abnormal labor

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Abnormal labor:

Abnormal labor 11/1/2013 A Amani UOK nursing 1

Introduction:

Introduction Labor is a physiological process during which a fetus is expelled. The mainly labor force is uterine contracion. In the labor process, cervical effacement and dilation and fetal delivery occur. 11/1/2013 A Amani UOK nursing 2

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Normal labor:

Normal labor Normal labor is divided into 3 stages by Froedman. The first stage, the second stage and the third stage. The first stage is subdivided into the latent phase and the active phase. 11/1/2013 A Amani UOK nursing 4

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Normal labor staging:

Normal labor staging 11/1/2013 A Amani UOK nursing 6

Abnormal labor :

Abnormal labor Abnormal labor refers to difficult labor. Another name is dystocia. Clinical presentation is slow labor process. 11/1/2013 A Amani UOK nursing 7

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The diagnostic criteria of abnormal labor:

The diagnostic criteria of abnormal labor 11/1/2013 A Amani UOK nursing 9

Causes of abnormal labor:

Causes of abnormal labor Abnormalities of expulsive forces Abnormalities of birth canal Abnormalities of presentation & position of fetus 11/1/2013 A Amani UOK nursing 10

Abnormalities of birth canal:

Abnormalities of birth canal The morphology and capacity are primary causes of dystocia. Pelvic structure: pubis, sacrum and ischium. Pelvic plane: inlet, midpelvic and outlet Bony marker: ischial spine 11/1/2013 A Amani UOK nursing 11

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Ischial spine:

Ischial spine The Ischial spine is halfway of birth canal. Station of fetal presentation is discribed in relationship with the ischial spine. the axis of birth canal above and below the ischial spine is divided into fifth respectively. As the presenting part reaches the ischial spine, the designation is 0 station. 11/1/2013 A Amani UOK nursing 14

Classification of abnormalities of pelvis:

Classification of abnormalities of pelvis Contracted pelvis contracted inlet plane contracted midpelvis contracted outlet plane Pelvic malformation 11/1/2013 A Amani UOK nursing 15

Mechanism :

Mechanism For Contracted pelvis , the fetus has difficulty in passing through birth canal. The labor is protracted or arrested. Secondary uterine inertia occurs. 11/1/2013 A Amani UOK nursing 16

Contracted inlet plane:

Contracted inlet plane Ctriteria: sacral-pubic diameter<18cm Clinical findings: fetal head palpable above the inlet plane. prolonged latent phase 11/1/2013 A Amani UOK nursing 17

Contracted midpelvis and outlet plane:

Contracted midpelvis and outlet plane Bi-ischial spine diameter<10cm Bi-ischial tubercle diameter<8cm Clinical findings: disorders of active phase and the second stage. 11/1/2013 A Amani UOK nursing 18

Management:

Management To assess cephalopelvic relationship by a series of examination. Mild cephalopelvic disproportion: trial labor Obvious cephalopelvic disproportion: cesarean section. 11/1/2013 A Amani UOK nursing 19

Abnormalities of fetus:

Abnormalities of fetus Abnormalities of fetal position Macrosomia Fetal malformation 11/1/2013 A Amani UOK nursing 20

Fetal status:

Fetal status Fetal lie:The relation of the fetal long axis to that of the mother is termed fetal lie and is either longitudinal or transverse Fetal presentation: the foremost part in birth canal. Cephalic, breech and should presentation. 11/1/2013 A Amani UOK nursing 21

Cephalic presentation:

Cephalic presentation According to degree of fetal head flex, cephalic presentation is divided into vertex, brow and face presentation. Brow and face presentation result in dystocia. 11/1/2013 A Amani UOK nursing 22

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Fetal head diameter:

Fetal head diameter Bi-parietal dimension: 9.5cm Suboccipitobregmatic dimension: 9.5cm Occipitofrontal dimension:11.5cm Occipitomental dimension: 13cm 11/1/2013 A Amani UOK nursing 26

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Fetal position:

Fetal position Refer to relation of fetal presentation to mother’s pelvis. The occipital bone is the determining point of vertex presentation. vertex presentation has a variety of positions. 11/1/2013 A Amani UOK nursing 29

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Definition of Persistent Occiput transverse position : engagement and descent of fetal head in Occiput transverse position. Definition of Persistent Occiput posterior position : engagement and descent of fetal head in Occiput posterior position. 11/1/2013 A Amani UOK nursing 30

Cephalic dystocia:

Cephalic dystocia In cephalic presentation, when delivery cannot be accomplished with occiput anterior position, it is called cephalic dystocia. Clinical findings: disorders of labor process 11/1/2013 A Amani UOK nursing 31

Management :

Management To assess cephalopelvic relationship by a series of examination. Mild cephalic distocia: trial labor Obvious cephalic distocia: cesarean section. 11/1/2013 A Amani UOK nursing 32

Transverse lie:

Transverse lie The longitudinal axis of the fetus is perpendicular to that of the mother. The presenting part is the shoulder. Management: cesarean section. 11/1/2013 A Amani UOK nursing 33

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Breech presentation:

Breech presentation Incidence: 3-5% Classification: frank, complete and incomplete Basis: hip and knee flexed or extended Management: cesarean section 11/1/2013 A Amani UOK nursing 35

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Abnormal uterine contractions:

Abnormal uterine contractions The uterine contraction is the most important expulsive force. Bring about dilation of cervix and expulsion of fetus and placenta. Common causes of dystocia 11/1/2013 A Amani UOK nursing 39

Classification:

Classification Hypotonic uterine dysfunction: another name Uterine inertia. Uterine contractions is less than normal. Hypertonic uterine dysfunction: uterine tone elevated. Uterine inertia is more common. 11/1/2013 A Amani UOK nursing 40

Clinical presentation:

Clinical presentation Abdominal palpation: uterine contraction is weak, and intervals is prolonged. Abnormal labor course: the most important clinical presentation. 11/1/2013 A Amani UOK nursing 41

The diagnostic criteria of abnormal labor:

The diagnostic criteria of abnormal labor 11/1/2013 A Amani UOK nursing 42

Interaction :

Interaction 11/1/2013 A Amani UOK nursing 43

Management :

Management Vaginal examination: rule out cephalopelvic disproportion Supportive mangement augmentation 11/1/2013 A Amani UOK nursing 44

The Vaginal examination:

The Vaginal examination To determine fetal presentation, position and station. To assess the cephalopelvic relation. To consider the route of delivery. 11/1/2013 A Amani UOK nursing 45

The supportive management:

The supportive management Sufficient rest To relieve anxiety and fear. Fluid and food intake. 11/1/2013 A Amani UOK nursing 46

Augmentation:

Augmentation Increase the frequency and force of the existing uterine contractions. Methods: amniotomy oxytocin administration 11/1/2013 A Amani UOK nursing 47

Amniotomy :

Amniotomy If the fetal head is engaged, amniotomy is a choice to facilitate the uterine activity. After amnitomy the fetal head descends , pressing directly on cervix to enforce uterine contraction. Accelerating labor. 11/1/2013 A Amani UOK nursing 48

oxytocin:

oxytocin Capable of inducing uterine contracion in the third trimester. Contraindiction: cephalopelvic disproportion and severe fetal malposition. 11/1/2013 A Amani UOK nursing 49

questions :

questions To state The pattern of abnormal labor. To state the causes of abnormal labor. To state the classification of breech presentation. 11/1/2013 A Amani UOK nursing 50

Thanks :

Thanks 11/1/2013 A Amani UOK nursing 51