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Презентация на тему Diagnosis and mangement of abnormal labour

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2. Labor refers to uterine contractions resulting in
3. Abnormal labor, dystocia, and failure to progress
4. A better classification is to characterize labor
5. Approximately 20 percent of labors involve either
6. NORMAL LABOR Friedman, in his classic studies,
7. NORMAL LABORThird stage: time from expulsion of
8. NORMAL LABORFirst stage = A + B
9. Latent phase The onset of the latent
10. Latent phaseThis phase is typically characterized by
11. Latent phaseThe average duration of latent phase
12. Latent phaseAn abnormally long latent phase is
13. Active phase The beginning of the active
14. Active phaseThe active phase is characterized by
15. Active phaseThe average duration of the active
16. Active phaseAn abnormally long active phase is
17. Second stage The mean duration of the
18. Second stageabnormally long second stage as three
19. Second stageNeuraxial anesthesia, duration of the first
20. Second stage(ACOG) recommends that the normal duration
21. Normal uterine activity Uterine activity can be
22. Normal uterine activityExternal and intrauterine monitoring devices
23. Normal uterine activityNinety-five percent of women in
24. Normal uterine activityMontevideo units (ie, the peak
25. Normal uterine activity91 percent of women in
26. CLASSIFICATION AND DIAGNOSIS OF LABOR ABNORMALITIES
27. Diagnostic criteria for abnormal patterns in active
28. Protraction and arrest disorders occur in both
29. In the first stage of labor progressive
30. An arrest disorder can be diagnosed when
31. second stage of laborprotracted labor is defined
32. An arrest of descent can be diagnosed
33. labor can be too fast
34. ETIOLOGY Abnormal labor can be the result
35. Risk factors for abnormal labor
36. The passages (the pelvis)Pelvic inlet A-P
37. The passages (the pelvis)The clinician's ability to
38. Clinical or radiologic assessment of the maternal
39. The passengerFetal weight, larger babies will have
40. The passengerThe most common presentation is vertex,
41. The passengerThe occiput is on the longer
42. The passengerOccipitofrontl 11.5 cm (Brow presentation)
43. The powersHypocontractile uterine activity is the most
44. The powersThis entity refers to uterine activity
45. The powersIt occurs in 3 to 8
46. The powersNeuraxial anesthesia neuraxial anesthesia is associated
47. The powersNeuraxial anesthesia has not been proven to increase the rate of cesarean delivery
48. The powersIt is possible that changes in
49. The powersThe consequences of withdrawing the block
50. MANAGEMENT disciplined approach to the diagnosis of
51. Advancement of cervical dilation charted on a partogram.
52. MANAGEMENT Poor progression in the first stage Hypocontractile
53. MANAGEMENT Other — Other interventions, such as ambulation and continuous
54. MANAGEMENT Poor progression in the second stage Three
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Labor refers to uterine contractions resulting in progressive dilation and effacement of the cervix, and accompanied by descent and expulsion of the fetus

Diagnosis and mangement of abnormal labourDr.Entesar Al-MadaniObstetrician, Gynecologist & perinatologist

Abnormal labor, dystocia, and failure to progress are imprecise terms that have

A better classification is to characterize labor abnormalities as protraction disorders (ie,

Approximately 20 percent of labors involve either protraction or arrest disordersA labor

NORMAL LABOR Friedman, in his classic studies, divided labor into three stagesFirst

NORMAL LABORThird stage: time from expulsion of the fetus to expulsion of

NORMAL LABORFirst stage = A + B + C + D where

Latent phase The onset of the latent phase of labor begins when

Latent phaseThis phase is typically characterized by mild infrequent contractions and a

Latent phaseThe average duration of latent phase in nulliparous and multiparous women

Latent phaseAn abnormally long latent phase is defined as 20 hours for

Active phase The beginning of the active phase typically occurs when the

Active phaseThe active phase is characterized by painful contractions of increasing frequency,

Active phaseThe average duration of the active phase in nulliparous and parous

Active phaseAn abnormally long active phase is defined as 12 hours for

Second stage The mean duration of the second stage of labor in

Second stageabnormally long second stage as three hours for the nulliparous and

Second stageNeuraxial anesthesia, duration of the first stage, parity, maternal size, birth

Second stage(ACOG) recommends that the normal duration of second stage of labor

Normal uterine activity Uterine activity can be monitored by palpation, external tocodynamometry,

Normal uterine activityExternal and intrauterine monitoring devices appear to perform equally well,

Normal uterine activityNinety-five percent of women in active labor will have three

Normal uterine activityMontevideo units (ie, the peak strength of contractions in mmHg

