Obstructed and Prolonged labor

Obstructed and Prolonged Labor

Prolonged Labor

When the first and second stages of labor extend more than 12 hours without counting false labor, this is referred to as prolonged labor. The length of labor is determined by the mother's subjective estimation of the start of real labor. When a good contraction is present, the presenting part stays high or descends slowly; this is referred to as prolonged labor.

Cause

• Fault in the Power: abnormal uterine action.
• Hypotonic uterine dysfunction.
• Hypertonic uterine dysfunction.
  • In co—ordinate uterine action.
  • Colicky uterus.
  • Asymmetrical uterine contraction.
  • Constriction ring.
  • Generalized tonic contraction.
  • Cervical dystocia.
• Fault in the Passage
  • Contracted pelvis.
  • Cephalo-pelvic disproportion.
  • Pelvic tumor.
  • Congenital abnormalities of vagina.
  • Rigid perineum.
  • Even full bladder.
• Fault in the passenger.
• Malposition: occipito-posterior position.
• Malpresentation: face, brow, shoulder and compound presentation.
• Fetal macrocosmia or big baby.
• Fetal malformation.
• Other
  • Psychological causes
  • Judicious administration of sedative and analgesics before actual active labors begins.

Management of Prolonged Labor

• It could be advisable to simply relax for a short period if labor is moving slowly. When using medication to relax and lessen labor pains, a person may feel the need to adjust their body posture in order to feel more comfortable.
• Depending on why your labor is taking so long, you may need additional treatment.
• The doctor or midwife may use forceps or a vacuum device to help pull the baby out through the vagina if it is already in the birth canal.
• Pitocin may be administered if your doctor determines that you require more or more forceful contractions (oxytocin). This medication strengthens and accelerates contractions. You might require a C-section if the labor is still not progressing after your doctor determines that you are contracting sufficiently.
• You will require a C-section if the baby is too big or the medication does not hasten delivery.

Obstructed Labor

Strong uterine contractions can cause obstructed labor, which is when labor does not advance. There is no indication that the presenting component is gradually descending as a result of mechanical blockage, and if the labor is let to continue, obstruction characteristics would emerge.

Causes

• Fault in the passage.
• Contracted pelvic.
• Pelvic tumor.
  • Uterine fibroid, fibroid in cervix.
  • Ovarian tumors.
  • Fibroid in lower pole of the uterus.
• Tumor of pelvic bone, rectum or bladder.
• Stenosis of the cervix.
• Sacculation of the uterus.
• Contraction ring of the uterus.
• Fault in the passenger.
• Large baby.
• Malpresentation- brow, face, transverse or oblique lie and locked twins.
• Malformation of the fetus.
  • Hydrocephalus.
  • Fetal ascites.
  • Fetal abdominal tumor.
  • Conjoined twins.
• Malposition: persisted occipito-posterior position.

Signs and Symptoms

• Labor is typically drawn out.
• Despite a strong uterine contraction, the presenting portion does not enter the pelvic brim.
• uterine contractions that are only somewhat relaxed in between.
• Slow cervix enlargement with effacement drapes below the presenting area like a curtain.
• Early membrane rupture occurs when the cervix and lower segment of the presenting section are late in developing.
• Forms of large caput succedaneum.
• Patients experience stress and exhaustion.
• Increasing respiratory and pulse rates.
• Metabolic keto acidosis and ketosis symptoms.
• Lower segment overdistension and potential uterine rupture.
• Such as fetal hypoxia.

Management

• General Management
  • Taking vital signs and noting the volume and color of the mother's urine allows for an assessment of her general health.
  • If prompt delivery for the benefit of the fetus is not carried out, the mother should be sedated with intramuscular pethidine 755–100mg.
  • Blood grouping and typing should be investigated, and any dehydration or ketoacidosis should be treated with two units of blood.
  • It is best to give parents 500 mg of ampicillin or similar antibiotic, and to repeat the dose every six hours.
  • To track urine output, a vaginal swab is collected.
  • FHS should be taken every half-hour to monitor fetal health.
•  Specific Management
  • Vaginal delivery
    • If the fetus is alive, the cervix is fully dilated and the fetal head is at 0 stations or below, delivery by vacuum extraction.
    • If the fetal is alive but the cervix is not fully dilated or fetal head is too high for vacuum extraction, delivery by caesarean section.
    • If fetal is dead delivery by craniotomy or if the operator is not proficient in craniotomy delivery by CS.

Caesarean Section

If a caesarean section is planned, a mother should be prepared to:

• Take consent for anesthesia and operation.
• Physical preparation by trimming hair.
• Remove ornament, cloth and other.
• Stomach must be emptied by a gastric tube.
• Sent investigation.
• Insert Foley’s catheter and maintain intake and output.
• The pediatric should be at hand because resuscitation is needed.

After Delivery

• The mother's overall health has to be constantly monitored and documented.
• Watch for bleeding at the surgical site.
• Given should be an antibiotic.
• ICU or an incubator should be used to care for the infant.
• IO chart needs to be kept up with.
• After surgery, patients should receive quality cared.

 References

• Tuitui, Roshani and S. N. Dr. Suwal. Manual of Midwifery II (Intrapartum Care). Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar, 2014.
• www.who.int/making_pregnancy_safer/documents/3_9241546662/en/
• www.webmd.com › Pregnancy › Guide
• www.who.int/healthinfo/statistics/bod_obstructedlabour.pd