Normal labour. 3 elements :expulsive forcebirth canalfetus. Abnormal labour. Abnormalities of the expulsive forcesAbnormalities of the fetusAbnormalities of the maternal pelvis. expulsive forces. expulsive forces. Abnormal expulsive force. Uterine dysfunctionhypotonic uterine dysfunctionhypertonic uterine dysfunction.
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1. Abnormal Labour
2. Normal labour 3 elements :
3. Abnormal labour Abnormalities of the expulsive forces
Abnormalities of the fetus
Abnormalities of the maternal pelvis
4. Abnormal expulsive force Uterine dysfunction
hypotonic uterine dysfunction
hypertonic uterine dysfunction
5. Hypotonic uterine dysfunction Effective contraction:
uterine activity is sufficient to make the cervix effacement and dilatation, fetus descent.
6. Etiology Cephalopelvic disproportion or fetal malposition
excessive sedation or conduction analgesia
7. Clinical manifestation Coordinate hypotonic uterine dysfunction
incoordinate hypotonic uterine dysfunction
partogram: World Health Organization partograph
8. 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 4-hour wait 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)
9. 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
10. 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.
11. Hypertonic uterine contraction Localized abnormalities of uterine action
pathological retraction ring
localized rings or constrictions of the uterus develop in 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.
12. Generalized abnormalities of uterine action Precipitate labor:
total duration less than 3 hours
abnormally low resistance
abnormally strong uterine and abdominal contractions
very rarely, the consequence of painful sensations and thus a lack of awareness of vigorous labor.