Normal uterine activity91 percent of women in spontaneous active labor achieved contractile

CLASSIFICATION AND DIAGNOSIS OF LABOR ABNORMALITIES

Diagnostic criteria for abnormal patterns in active labor Values represent approximately two

Protraction and arrest disorders occur in both the first and second stages

In the first stage of labor progressive dilatation slower than the rate

An arrest disorder can be diagnosed when the cervix ceases to dilate

second stage of laborprotracted labor is defined as a second stage longer

An arrest of descent can be diagnosed after one hour if there

labor can be too fast as well as too slow

ETIOLOGY Abnormal labor can be the result of one or more abnormalities

The passages (the pelvis)Pelvic inlet A-P 11.5 cm

The passages (the pelvis)The clinician's ability to predict maternal pelvis-fetal size discordance

Clinical or radiologic assessment of the maternal pelvis (ie, pelvimetry) is associated

The passengerFetal weight, larger babies will have greater difficulty in passing through

The passengerThe most common presentation is vertex, which occurs in 96 percent

The passengerThe occiput is on the longer end of the head lever.

The passengerOccipitofrontl 11.5 cm (Brow presentation)

The powersHypocontractile uterine activity is the most common cause of protraction or

The powersThis entity refers to uterine activity that is either not sufficiently

The powersIt occurs in 3 to 8 percent of parturients and can

The powersNeuraxial anesthesia neuraxial anesthesia is associated with an increased duration of

The powersNeuraxial anesthesia has not been proven to increase the rate of cesarean delivery

The powersIt is possible that changes in neuraxial technique or drugs (eg,

The powersThe consequences of withdrawing the block before the second stage of

MANAGEMENT disciplined approach to the diagnosis of labor, assessment of maternal and

Advancement of cervical dilation charted on a partogram.

MANAGEMENT Poor progression in the first stage Hypocontractile uterine activity is treated with

MANAGEMENT Other — Other interventions, such as ambulation and continuous labor support, may increase the

MANAGEMENT Poor progression in the second stage Three options:Continued observation Attempt at operative

Слайды презентации

Слайд 2
Labor refers to uterine contractions resulting in progressive

Labor refers to uterine contractions resulting in progressive dilation and effacement

dilation and effacement of the cervix, and accompanied by

descent and expulsion of the fetus

Слайд 3
Abnormal labor, dystocia, and failure to progress are

Abnormal labor, dystocia, and failure to progress are imprecise terms that

imprecise terms that have been used to describe a

difficult labor pattern that deviates from that observed in the majority of women who have spontaneous vaginal deliveries

Слайд 4
A better classification is to characterize labor abnormalities

A better classification is to characterize labor abnormalities as protraction disorders

as protraction disorders (ie, slower than normal progress) or

arrest disorders (ie, complete cessation of progress)

Слайд 5
Approximately 20 percent of labors involve either protraction

Approximately 20 percent of labors involve either protraction or arrest disordersA

or arrest disorders
A labor abnormality is the most common

indication for primary cesarean birth

Слайд 6 NORMAL LABOR
Friedman, in his classic studies, divided

NORMAL LABOR Friedman, in his classic studies, divided labor into three

labor into three stages
First stage: time from the onset

of labor until complete cervical dilatation
Second stage: time from complete cervical dilatation to expulsion of the fetus

Слайд 7 NORMAL LABOR
Third stage: time from expulsion of the

NORMAL LABORThird stage: time from expulsion of the fetus to expulsion

fetus to expulsion of the placenta

The first stage

is further subdivided into the latent and active phases, the active phase subdivided into three additional phases: acceleration phase, phase of maximum slope, and deceleration phase

Слайд 8 NORMAL LABOR
First stage = A + B +

C + D where
A=latent phase; B=acceleration phase; C=phase

of maximum slope; D=deceleration phase Second stage = E

Слайд 9 Latent phase
The onset of the latent phase

Latent phase The onset of the latent phase of labor begins

of labor begins when the mother perceives regular contractions.

