what is labor ? (: work)
DESCRIPTION
What is Labor ? (: work). Regular painful uterine contractions accompanied by progressive effacement and dilatation of the cervix. Timing of Labor. 40 weeks 8% deliver on E.D.C. 7% premature < 37 weeks 10% post-mature > 42 weeks. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/1.jpg)
What is Labor ?
(: work)
Regular painful uterine contractions
accompanied by progressive effacement
and dilatation of the cervix
![Page 2: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/2.jpg)
Timing of Labor
• 40 weeks
• 8% deliver on E.D.C.
• 7% premature < 37 weeks
• 10% post-mature > 42 weeks
![Page 3: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/3.jpg)
Signs of Onset of Labour
“Show”
Rupture of membranes
Contractions
![Page 4: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/4.jpg)
Detection of ruptured membranes
Nitrazine Test - alkaline pH of fluid
turns blue
Ferning - high Na+ content causes
“ferning” on air dried slide
![Page 5: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/5.jpg)
Stages of Labor
1st stage - Onset to ‘full dilatationLatent active
2nd stage - Full dilatation to deliveryof baby
3rd stage - Delivery of placenta
4th stage - Bonding
![Page 6: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/6.jpg)
![Page 7: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/7.jpg)
![Page 8: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/8.jpg)
![Page 9: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/9.jpg)
![Page 10: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/10.jpg)
![Page 11: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/11.jpg)
![Page 12: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/12.jpg)
DR. DR.
![Page 13: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/13.jpg)
Table 30-1. Characteristics of Labor Nulliparas and Multiparas*
Characteristic All patients Ideal Labor All patients Ideal laborNulliparas Multiparas
Duration of first stage(hr)Latent phase 6.4(±5.1) 6.1 (±4.0) 4.8 (±4.9) 4.5 (±4.2)Active phase 4.6(±3.6) 3.4(±1.5) 2.4(±2.2) 2.1 (±2.0)Total 11.0(±8.7) 9.5(±5.5) 7.2(±7.1) 6.6(±6.2)
Maximum rate of descent (cm/hr) 3.3(±2.3) 3.6(±1.9) 6.6(±4.0) 7.0(±3.2)Duration of secondstage (hr) 1.1(±0.8) 0.76(±0.5) 0.39(±0.3) 0.32(±0.3)
* All values given are ± SD.
(Data from Friedman EA: Labor: Clinical Evaluation and Management. 2nd ed. New York, Appleton-Century-Crofts, 1978).
![Page 14: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/14.jpg)
![Page 15: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/15.jpg)
![Page 16: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/16.jpg)
![Page 17: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/17.jpg)
![Page 18: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/18.jpg)
![Page 19: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/19.jpg)
Cesarean SectionIndications
Failure to progressRepeat (Failed VBAC)Fetal DistressBreech PresentationPlacenta PreviaCord prolapseAbruptionDiabetesSocial...
![Page 20: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/20.jpg)
DYSTOCIA
![Page 21: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/21.jpg)
DYSTOCIA DIAGNOSIS• Abnormal progression of labour in
the ACTIVE Phase– Cervical dilatation of <0.5 cm/hr over a 4 hr
period– arrest of progress in the ACTIVE phase
either in the first or second stage of labour
This includes a failure in the descent of the presenting part
![Page 22: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/22.jpg)
![Page 23: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/23.jpg)
OUTCOME OF PROLONGED LATENT PHASE
• NCPP 1965 Apgar perinatal death and poor outcomewhere latent phase greater than 15 hours
• Chelmow are 1993 - for labour intervention and low apgars where latent phase greater than 12 hours in nullip and 6 hours in multips
• Piezner 1985 found that length of latent phase related to cervical dilatation on admission
• Roemer 1996 found lower I.Q.’s in siblings with dystocia greater than 12 hours.
![Page 24: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/24.jpg)
CAUSES OF DYSTOCIA
Power Incoordinate uterine action Dysfunctional Labour
Passenger CPDRelative disproportion
Passages Diameters
![Page 25: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/25.jpg)
DYSTOCIA
• A 4 cm cut off separates latent from active labour
• Abnormal progress never diagnosed before 4cm dilatation
• Women not in active labour ‘triaged’ from the labour floor
![Page 26: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/26.jpg)
CESAREAN SECTION FOR DYSTOCIA
• Timing of procedure Rate
• Latent phase 41%• Active phase 38%• Second stage 21%
• Source: Stewart CMAJ 1990:142; 459-463
![Page 27: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/27.jpg)
DYSFUNCTIONAL LABOUR - FACTORS OF INTEREST
• Age• Parity• Infection• Epidural• Position in labour• Cervix• Induction• Macrosomia
![Page 28: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/28.jpg)
INITIAL MEASURE TO TREAT DYSTOCIA
– Comfort– wellbeing– hydration
B. Amniotomy
C. Oxytocin if A+B fail
D. Wait long enough to see a response
A. Attention to
![Page 29: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/29.jpg)
![Page 30: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/30.jpg)
OXYTOCIN USAGEInitial dose: 1 to 2 mlu/min
Rate increased by 1 to 2 mlu/min every 30 min
Until contractions are considered adequateand
cervical dilatation achieved
Clinical response usually seen at dose levels of 8 - 10 mlu/min
![Page 31: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/31.jpg)
REDUCTION OF RISK OF DYSTOCIA
Factors to avoid• Induction for large fetal weight
• Oxytocin use with unfavourable cervix
• No admission to Labour and Delivery at <4cm dilatation
• Discontinuation of epidural at full dilatation
• Immediate pushing after full dilatation
![Page 32: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/32.jpg)
![Page 33: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/33.jpg)
![Page 34: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/34.jpg)
![Page 35: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/35.jpg)
SUPPORTIVE STRATEGIES
• Cervical evaluation for ripening prior to booking induction
• Obstetrical triage• Continuous professional support in active
labour• Mobilisation of women in active labour• Minimisation of motor blockage with epidural• Use of amniotomy and oxytocin prior to C/S
for dystocia
![Page 36: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/36.jpg)
APPROPRIATE MANAGEMENT FOR SLOW LABOURASSOCIATED WITH AN OCCIPITO POSTERIORDURING THE FIRST STAGE OF LABOUR WOULDINCLUDE:
a) immediate cesarean section
b) forceps
c) augmentation with oxytocin
d) external cephalic version
e) fetal blood sampling
![Page 37: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/37.jpg)
![Page 38: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/38.jpg)
![Page 39: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/39.jpg)
![Page 40: What is Labor ? (: work)](https://reader036.vdocuments.net/reader036/viewer/2022062305/568148c6550346895db5e2d3/html5/thumbnails/40.jpg)
NS NS
--------------------------------------------
C C C C C C C