Successful completion of a pregnancy requires the harmonious functioning of the critical factors in labor. When this does not occur, it is noted as a dysfunctional labor.
d. What interventions might the nurse implement?
Define the term cephalopelvic disproportion (CPD): a. What are the causes of CPD? b. What are the symptoms for CPD in the laboring woman? c. What is the medical treatment for CPD?
Partograph and labor dystocia for undergraduate
A partograph is a graphical
record of the observations made
of a women in labor
For progress of labor and
conditions of the mother and
History Of PartogramHistory Of Partogram
Cervical dilatation and fetal
station against time in hours
from onset of labour.yielded
the typical sigmoid or 'S'
early detection of abnormal progress of a labour
prevention of prolonged labour
Recognize cephalo pelvic disproportion long before
Assist in early decision on transfer , augmentation , or
termination of labour
Early recognition of maternal or fetal problems
Components of the partographComponents of the partograph
Part 1 : fetal condition ( at top )
Part 2 : progress of labour ( at middle )
Part 3 : maternal condition ( at bottom )
• Fetal heart rate
• Character of liquor
• Uterine contraction
• Pain relief (e.g. pethidine)
• BP, Pulse, Temperature
• Urine – albumin, glucose, acetone
• Urine output
Membranes and liquorMembranes and liquor
Dilated cervix with bag of fore water
C : clear
M : muconium
B : blood stained
Molding the fetal skull bonesMolding the fetal skull bones
. Increasing molding with the head high in the pelvis is an ominous
sign of Cephalopelvic disproportion.
separated bones . sutures felt easily……….O
bones just touching each other……………..+
overlapping bones …………… …………...++
severely overlapping bones ( notable ) ……..+++
Part 2 – progress of labourPart 2 – progress of labour
. Cervical dilatation: it is divided into a latent phase and an
Descent of the fetal head
Cervical dilatationCervical dilatation
It is the surest way to assess progress of labour
latent phaselatent phase
Starts from onset of labour until the cervix reaches 3
lasts 8 hours or less
Contractions at least 2/10 min contractions
each lasting < 20 seconds
Active phase :Active phase :
The cervix should dilate at a rate of 1 cm / hour
Contractions at least 3 / 10 min each lasting < 40
Alert line ( health facility line )Alert line ( health facility line )
The alert line drawn from 3 cm dilatation
represents the rate of dilatation of 1 cm / hour
Moving to the right or the alert line means
referral to hospital for extra care
Action line ( hospital line )Action line ( hospital line )
The action line is drawn 4 hour to the right
of the alert line and parallel to it
This is the critical line at which specific
management decisions must be made at the
When labor goes from latent to active phase , plotting of
the dilatation is immediately transferred from the latent
phase area to the alert line
Causes of Protraction disordersCauses of Protraction disorders
minor malpositions such as occiput posterior.
improperly administered conduction
anesthesia. ,excessive sedation.
Treatment of protraction andTreatment of protraction and
arrest disorderarrest disorder
Cesarean section is indicated in the presence
of confirmed fetopelvic disproportion.
In the absence of fetopelvic disproportion,
support and close observation
Dysfunctional Labor is related to
Abnormalities of the Critical Factors:
Psychology of birthPsychology of birth
The progress of labor and birth can be
adversely affected maternal fear and tension.
Norepinephrine and epinephrine may stimulate
both alpha and beta receptors of the
myometrium and interfere with the rhythmic
nature of labor.
Anxiety can also increase pain perception and
lead to an increased need for analgesia &
Characteristics of theCharacteristics of the powerpower
Intensity is greater in the fundus
Rhythm and force
Basal resting pressure 12-15mmHg
Friedman’s GraphFriedman’s Graph
Hypotonic Uterine ContractionsHypotonic Uterine Contractions
Prolonged active phase
Therapeutic InterventionsTherapeutic Interventions
– Nipple Stimulation --release of endogenous Pitocin
– Enema--warmth of enema may stimulate contractions
– Amniotomy--artificial rupture of the membranes
– Augmentation of labor with Pitocin
Amniotomy is the artificial rupture of the amniotic
sac with a tool called the amniohook
# 1-Check the fetal heart tones
– Assess color, odor, amount
– Provide with perineal care
– Monitor contractions
– Check temperature every 2 hours
Hypertonic and uncoordinatedHypertonic and uncoordinated
Frequent intense contraction
Cephalopelvic Disportion (CPD)Cephalopelvic Disportion (CPD)
– Large baby or small pelvis
– Usually diagnosed when there is an arrest in descent
– Station remains the same does not descend
– Usually do a cesarean delivery if cause is pelvis
– Utilize other measures such as forceps, vacuum
Pelvi- Latin word pelvis (basin)
Metron - Greek word for measure
Pelvimetry means to measure the pelvis.
Three level of bony pelvisThree level of bony pelvis
Measuring diagonal conjugate
Insert two fingers into the vagina until they reach the
The distance from the sacral promontory to the exterior
portion of the symphysis is the diagonal conjugate and
should be greater than 11.5 cm.
Unengaged fetal head
• Feel the ischial spines for their relative
prominence or flatness.
• Ischial prominence narrows the transverse
diameter of the pelvis.
• Feel the pelvic sidewalls to determine
whether they are parallel (OK), diverging
(even better), or converging (bad).
• Narrow sacrosciatic notch
Measure the bony outlet by pressing your
closed fist against the perineum.
Greater than 8 cm bituberous ( or transverse
outlet) is considered normal.
Narrow pubic arch<90