Prevention, Diagnosis and Treatment of protracted Labor

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Prevention, Diagnosis and Treatment of
protracted Labor
Dr. Mohammed Abdalla
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Guideline Objective

• To prevent unnecessary protracted labor
• To increase the use of procedures that assist in
  progress to vaginal birth

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Unsatisfactory progress of labour

• Cervix not dilated
• No palpable contractions/infrequent contractions

• False labour

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Unsatisfactory Progress of Labour
Cervix not dilated beyond 4 cm after 8 hours of
regular contractions

• Prolonged latent phase

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Unsatisfactory progress of labour
Less than three contractions in 10 minutes, each
lasting less than 40 seconds

• Inadequate uterine contractions

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Unsatisfactory Progress of Labour
Cervical dilatation to the right of the alert
line on the partograph

• Prolonged active phase

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Unsatisfactory progress of labour
Secondary arrest of cervical dilatation and
descent of presenting part in presence of good
contractions

• Cephalopelvic disproportion

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Unsatisfactory progress of labour
Secondary arrest of cervical dilatation and
descent of presenting part with large caput,
third degree moulding, cervix poorly applied to
presenting part, oedematous cervix, ballooning of
lower uterine segment, formation of retraction
band, maternal and fetal distress

• Obstruction

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1. Confirm Active Labor Before Admitting to
Facility
Spontaneous contractions at least 2 per 15
minutes, and two or more of the following

• Complete effacement of cervix
• Cervical dilation greater than or equal to 3 cm
• Spontaneous rupturing of membranes (SROM)

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2. Perform Amniotomy Early in Labor

• Spontaneous rupture of membranes
• Presentation unknown, floating or unstable
• Cervix dilated less than 3 cm
• Patient refuses

Perform amniotomy early in labor unless one or
more of the following occurs
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3-conduct Frequent Cervical Checks

• Cervical checks should indicate at least 1 cm
  dilation per hour

Failure to progress is defined as cervical
changes of less than 1 cm per hour for 2
consecutive hours.
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Partograph and Criteria for Active Labor

• Label with patient identifying information
• Note fetal heart rate, color of amniotic fluid,
  presence of moulding, contraction pattern,
  medications given
• Plot cervical dilation
• Alert line starts at 4 cm--from here, expect to
  dilate at rate of 1 cm/hour
• Action line if patient does not progress as
  above, action is required

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4-Augment with Oxytocin to achieve adequate labor
for 2 to 4 hours.
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2.5 U Oxytocin in 500 ml. G. 5
In multigravida and in previous C.S.
15 drops / min
increase infusion rate by 15 drops every 30
minutes
When contractions lasting more than 40 seconds
and occurring three times in 10 minutes).
maintain infusion
If good contractions are not established at 60
drops per minute .
5 units in 500 mL dextrose
30drops / min
increase infusion rate by 15 drops every 30
minutes
If good contractions are not established at 60
drops per minute do c.s.
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5 units Oxytocin in 500 mL dextrose
In primigravida
30 drops / min
increase infusion rate by 15 drops every 30
minutes
When contractions lasting more than 40 seconds
and occurring three times in 10 minutes).
maintain infusion
If good contractions are not established 60
drops per minute .
10 units in 500 mL dextrose
30 drops / min
increase infusion rate by 15 drops every 30
minutes
If good contractions are not established at 60
drops per minute do c.s.
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Uterine Hyperstimulation

• Is defined as contractions lasting longer than 90
  seconds, OR more than five contractions in 10
  minutes

can be managed by changing the maternal position
and administering oxygen, shutting off the
pitocin until recovery has occurred and possibly
the administration of terbutaline 0.25 mg SC.
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Category Definition

• Normal A CTG where all four features fall into
  the reassuring category.
• Suspicious A CTG whose features fall into one of
  the non-reassuring categories and the remainder
  of the features are reassuring.
• Pathological A CTG whose features fall into two
  or more non-reassuring categories or one or more
  abnormal categories.

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5-If patient is in Stage II labour and is not
making progress

• Positioning.
• Fluid balance.
• Oxytocin augmentation.
• Obstetrical/surgical consult.

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6- Consider operative vaginal delivery or
cesarean delivery
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