Abnormal Labour

ABNORMAL LABOUR
NORMAL LABOUR
• Occurance of coordinated uterine
contractions associated with progressive
dilatation of the cervix and descent of the
fetal head
ABNORMAL LABOUR
• Occurance of
– Abnormal/incoordinated uterine contractions
– Non- progressive dilatation of the cervix
– Poor descent of the fetal head
Abnormal uterine contractions
• Normal polarity
– Hypertonic Dysfunction
• Obstruction; Obstructed labour
• No-obstruction; Precipitate labour
– Hypotonic dysfunction; uterine inertia-
• Abnormal polarity- incoordinate uterine action
– Spastic lower uterine segment
– Colicky uterus
– Asymetrical uterine contractions
– Constriction ring
– Generalized tonic contractions
Predisposed
• Primigravida
• Prolonged pregnancy
• Overdistention of the uterus
• Emotional
• Obesity
• Contracted pelvis
• Malpresentation/malposition
• Injudixious use of sedatives, analgesics or oxytocic
Obstructed labour
• Increase in intensity, duration and frequency of uterine contraction
• Relaxation phase becomes less and less
• Tonic uterine contractions and retraction
• The lower uterine segment becomes progressively thinner
• Pathological retraction ring ( Bandl’s ring); circular groove between the active upper segment and the
lower segment
• Uterine exhaustion
• Lower uterine segment rupture
Management
• Prevention
– Partograph
– Early diagnosis of malpresentation and disproportion
• Treatment
– Rehydrate
– Pain relief
– Parentral antbiotics
– Delivery by CS
Precipitate labour
• Combined duration of 1st stage and 2nd stage is less than 2 hours
• Common in multiparae and may be repetitive
• Hypertonic uterus with diminished soft tissue resistance
• Risk factors
– Maternal
• Genital trauma; cervix, vagina and perineum
• PPH
• Uterine inversion
• Uterine rupture
• Amniotic fluid embolism
– Fetal
• Intracranial haemorrhage
• Direct fetal trauma; head, limbs
• Torn umbillical cord; bleeding
• Treatment
– Anticipation and early admission
– MgSO4 admistered in labour
– Controlled delivery , episiotomy
– Avoid oxytocin augmentation
Hypotonic Uterine dysfunction; uterine inertia
• Uterine intensity is diminished, duration shortened, intervals
are incresed. More relaxation between the contractions
• Poor dilatation of the cervix
• Effects
– Maternal Exhaustion
– Fetal distress
• Management
– Exclude CPD
– Posture; avoid supine
– Augment with oxytocics
– CS if other indications
• Incoordinate uterine action
– Spastic lower uterine segment
– Colicky uterus
– Asymetrical uterine contractions
– Constriction ring (Scroeder’s ring)
– Generalized tonic contractions
• New pacemakers all over the uterus
• The contraction force neither dilates the cervix nor
descends the fetus
• Uterine tonus with pain before, during and after contraction
• Featl hypoxia, placenta abruptio,
Cervical dystocia
• Non- progressive dilatation of the cervix due to
• Ineffective uterine contraction
• Malpresentation, malposition
• Spasms/ contraction of the cervix
• Primary cervical dystocia; in primigravidae, rigid
cervix with ineffective uterine contraction
• Treatment; Push up manually, CS, Duhrssen’s incision at 2
and 10 o’clock then ,Forceps/ vacuum
• Secondary dystocia from excessive scarring of cervix;
CA cervix, cervical tears( delivery, D&C
Descent disorders
• Poor descent of the fetal head

• Cephalopelvic disproportion
• Malposition
• Malposition of the vertex other than flexed occipto-
anterior
Descent disorders
Occipito- Posterior Position

• The occiput is placed posteriorly over the sacro-iliac joints
or over the sacrum; ROP or LOP and Direct OP
respectively
• May develop before onset of labour (primary) or after
onset of labour ( secondary)
• 90% of cases anterior rotation of the occiput occurs
• Causes
• Shape of pelvic inlet; anthropod or android
• Fetal deflection
• Uterine contraction
Descent disorders

Diagnosis
• Abdominal examination; flat below umbilicus, fetal back is
away from midline, head not engaged, heart sounds best
heard at the flanks.
• Vaginal examination; bulging membranes, satital suture in
obliqaue diameter, posterior fontanelle is felt near the
sacro-iliac joint, anterior fontanelle is felt more easily.
Descent disorders

Mechanism of labour
• Engagement in ROP or LOP BPD 9.5 cm, DOP 10 cm in
suboccipto-frontal or 11cm in occipto-frontal
• 90%
• Flexion and descent to pelvic floor
• Internal rotation; head 1350 shoulders900 ( the long rotation)
• Descent
• Restitution
• External rotation
• Birth of shoulders and trunk
Descent disorders

Mechanism of labour
• Engagement in ROP or LOP BPD 9.5 cm, DOP 10 cm in
suboccipto-frontal or 11cm in occipto-frontal
• 10%; no rotation or malrotation due to deflexion of the
head, weak uterine contractions,pelvic shape
• Flexion and descent to pelvic floor
• Incomplete internal rotation;
– Short anterior rotation, head 450 ; Deep transverse arrest ,
– Non-rotation; Oblique posterior arrest
– Short posterior rotation; head 450 , Persistent Occipito-Posterior
position/ occipito-sacral arrest
Descent disorders

• Tendency to delayed first and second stage of labour.
• The long anterior rotation; SVD 90%
• Short Posterior Rotation; Assisted vaginal delivery as
face-to –pubis
• Non-rotation and Short Anterior rotation; Prolonged
and obstructed labour
• Early CS
• Manual rotation for OPP
• Kielland Forcep rotation
Descent disorders

• Tendency to delayed first and second stage of labour.
• The long anterior rotation; SVD 90%
• Short Posterior Rotation; Assisted vaginal delivery as
face-to –pubis
• Non-rotation and Short Anterior rotation; Prolonged
and obstructed labour

Abnormal Labour

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ABNORMAL LABOUR

• Poor descent of the fetal head

Occipito- Posterior Position

Occipito- Posterior Position

Occipito- Posterior Position

Occipito- Posterior Position

Occipito- Posterior Position

Occipito- Posterior Position

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