23. DEGREE OF DISPROPORTION
SEVERE DISPROPORTION
IN THIS THE OBSTETRIC
CONJUGATE IS <7.5 cm .
BORDERLINE DISPROPORTION
IN THIS OBSTETRIC
CONJUGATE IS BETWEEN 9.5 & 10cm .
24. OBSTETRICCONJUGATE
THE SHORTEST PELVIC DIAMETER
THROUGH WHICH THE FETAL HEAD MUST
PASS DURING BIRTH, MEASURED FROM
SACRAL PROMONTORY TO A POINT A FEW
MILLIMETERS FROM THE TOP OF PUBIC
SYMPHYSIS.
27. MANAGEMENT OF CPD
IN BORDER LINE CPD
VAGINAL DELIVERY AT TERM.
IN SEVERE CPD
ELECTIVE CS AT TERM
TRIAL LABOUR
28. TRIAL LABOR
IT IS THE CONDUCTION OF SPONTANEOUS LABOR IN A
MODERATE DEGREE OF DISPROPORTION IN AN INSTITUTION
UNDER SUPERVISION WITH WATCHFUL EXPECTENCY
HOPING FOR VAGINAL DELIVERY
OR
IT IS A TEST LABOR ALLOWING THE PATIENT TO ENTER INTO
ACTIVE LABOR PUTTING ALL VARIABLE [POWER,PASSAGE & PASSENGER]
INTO TEST & DETERMINE WHETHER VAGINAL DELIVERY IS POSSIBLE.
29. THE PROGRESS OF LABOUR
IS MAPPED WITH PARTOGRAPH
TO ACCESS THE
PROGRESSIVE DESCENT OF HEAD.
PROGESSIVE DILATATION OF
CERVIX.
30. AFTER RUPTURE OF MEMBRANE ,
PELVIS EXAMINATION IS TO BE
DONE TO
EXCLUDE CORD PROLAPSE
NOTE THE COLOR OF LIQUOR
NOTE THE CONDITION OF
CERVIX INCLUDING PRESSURE OF
PRESENTING PART ON CERVIX.
31. SUCCESSFUL TRIAL
A TRIAL LABOR IS SAID TO BE
SUCCESSFUL IF A HEALTHY BABY
IS BORN VAGINALLY, OR BY
FORCEPS OR VENTOSE WITH THE
MOTHER IN GOOD CONDITION.
32. FAILURE OF TRIAL
A TRIAL LABOR IS SAID TO
BE A FAILURE IF THE DELIVERY
IS BY CESAREAN SECTION OR
DELIVERY OF DEAD BABY
BY CRANIOTOMY.
33. FAVOURABLE FACTORS
FLAT PELVIS IS BETTER THAN
ANDROID.
VERTEX PRESENTATION.
MINOR DEGREE OF CONTRACTION.
INTACT MEMBRANES TILL FULL
DILATATION.
GOOD UTERINE CONTRACTION.
EMOTIONAL STABILITY OF WOMAN.
34. CONTRAINDICATIONS:
PRIMIGRAVIDA
MAL PRESENTATION
POST MATURITY
POST CAESEREAN PREGNANCY
PRE-ECLAMPSIA
DIABETES
LACK OF FACILITIES FOR C-SECTION
35. UNFAVOURABLE FACTORS
APPEARANCE OF ABNORMAL UTERINE
CONTRACTION.
CERVICAL DILATATION <1cm/hr.
DESCENT OF FETAL HEAD <1cm/hr.
ARREST OF CERVICAL DILATATION
AND NON DESCENT OF FETAL HEAD
INSPITE OF OXYTOCIN THERAPY.
FETAL DISTRESS.
37. DISADVANTAGES:
MAY END IN FULL DILATATION
OF CERVIX.
INCREASED FETAL MORTALITY
& MORBIDITY.
IN FAILED TRIAL INCREASED
OPERATIVE RISKS.
38. HOW LONG TO CONTINUE
TRIAL LABOUR ?
THE METHODS OF
TERMINATION OF TRIAL IS BY
SPONTANEOUS DELIVERY[30%].
SYMPHYSIOTOMY FOLLOWED BY
FORCEPS OR VACCUM[30%].
C-SECTION[30%]
CRANIOTOMY [IF FETUS IS DEAD]