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  2. I. Uterine over activitya. palaborumb. Excessive uterine contraction (obstructed labor)  II. Uterine Inertiaa. Hypotonic inertia b. Hypertonic inertia III. Construction RingIV. CERVICAL DYSPLASIA a. Organic b. Functional

  3. A. P. LABOUR (less than 3 hours) Definition: Uterine contraction strong, no obstruction in the birth canal, painless except in the last contraction and expulsion of fetus. Complication:. A. Maternal 1. Laceration cervix vagina 2. p.pHge 3. inversion of uterus 4. shock due to p. pHge 5. Sepsis laceration no sterilization B. Fetal a. I C Hg compression and decompression b. Injury of fetus c. Avulsion umbilical cord

  4. Management1. Rare before delivery give anesthesia to slow course of labour2. After delivery examination Mother Infant 3. For next pregnancy ANC Early admission

  5. C. Excessive uterine Gontraction and retraction During labor there islline between upper and lower segment physiological retraction ring. In obstructed labor marked retraction Thickening of U. segment L. S stretched and thinned The retraction ring up felt in abdomen as transverse groove above umbiltcus ~ pathological retraction ring or Banuel's ring the uterus rupture

  6. II. HYPOTONIC UTERINE INERTIA Etiology - unknowna) General factor 1. Primigravida -- old primi 2. Anaemia and AntepartumHge 3. Toxaemia I. 4. Improper use pf analgesics b) Local Factor 1. Over distention and uterus 2.Anomalies of uterus 3. Disproportion . 4.Full bladder rectum 5. Uterine fibroid 6.Post maturity

  7. Clinical Picture1. Prolonged labour a. weak uterine ontraction b. slow cervical dilatation c. intact membrane d. retension of placenta e. atonic P.P. HgTREATMENT : A. Proper management 4st stage of labour: 1. Rest 2. Sedation 3. I. V. fluid glucose 4. Evacuate b adder and rectum 5. Observe F. --- CTG 6. Use Porte aD1 to assess - progress, labour 7. If membrane rupture - antibiotic

  8. B. Uterine stimulus: 1. Syntocinon 2. Close obseation FH • Oxytocin contra indicated in: a. Dispr portion b. Malpesentation c. Scar' uterus - relative d. Gran . D1ultipara e. F. Di~tressC. Operative interference 1.ARM - to accelerate lab. 2.Operative delivery. vaginal delivery forceps Ventous Abdominal C.S.

  9. Hypertonic Uterine Inertia

  10. 1. Common in primigravida2. If there is dispropdrtionMalpresentationMalpositionLabour is prolonged uterus contraction irregular and painful cervix slow dilation presenting part high fetal and maternal distress

  11. Treatment 1. Exclude disproportioh 2. Reassurance and I.V 3. Antibiotic 4. Good analgesia I 5. C.S indication disproportion f. distress

  12. ComplicationA. Mternal 1. Prolonged laboar --- exhaustion and ketoacidosis 2. infection 3. laceration, birth canal 4. p.pHge 5. Puerperal sepsis B. Fetal 1. Asphyxia 2. ICHge

  13. III. Contraction Ring DefinitionIt is localized annular spasm of the uterine muscles It causes prolonged 2nd stage In the 3rd stage hour glass Contraction of the uterus retain placenta P. P. HgeEtiology 1. Unknown 2. Malpresentatioh + malposition 3. Improper use of Syntocinon

  14. DiagnosisFeeling it with hand Treatment 1. Exclude disproportion 2. If forceps fail on ring below presentingpart C.S. 3. Give anesthesia in the ]"d and 3rd stage of labor DD between the contraction ring and pathological ring

  15. CERVICAL DYSTOCIADefinition:CX fails to dilate within reasonable time inspite good uterine contraction I. Organic Rigidity a. Stenosis Cervix -+ due to previous injury, amputation, over cauterization C. S Indicated

  16. ORGANIC OBST. CX ---» CERVICAL FIBROID ---» CA CX II. Functional RigidityNo history of * Trauma * Operative * No evidence of cervical anatomical change It is manifested by nondilatation of external os although cx effaced and head well applied it. ---» take long time or ---»obstructed labor TREATMENT: 1. Analgesia 2. F.D ---» C.S