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PROLONGED LABOR AND PRECIPITATE LABOR /BSc Nursing Notes/OBG/PPT

This PPT Explains prolonged labor and precipitate labor, including its definition, causes, signs and symptoms, diagnosis, dangers of prolonged labor, prevention and management.

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PROLONGED LABOR AND PRECIPITATE LABOR By MISS MADHU M H M.Sc (N) Obsterics And Gynecologic Nursing Lecturer
DEFINITION OF PROLONGED LABOR  When the combined duration of first and second stages is more than the arbitrary time limit of 18 hours, the labor is said to be prolonged labor. According to World Health Organization (WHO), labor is considered prolonged when for a period of 4 hours, observation shows: • Cervical dilatation <1 cm/hr. • Descent of presenting part <1 cm/hr.
causes OF PROLONGED LABOR 1. First stage: Failure to dilate the cervix: 1.Fault in power 2. Fault in the passage 3. Fault in the passenger 4. Others Includes abnormal uterine contraction such as uterine inertia or uncoordinated uterine action. Includes contracted pelvis, cervical dystocia, pelvic tumor or even full bladder Includes malposition and malpresentation, congenital anomalies of the fetus such as hydrocephalus. Injudicious early administration of sedatives and analgesics before the actual active labor begins.
causes OF PROLONGED LABOR 2.Second stage: Sluggish or nondescent of the presenting part due to: A. Fault in power: B. Fault in the passage: C. Fault in the passenger: • Uterine inertia • Inability to bear down • Epidural analgesia • Constriction ring • Contracted pelvis and CPD • Undue resistance of pelvic floor muscles due to old scarring/spasm • Soft tissue pelvic tumor • Malposition • Malpresentation • Large size baby (>3.5 kg) • Congenital malformation of the baby
Signs and symptoms OF PROLONGED LABOR 1. Mother looks exhausted and distressed. 2. Dry mouth due to prolonged mouth breathing. 3. Presence of dehydration. 4. Pain more on back radiating to thighs rather than inside the abdomen. 5. Initially pain may be severe, frequent and prolonged but later it decreases and becomes very mild due to muscle fatigue. 6. Tenderness in uterus and it does not feel relaxed fully between contractions. 7. Fetal distress may be present.
DIAGNOSIS OF PROLONGED LABOR • Prolonged labor is a manifestation of an abnormality, the cause of which should be detected by a thorough abdominal and vaginal examination supplemented by partographic analysis of labor. • Intranatal radiography is useful in determining the fetal station and position as well as pelvic shape and size FIRST STAGE • First stage of labour is considered prolonged when the duration is more than 12 hrs. The rate of cervical dilatation is < 1 cm / hr in primi and < 1.5 cm / hr in multi. The rate of descent if the presenting part is < 1 cm / hr in primi and < 2 cm/hr in multi
DIAGNOSIS OF PROLONGED LABOR SECOND STAGE • The 2nd stage is considered prolonged if it lasts for more than 2 hrs in primi, and 1 hr in multi. • The diagnostic features are:  Sluggish or non descent of the presenting part even after full dilatation of the cervix  Variable degrees of moulding and caput formation in cephalic presentation  Identification of the cause of prolongation
DANGERS OF PROLONGED LABOR FETAL MATERNAL 1. Hypoxia 1. Puerperal sepsis 2. Intrauterine infection 2. Postpartum haemorrhage 3. Intracranial hemorrhage 3. Subinvolution 4. Distress 5. Trauma
PREVENTION OF PROLONGED LABOR • Detection of factors (such as good size baby, small pelvis, malpresentation, malposition, etc.) responsible for prolonged labor as early as possible. • Use partograph for early detection of prolonged labor. • Induction of labor by low rupture of membrane followed by oxytocin drip. • Position the woman in other than supine position to increase uterine contractions. • Avoid dehydration by adequate fluid intake. • Use analgesics for relieving pain.
MANAGEMENT OF PROLONGED LABOR • Early diagnosis and prompt management of prolonged labor are important. • Careful evaluation to find out the cause of prolonged labor. • Assess the effect of prolonged labor on mother and fetus and manage accordingly. • In case of first stage delay: Vaginal examination should be performed to note fetal presentation, position and station. If uterine activity is suboptimal: Amniotomy. Epidural analgesia or IM pethidine to relieve pain for management of secondary arrest, especially in multipara, administration of oxytocin very safely. • In case of malposition, malpresentation and CPD, cesarean section is to be done. • In case of second stage delay: Short period of expectant management is reasonably provided if the FHR is reassuring and vaginal delivery is imminent. Otherwise, forceps, ventouse or cesarean are to be done.
DEFINITION OF PRECIPITATE LABOR • Labor is considered precipitate when the combined duration of the first and second stages is less than 3hours PREVALENCE OF PRECIPITATE LABOR It is about 2%. • Short labors may be associated with placental abruption and uterine tachysystole. They are common in multipara and may be repetitive. Rapid expulsion is due to the combined effect of hyperactive uterine contractions associated with diminished soft tissue resistance. Labor is short as the rate of cervical dilatation is 5 cm/hr or more for nulliparous women.
RISKS OF PRECIPITATE LABOR Maternal Risks Extensive laceration of the cervix, vagina and perineum (to the extent of complete perineal tear) PPH due to uterine hypotonia that develops after unusual vigorous contractions Inversion Uterine rupture Infection Amniotic fluid embolism. Fetal Risks Intracranial stress and hemorrhage are caused by rapid expulsion without time for moulding of the head.  The baby may sustain severe injuries if delivery occurs in a standing position: bleeding from the torn cord, a direct hit on the skull, and a brachial plexus injury
MANAGEMENT OF PRECIPITATE LABOR • The patient with a previous history of precipitate labour should be hospitalized before labor. • During labor, the uterine contraction may be suppressed by administering ether or magnesium sulfate during contractions. • Delivery of the head should be controlled. • Episiotomy should be done liberally. • Elective induction of labor by low rupture of membranes and conduction of controlled delivery is helpful. • Oxytocin augmentation should be avoided.