Abnormal Labor Professor Abdulrahim Rouzi MB, ChB, FRCSC

Abnormal Labor Dystocia: Slow progress of labor due to Passage Passenger Contraction

Abnormal Labor Passage Abnormal birth canal Road traffic accidents

Abnormal Labor Passenger Macrosomia Abnormal presentation Abnormal position

Abnormal Labor Power Abnormal or ineffective uterine contractions

Abnormal Labor Friedman curve One way to divide labor Latent and active phase Normal and abnormal latent phase Primiparous versus multiparous

Abnormal Labor Active phase: Cervical dilation rate of 1.0 cm/hr for nulliparas and cm/hr for parous women If abnormal rule out obstruction May use oxytocin

Abnormal Labor Second Stage: From 10 cm dilated cervix to expulsion of fetus For primigravidae 2 hours without epidural and to 3 hours with epidural For multigravidae 1 hour without an epidural and to 2 hours with an epidural

Abnormal Labor Before intervention by operative vaginal delivery or cesarean section we must Make sure  1. Latent phase is passed  2.Efficient contractions achieved  How?

Abnormal Labor Use of intrauterine pressure devices Unit of measuring contractions Caput and molding

Cesarean section Indications can be fetal or maternal: Maternal Request Exhausation Repeat cesarean section Abnormal pelvis Transverse lie Placenta previa Non-reassuring fetal heart rate when an operative delivery is not attainable Nonvertex presenting twin Breech Many more indications, including repeat s( decline TOL) ands elective cesarean section

Cesarean section Fetal indications Non reassuring fetal heart rate Abnormal presentation Abnormal position Abnormal placentation (previa….etc)

Vacuum and forceps Maternal indications Inadequate expulsive maternal efforts Fetal indications Non reassuring FHT

Requirements for operative vaginal delivery Empty bladder Fully dilated cervix Adequate anesthesia Fetal presentation, position and station well known Lithotomy position Experience

Complications of operative vaginal deliveries Maternal and Fetal complications: Lacerations PPH Anesthesia copmplications Intracranial hemorrhage Cephalhematoma