Слайд 10 Latent phase
This phase is typically characterized by mild

Latent phaseThis phase is typically characterized by mild infrequent contractions and

infrequent contractions and a gradual change in cervical dilation

(usually <1 cm per hour) and effacement

Слайд 11 Latent phase
The average duration of latent phase in

Latent phaseThe average duration of latent phase in nulliparous and multiparous

nulliparous and multiparous women is 6.4 and 4.8 hours,

respectively, and is not influenced by maternal age, birth weight, or obstetric abnormalities

Слайд 12 Latent phase
An abnormally long latent phase is defined

Latent phaseAn abnormally long latent phase is defined as 20 hours

as 20 hours for the nullipara and 14 hours

for the multiparous woman
It reflect four standard deviations from the mean duration of latent phase in the women

Слайд 13 Active phase
The beginning of the active phase

Active phase The beginning of the active phase typically occurs when

typically occurs when the cervix has reached 3 to

4 centimeters dilation

Слайд 14 Active phase
The active phase is characterized by painful

Active phaseThe active phase is characterized by painful contractions of increasing

contractions of increasing frequency, intensity, and duration accompanied by

a rapid rate of cervical change (usually >1 cm hour)

Слайд 15 Active phase
The average duration of the active phase

Active phaseThe average duration of the active phase in nulliparous and

in nulliparous and parous women is 4.6 and 2.4

hours, respectively

Слайд 16 Active phase
An abnormally long active phase is defined

Active phaseAn abnormally long active phase is defined as 12 hours

as 12 hours for the nullipara and 5 hours

for the multiparous woman

Слайд 17 Second stage
The mean duration of the second

Second stage The mean duration of the second stage of labor

stage of labor in nulliparous and multiparous women is

66 and 20 minutes, respectively

Слайд 18 Second stage
abnormally long second stage as three hours

Second stageabnormally long second stage as three hours for the nulliparous

for the nulliparous and one hour for the multiparous

woman

Слайд 19 Second stage
Neuraxial anesthesia, duration of the first stage,

Second stageNeuraxial anesthesia, duration of the first stage, parity, maternal size,

parity, maternal size, birth weight, and station at complete

dilation all play a role in predicting duration of the second stage

Слайд 20 Second stage
(ACOG) recommends that the normal duration of

Second stage(ACOG) recommends that the normal duration of second stage of

second stage of labor be based upon parity and

presence of regional anesthesia, with no intervention as long as the fetal heart rate pattern is normal and some degree of progress is observed

Слайд 21 Normal uterine activity
Uterine activity can be monitored

Normal uterine activity Uterine activity can be monitored by palpation, external

by palpation, external tocodynamometry, or internal uterine pressure catheters

Слайд 22 Normal uterine activity
External and intrauterine monitoring devices appear

Normal uterine activityExternal and intrauterine monitoring devices appear to perform equally

to perform equally well, although the latter may work

better in obese women

Слайд 23 Normal uterine activity
Ninety-five percent of women in active

Normal uterine activityNinety-five percent of women in active labor will have

labor will have three to five contractions per 10

minutes

Слайд 24 Normal uterine activity
Montevideo units (ie, the peak strength

Normal uterine activityMontevideo units (ie, the peak strength of contractions in

of contractions in mmHg measured by an internal monitor

multiplied by their frequency per 10 minutes) are most often employed

Слайд 25 Normal uterine activity
91 percent of women in spontaneous

Normal uterine activity91 percent of women in spontaneous active labor achieved

active labor achieved contractile activity greater than 200 Montevideo

units and 40 percent reached 300 Montevideo units

Слайд 26 CLASSIFICATION AND DIAGNOSIS OF LABOR ABNORMALITIES

Слайд 27 Diagnostic criteria for abnormal patterns in active labor

Diagnostic criteria for abnormal patterns in active labor Values represent approximately

Values represent approximately two standard deviations from the mean

Слайд 28
Protraction and arrest disorders occur in both the

Protraction and arrest disorders occur in both the first and second

first and second stages of labor

The incidence is about

15 percent in either stage

Слайд 29
In the first stage of labor
progressive dilatation

In the first stage of labor progressive dilatation slower than the

slower than the rate shown in the table is

suggestive of a protraction disorder

Слайд 30
An arrest disorder can be diagnosed when the

An arrest disorder can be diagnosed when the cervix ceases to

cervix ceases to dilate after reaching four or more

centimeters dilatation despite adequate uterine contractions (greater than or equal to 200 Montevideo units for two or more hours)

Слайд 31
second stage of labor
protracted labor is defined as

second stage of laborprotracted labor is defined as a second stage

a second stage longer than two hours in nulliparas

(three hours when regional analgesia is used), and longer than one hour in multiparas (two hours when regional analgesia is used)

Слайд 32
An arrest of descent can be diagnosed after

An arrest of descent can be diagnosed after one hour if

one hour if there is no descent, despite good

maternal pushing efforts

Слайд 33
labor can be too fast as

well as too slow
The term precipitous labor refers

to a labor that lasts no more than 3 hours from onset of contractions to delivery
A precipitous second stage refers to a second stage that is less than 15 to 20 minutes in duration.