define labour and stages,define prolonged labor,causes ,diagnosis,treatment

1. MISS ASMI ROYCHOWDHURY
NURSING TUTOR
RAMA COLLEGE OF NURSING

2.  DEFINITION OF LABOUR:-
Series of events that take place in
the genital organ in an effort to
expel the viable products of
conception out of the womb
through the vagina in to the outer
world.

3.  START OF THE TRUE LABOUR PAIN
TO FULL DILATATION OF THE
CERVIX (10CM)
Latent phase (primi-8hrs,multi-
4hrs)
Active phase (primi-4hrs,multi-
2hrs)

4.  From full dilatation of the
cervix to the expulsion of the
fetus.
oPropulsive phase
oExpulsive phase
oDuration :-Primi=2hours
Multi =30 minutes

5.  From expulsion of the fetus to the
expulsion of the placenta
Phase of placental separation
Phase of placental descent
Phase of placental expulsion
DURATION – 15 minutes (primi and
multi)
5 minutes in active
management.

6.  Up to 1 hours of delivery of placenta

7.  Labor is said to be prolonged when
the combined duration of the first and
second stage is more than the
arbitrary time limit of 18 hours.
 WHO-labor is considered to be
prolonged when the cervical dilatation
rate is less than1cm/hr and descent of
the presenting part is <1 cm/hr for a
period of minimum 4 hours
observation

8. 1. FIRST STAGE
a) FAULT IN POWER :-
o Abnormal uterine contraction
b)FAULT IN PASSAGE:-
o Contracted pelvis
o Cervical dystocia
o Pelvic tumor
o Full bladder

9.  C) FAULT IN THE PASSENGER
oMalposition or mal
presentation
oCongenital anomalies of the
fetus (hydrocephalus)

10. 2) SECOND STAGE :-
a) FAULT IN THE POWER :-
o Uterine inertia
o Inability to bear down
o Epidural analgesia
o Constriction ring

11. b) FAULT IN THE PASSAGE :-
o CPD,android pelvis, contracted pelvis
o Undue resistance
o Soft tissue pelvic tumor
c) FAULT IN THE PASSENGER :-
• Malposition
• Malpresentation
• Big baby
• Congenital malformation of the body

12.  PROLONGED LABOR IS NOT A DIAGNOSIS
BUT IT IS THE MANIFESTATION OF AN
ABNORMALITY.
 FIRST STAGE
DURATION >12 HOURS
CERVICAL DILATATION _<1cm/hr(primi)
<1.5 cm/hr (multi)
 SECOND STAGE :-
Duration >2hrs (nullipara),>1hrs (multipara)

13.  FETAL
 HYPOXIA
 INTRAUTERINE INFECTION
 INTRACRANIAL STRESS
 INCREASE OPERATIVE DELIVERY
MATERNAL
 DISTRESS
 POSTPARTUM HEMORRHAGE
 TRAUMA TO THE GENITAL TRACT
 PUERPEAL SEPSIS
 SUBINVOLUTION

14.  PREVENTION:-
 ANTENATAL OR EARLY DETECTION
 USE OF PARTOGRAPH
 SELECTIVE AND JUDICIOUS AUGMENTATION
 CHANGE OF POSTURE IN LABOR,AVOIDANCE
OF DEHYDRATION IN LABOR
 EVALUATE CAREFULLY TO FIND OUT
• Cause of prolonged labour
• Effect on the mother
• Effect on the fetus

15.  CORRECT FLUID AND
ELECTROLYTE IMBALANCE
 CONTROL OF INFECTION
(AMPICILLIN,METRONIDAZOLE)
 EMPTYING THE BLADDER
 EMPTYING THE STOMACH
 BLOOD CROSS MATCHING

16.  VAGINAL EXAMINATION AND CLINICAL
PELVIMETRY DONE
 IF ONLY UTERINE ACTIVITY IS
SUBOPTIMAL,
 AMNIOTOMY/OXYTOCIN INFUSION
 EFFECTIVE PAIN RELIEF
SECONDARY ARREST :-
CAREFUL USE TO OXYTOCIN
CESAREAN SECTION DELIVERY

17.  SHORT PERIOD OF EXPECTANT
MANAGEMENT IS REASONABLE
PROVIDED THE FHR IS REASSUARING
AND VAGINAL DELIVERY IS EMMINENT.
 APPROPRIATE ASSISTED
DELIVERY,VAGINAL OR ABDOMINAL
SHOULD BE DONE
 DIFFICULT INSTRUMENTAL DELIVERY
SHOULD BE AVOIDED.