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International
Management of Labor
Management of Labor
International
Objectives
Definition and diagnosis of labor Definition and diagnosis of dystocia
Causes of dystocia
Prevention and management of dystocia
Management of Labor
International
First Stage
Latent Phase Active Phase
Second Stage
Passive Active
Management of Labor
International
Labor is regular frequent uterine contractions and cervical change (dilatation and effacement)
Management of Labor
International
Philpotts Partogram
10
8
6 4 2 0 0 2 4 6 8 10
Time (hours)
Management of Labor
International
Source: WHO/UNFPA/UNICEF/WORLD BANK. IMPAC-Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. WHO 2000 (WHO/RHR/ 00.7)
Management of Labor
International
Etiology of Dystocia
Power Passenger Passage
Management of Labor
International
Adequate Powers
Contractions that
last 60 seconds
reach 50 - 60 mm Hg of pressure
occur every 2 - 3 minutes
or
result in good progress
Management of Labor
International
Preventing Dystocia
Accurate diagnosis of labor Management of prolonged latent phase
Labor preparation
Birth companion
Management of Labor
International
Amniotomy (ARM)
Fetal size
Management of Labor
International
Management of Dystocia
Arrest without CPD
- amniotomy
Management of Labor
International
Management of Labor
International
Management of Labor
International
Augmentation of Labor
Initial dose of oxytocin Increase interval 1 - 2 mU / min every 30 min.
Dosage increment
Usual dose for good labor
1 - 2 mU
8 - 10 mU / min.
Management of Labor
International
Management of Labor
International
Adverse Effect
Fetal compromise
Mechanism
Hyperstimulation
Prevention
Correct dose
Uterine rupture
Water intoxication Hypotension
Hyperstimulation
ADH effect Vasodilatation
Correct dose
Limit free water Low dose
Management of Labor
International
Management of Labor
International
Management of Labor
International
Obstructed Labor
Management of Labor
International
Failure of descent of the fetus in the birth canal for mechanical reasons in spite of good uterine contractions. (Philpott, 1982)
Incidence: 1-3%
Management of Labor
International
Fetal: Asphyxia, sepsis, death Maternal: Sepsis, uterine rupture, hemorrhage, fistula, death
Management of Labor
International
Management of Labor
International
Management of Labor
International
State of the Uterus: Ruptured Uterus State of the Bladder: Vaginal Findings Cervical Findings
Management of Labor
International
Maternal:
Ruptured uterus Vsico-Vaginal Fistulae Recto-vaginal Fistulae Pueperal Sepsis
Fetal:
Asphyxia/ cerebral palsy Neonatal sepsis Death
Management of Labor
International
Treatment
Prevention
- Good nutrition in childhood
- Promotion of antenatal care - Use of partogram in the health unit - Development of appropriate and timely referral systems
Cesarean section
Management of Labor
International