10. BISHOP SCORE
- 11. How to calculate bishop score
- 12. Methods of induction 3) Amniotomy ARM is performed to induce labor only when The cervix is favorable There is well fitting presenting part ARM allows the presenting part to descend pressure on the os increases the level of prostaglandins 4) Oxytocin It is a hormone released from the posterior pituitary gland the receptors of the uterus start to respond to its production at term Side effects of oxytocin Hyperstimulation Postpartum atony Water retention Transient vasodilatation and hypotension
- 13. Maternal well being Observation of vital signs and plotting of partogram Uterine contractions Observe for their frequency duration and strength Continuous CTG assessment Appropriate pain relief Assess progress of labour Fetal well being Watch for signs of fetal distress
- 14. prolonged labour It is defined as labour which exceeds 24 hours or it exceeds 12 hours when labour is established or actively managed Prolonged labour is common among primi and may be caused by a) Inactive uterine action b) CPD c) OP positions Prolonged latent phase The average duration of latent phase of primi is 8.6 hours but if lasted more than 20 hours it is considered prolonged Prolonged active phase When the cervix doesn't dilate at a fixed rate that is 1cm per hour it causes prolonged active phase Factors which contribute are The cervix and the uterus The fetus and mother's pelvis Slow progress of labour is attributed to inefficient uterine action which is usually because of ketoacidosis and the positioning of the mother
- 15. augmentation of labour It is done to correct slow progress of labour It includes amniotomy and administration of oxytocin
- 16. incoordinate uterine activity This called colicky uterus and it is due to hypertonic inefficient uterine action lacking fundal dominance the contraction begins and lasts longer in the lower uterine segment The coordination of the contraction is completely lacking different areas of the uterus which it contracts independently causing severe pain. Incoordination causes fetal distress and diminished placental perfusion.
- 21. constriction ring dystocia It is localized spasm of a ring of muscles fibers which occur at the junction of the upper and lower uterine segment It is commonly seen in late first stage and early second stage of labour and it is due to oxytocin.
- 25. management of prolonged labour 1) Give information to the mother and family 2) Comfort and analgesia 3) Observation of the partogram and vital signs 4) Fluid balance intake and output 5) Assessment of progress 6) Fetal well being
- 27. What is the partograph according to WHO? Partograph is a paper-based tool developed by the W.H.O. to monitor labour during pregnancy. The use of the partograph is recommended as an important indicator for monitoring intrapartum care. Partograph includes several labour vitals including cervix dilatation of the mother.
- 28. How do you interpret the partogram? The WHO partograph has two diagonal lines: an alert line and an action line. The alert line goes from 4 to 10 cm and corresponds to an average dilation rate of 1 cm per hour. If the labour curve crosses to the right of this alert line, this means that the dilation is less than 1 cm per hour.
- 29. management of prolonged second stage Vaginal exam should be carried out to confirm Position Attitude Station Presenting part and assessment of fetal heart In the presence of inefficient uterine contractions oxytocin should be started
- 30. cervical dystocia It is due to cervical scaring or congenital structural anomaly where despite good contractions the cervix fails to dilate although it may efface but C/S is necessary to deliver the baby.
- 31. Overt efficient uterine activity or precipitate labour It is due to frequent and strong contractions from the onset of labour resulting in rapid completion of the first and second stage of labour Complications Retained pieces or PPH Fetal hypoxia Precipitate labour can repeat itself in the coming pregnancies
- 32. What is the diagnosis for labor? The diagnosis of labor is simple if the woman has contractions less than 10 minutes apart, a fully effaced cervix, and a few centimeters' dilatation.
- 33. The exact cause of precipitous labor is unknown. It can happen to anyone, but certain factors may increase your chances of a quick birth: Being in your teens or early 20s at the time of delivery Having a previous vaginal birth Preeclampsia, a disorder of high blood pressure and other signs that occur after 20 weeks of pregnancy A baby with a low birth, which refers to any newborn weighing less than 2.5kg Placental abruption, when the placenta
- 34. trial of labour A trial of labour is offered when the mother has a minor degree of CPD. The outcome of labour depends on 1) The effectiveness of the uterine contractions 2) The give of the pelvic joints 3) Flexion of the head 4) The degree of moulding of the head 5) Trial is done when the fetus is cephalic and the progress is assessed by the partogram and the fetal well being
- 35. obstructed labour Labour is said to be obstructed when there is no advancement of the presenting part despite strong uterine contractions Causes of obstructed labour 1) CPD 2) Deep transverse arrest 3) Malpresentations 4) Pelvic masses 5) Fetal abnormalities
- 36. signs and symptom of obstructed labour 1) The presenting part doesn't enter the brim despite good contractions 2) Inefficient cervical dilatation 3) Empty sleeve cervix 4) Elongated ac of fore water 5) Dehydration and ketosis 6) Pyrexia and rapid pulse 7) Decreased urine output 8) Fetal distress 9) Moulding of the uterus around the fetus 10) Formation of retraction ring or Bundles ring 11) On vag. Exam is hot and dry presenting part is high with excessive moulding and formation of caput succedaneum
- 37. Management of obstructed labour Antenatal ABDOMINAL EXAM Labour DECENT VAGINAL EXAM AND CONTRACTIONS
- 38. COMPLICATIONS OF OBSTRUCTED LABOUR Maternal 1) Trauma to the bladder 2) Vesicovaginal fistula 3) Intrauterine infection 4) Urine incontinence 5) Rupture uterus 6) Death of the mother and the fetus
- 39. fetal complication Intrauterine asphyxia Stillbirth Alive but with brain damage Meconium aspiration causing pneumonia Ascending infection due to ruptured membranes