1. Abnormal Labour page 211

2. Normal labour 3 elements : expulsive force birth canal fetus

3. Abnormal labour Abnormalities of the expulsive forces Abnormalities of the fetus Abnormalities of the maternal pelvis

4. Abnormal expulsive force Uterine dysfunction  hypotonic uterine dysfunction  hypertonic uterine dysfunction

5. Hypotonic uterine dysfunction Effective contraction: uterine activity is sufficient to make the cervix effacement and dilatation, fetus descent.

6. Etiology Cephalopelvic disproportion or fetal malposition abnormal uterus psychological factors endocrinal dysfunction excessive sedation or conduction analgesia

7. Clinical manifestation Coordinate hypotonic uterine dysfunction incoordinate hypotonic uterine dysfunction partogram: World Health Organization partograph

8. World Health Organization partograph A partogram was designed for use in developing countries (1992).Labour is divided into a latent phase,which should last no longer than 8hours, and an active phase starting at 3cm dilatation, the rate of which should be no slower than 1cm per hour. A 4- hour wait(lag time) is recommended before intervention when the active phase is slow. Labor is graphed and analysis includs use of alert and action lines. The protocol was found to be beneficial in Southeast Asia.(WHO,1994)

9. 7 concepts Prolonged latent phase:16 hr prolonged active phase:8 hr arrest active phase:0cm/2hr prolonged second-stage labor:2hr/1hr arrest second-stage labor:0cm/1hr delayed descent:<1cm/hr arrest descent:>=0cm/hr

10. Treatment Enhance the uterine contractibility the goal is to affect uterine activity that is sufficient to produce cervical change and fetal descent while avoiding uterine hyperstimulation and fetal distress.

11. Hypertonic uterine contraction Localized abnormalities of uterine action constriction ring pathological retraction ring  localized rings or constrictions of the uterus develop in association with prolonged labors, which is often the result of obstructed labor, with marked streching and thinning of the lower uterine segment. The ring may be seen clearly as an abdominal indentationand signifies impending rupture of the lower uterine segment.

12. Generalized abnormalities of uterine action Precipitate labor: extremely rapid-labor total duration less than 3 hours  abnormally low resistance  abnormally strong uterine and abdominal contractions  very rarely, the consequence of painful sensations and thus a lack of awareness of vigorous labor.