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Obstructed Labor & Prolonged Labur

Obstructed Labor & Prolonged Labur. Objective. Determine the factors affecting normal labor Early diagnosis of abnormal labor How to manage abnormal or prolonged labor. Identify the complications of prolonged labor. Determinants of Successful Labor.

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Obstructed Labor & Prolonged Labur

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  1. Obstructed Labor & Prolonged Labur

  2. Objective • Determine the factors affecting normal labor • Early diagnosis of abnormal labor • How to manage abnormal or prolonged labor. • Identify the complications of prolonged labor.

  3. Determinants of Successful Labor ► Adequate Power (uterine contractions) ► Adequate Passage (maternal pelvis) ► Adequate Passenger (fetal size) • DEFINITION OF PROLONGED LABOUR • When labor tends to be prolonged for more • than 18 hours both in primigravida and • multigravida women

  4. Causes ►Fault in passage ►Fault in passenger ►Fault in power : ▪ Hypotonic Uterine Dysfunction (inertia) ►Can be 2ry to Epidural analgesia or • Chorioamnionitis • ▪ Hypertonic / In coordinate Uterine function

  5. Diagnosis • History: • 1.Age • 2.Parity • 3.Duration of labor • 4.Duration of membrane rupture • 5.Whether the patients was handle outside the hospital • 6.Whether she was treated with oxytocin drugs • 7.Previous history of difficult labor, instrumental delivery or stillbirth

  6. Abdominal examination: • 1. Contour of the uterus • 2. Presentation & position • 3. Tenderness • 4. Frequency, intensity & duration of uterine contraction • 5. Lower segment distended • 6. Distension of the bladder

  7. Vaginal examination: - The vulva usually swollen and edematous. - The vaginal is dry, hot and occasionally offensive and purulent discharge - The cervix is almost fully dilated - The presenting part is extremely molded and jammed in the pelvis - There is usually large caput formation

  8. Management A. General management : 1. NPO & i/v fluid start immediately 2. Bladder evacuation. 3. Parenteral antibiotics. 4. Intake output chart should be strictly maintain 5. Blood should be send for grouping and cross matching

  9. Obstetric Management • During 1st stage: 1. Role of oxytocin : hypotonic uterine contraction • Role of sedation : incoordinateuterine contraction use of narcotics may lead to spontaneous correction • Role of amniotomy in correction of hypotonic uterine contraction 4. Role of cesarean section: contracted pelvis, big baby, malpresentation, malposition, severe fetal distress

  10. During 2nd stage: 1. Role of episiotomy: rigid / tight perineum 2. Role of instrumental delivery (Forceps or Vacuum): in case of fetal distress, • 3. Role of cesarean section: contracted pelvis, big baby, malpresentation, malposition, and severe fetal distress

  11. Complications

  12. Obstructed labour ►Definition : defined as labor where there is poor or no progress of labor in spite of good uterine contraction! ►Incidence :- 1 -2% of cases in developing country

  13. Causes ►Maternal condition (fault in the passage): 1. Contracted pelvis 2. Abnormal pelvis: android, anthropoid 3. Pelvic tumor: fibroid, ovarian tumor 4. Tumor of rectum, bladder or pelvic bone 5. Abnormality in uterus & vagina: scarring in cervix, vaginal septum, rigid perineum

  14. fetal causes • Big baby • Big head, hydrocephalus • Deflexed head, brow and face mentoposterior. • Oblique or transverse lie

  15. Diagnosis ►Partogramwill recognize impending obstruction of labor ►Careful general, abdominal and vaginal examination can detect if labor is slow or no progress

  16. General examination: • Features of maternal distress • Dehydration • Tachycardia >100/m • Raise temperature • Scanty urine

  17. Abdominal examination : • -The retraction ring might appear and felt • between the tonic contracted upper • segment of the uterus and the distended • lower segment • - Distended urinary bladder

  18. Vaginal examination: - The vulva usually swollen and edematous - The vaginal can be dry and hot - The cervix is almost fully dilated or hanging like a curtain - The presenting part is extremely molded and jammed in the pelvis - There is usually large caput formation

  19. Complication

  20. Management ►Preventive: - Proper assessment of pregnant woman during ANC - Regular ANC visit - Proper assessment in early labor to - Use of Partogram - Prompt and appropriate treatment

  21. Obstetric Management 1. Delivery of fetus: a. Vaginal delivery: if head is low and vaginal delivery is not risky, forceps extraction may be done b. Caesarean section: 2. Active management of 3rd stage of labor 3. Continuous bladder drainage for 2-3 days to prevent any urogenital fistula

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