Precipiate and Slow Labour

University:
Stanford University
Course:
PEDS 282 | Pregnancy, Birth, and Infancy
Academic year:

2023
Views:

62

Pages:

1
Author:

Pierre BERNARD

Precipiate and Slow Labour Precipitate Labour Hypoxia – placenta blood is from intramyometrial vessels (so stops during contraction). Worsens if contractions are increased in frequency or duration Spontaneous Hypercontractility – excessively long or frequent à risk of fetal hypoxia Hyperstimulation – due to the use of oxytocics (syntocinon & prostaglandins) Uterine rupture – is a risk with parous women, esp if C-sect scar Placental Abruption – assoc with contractions > every 2 min. also abdo pain, back ache, vaginal bleeding. Management – stop any oxytocics & give tocolytic (terbutaline/ritodrine). If severe fetal distress à instrumental / operative delivery (dep on cervical dilatation) Slow Labour Assoc with – fetal distress & risk of hypoxia, infection, maternal anxiety & psychological scarring, loss of confidence in staff & increased requirement for instrumental / operative delivery Causes – hypoactive/incoordinate uterus (prolonged active phase with 2o arrest), obstruction (cephalopelvic disproportion & shoulder dystocia) Prolonged latent phase – cervix unfavourable, common in primips, usually no serious cause or problem Prolonged active phase – Hypoactive uterus – low resting tone & weakly propagated contractions. Long intervals between contractions & not very painful Incoordinate uterus – inadequate “fundal dominance” (where contractions should originate). Maximum contractions occur at lower segment rather than fundus. Also increased resting tone and pain threshold reached sooner. Inadequate uterine activity – no specific cause, more common in primips. Management - Mostly respond well to oxytocics (ensure mother does not become dehydrated or ketotic Cephalopelvic Disproportion = 2o arrest True - Head is presenting optimally but is too large Malpresentation/Malpositition – presenting part is relatively too large (usually if OP) Pelvic anomaly – due to abnormal shape to pelvis. Due to rickets in childhood, injury, disease or congenital malformation. Management of slow labour Try to establish cause. Consider starting syntocinon (risks hyperstimulation & uterine rupture- esp if multip with scar) if no fetal distress & ROM occurred. Titrate infusion to 3-4 per 10 minutes. VE every 2-3 hours to ensure progress. Otherwise operative delivery required.