Management of Labor

International

Management of Labor

Management of Labor
International

Objectives
Definition and diagnosis of labor Definition and diagnosis of dystocia

Causes of dystocia
Prevention and management of dystocia

Appropriate use of oxytocin

Management of Labor
International

First Stage
Latent Phase Active Phase

Second Stage
Passive Active

Third Stage Fourth Stage

Management of Labor
International

Labor is regular frequent uterine contractions and cervical change (dilatation and effacement)

Management of Labor
International

Philpotts Partogram
10

Cervical dilatation (cm)

8
6 4 2 0 0 2 4 6 8 10

Time (hours)

Management of Labor
International

Source: WHO/UNFPA/UNICEF/WORLD BANK. IMPAC-Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. WHO 2000 (WHO/RHR/ 00.7)

Management of Labor
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Etiology of Dystocia
Power Passenger Passage

Management of Labor
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Adequate Powers
Contractions that
last 60 seconds

reach 50 - 60 mm Hg of pressure
occur every 2 - 3 minutes

or
result in good progress

Management of Labor
International

Preventing Dystocia
Accurate diagnosis of labor Management of prolonged latent phase

Labor preparation
Birth companion

Management of Labor
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Preventing Dystocia (cont.)

Ambulation Analgesia

Amniotomy (ARM)
Fetal size

Management of Labor
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Management of Dystocia
Arrest without CPD
- amniotomy

- consider oxytocin augmentation if contractions

are inadequate

Arrest with true CPD

- C-Section

Management of Labor
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Active Management of Labor

Rigorous diagnosis of labor Close surveillance of progress of labor by partogram Continuous support in labor

Management of Labor
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Active Management of Labor (cont.)

Early intervention to correct inadequate progress of labor - ARM - Oxytocin

Management of Labor
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Augmentation of Labor
Initial dose of oxytocin Increase interval 1 - 2 mU / min every 30 min.

Dosage increment
Usual dose for good labor

1 - 2 mU
8 - 10 mU / min.

Management of Labor
International

Contraction Strength with Oxytocin

Depends on: the dose of oxytocin and the uterine sensitivity to oxytocin

Management of Labor
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Adverse Effects of Oxytocin

Adverse Effect
Fetal compromise

Mechanism
Hyperstimulation

Prevention
Correct dose

Uterine rupture
Water intoxication Hypotension

Hyperstimulation
ADH effect Vasodilatation

Correct dose
Limit free water Low dose

Management of Labor
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Summary - Prevention of Dystocia

Avoid unnecessary induction
Admit women in active labor

Encourage ambulation / upright posture

Encourage the use of prenatal education

Continuous support of laboring women

Use of appropriate analgesia

Management of Labor
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Summary - Management of Dystocia

Appropriate assessment of adequate progress in labor
Appropriate intervention when necessary - Amniotomy - Analgesia - Rest - Ambulation - Augmentation - C-sections

Management of Labor
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Obstructed Labor

Management of Labor
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Definition and Incidence

Failure of descent of the fetus in the birth canal for mechanical reasons in spite of good uterine contractions. (Philpott, 1982)
Incidence: 1-3%

Management of Labor
International

Risks Associated with neglected obstructed labor

Fetal: Asphyxia, sepsis, death Maternal: Sepsis, uterine rupture, hemorrhage, fistula, death

Management of Labor
International

Fetal: Pelvic disproportion: Malpresentations, malposition, malformations

Etiology of Obstructed Labor

Maternal: Small pelvis, soft tissue tumors of the pelvis

Management of Labor
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Clinical Presentation of a Patient with Obstructed Labor

Dehydration Oliguria Keto-acidosis Sepsis

Management of Labor
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Clinical Presentation of a Patient with Obstructed Labor

State of the Uterus: Ruptured Uterus State of the Bladder: Vaginal Findings Cervical Findings

Management of Labor
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Complications of Obstructed Labor

Maternal:
Ruptured uterus Vsico-Vaginal Fistulae Recto-vaginal Fistulae Pueperal Sepsis

Fetal:
Asphyxia/ cerebral palsy Neonatal sepsis Death

Management of Labor
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Treatment

Prevention
- Good nutrition in childhood
- Promotion of antenatal care - Use of partogram in the health unit - Development of appropriate and timely referral systems

Cesarean section

Management of Labor
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Prolonged or neglected obstructed labor Ruptured Uterus