Suddenly complications during birth and labor

• Uterine Inertia


  A time-honored term to denote sluggishness of contractions or that the force of labor is less than usual
• Uterine Inertia is a labour in which the first stage has lasted 48 hours or more in the absence of pelvic contraction, the delay being associated with abnormal uterine action
• Dysfunctional Labor


  A more current term used nowadays for prolonged labor, typically in the first stage of labor
• Diagnosis of delay in labor


  Dependent on careful monitoring of uterine contraction intensity, duration and frequency, cervical dilation, and descent of the fetus through the pelvis
• Cardiotocography (CTG)


  A continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen
• CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications
• How to read a CTG

  Structured method of assessing its various characteristics using the acronym DR C BRAVADO: Define risk, Contractions, Baseline rate, Variability, Accelerations, Decelerations, Overall impression
• Normal antenatal CTG trace features: Baseline fetal heart rate (FHR) is between 110-160 bpm, Variability of FHR is between 5-25 bpm, Decelerations are absent or early, Accelerations x2 within 20 minutes
• Baseline FHR


  The average fetal heart rate (FHR) rounded to increments of 5 beats per minute during a 10-minute segment, excluding periodic or episodic changes, periods of marked variability, or baseline segments that differ by more than 25 beats per minute
• Variability


  The variation of fetal heart rate from one beat to the next
• Accelerations


  Transient increases in FHR of 15 bpm or more above the baseline and lasting 15 seconds
• Decelerations


  Abrupt decrease in the baseline fetal heart rate of greater than 15 bpm for greater than 15 seconds
• Classifications of Dysfunctional Labor

  • Primary, Secondary, Labor Dystocia
• Common Causes of Dysfunctional Labor

  • Primigravid status, Pelvic bone contraction narrowing the pelvic diameter, Posterior fetal position, Failure of uterine muscle contraction, Unripe cervix, Full rectum or bladder, Exhaustion from labor, Inappropriate use of analgesia
• Ineffective Uterine Force


  When uterine force is less strong than usual or rapid but ineffective, leading to dysfunctional labor
• Hypotonic Contractions


  Infrequent contractions, resting tone of the uterus remains less than 10 mmHg, strength of contraction does not rise above 25 mmHg, occur during the active phase of labor, may occur after analgesia administration, may occur in an overstretched uterus, contractions are not exceedingly painful
• Hypertonic Contractions


  Marked by an increase in resting tone to more than 15 mmHg, intensity may not be stronger than hypotonic contractions, commonly seen in the latent phase of labor, painful contractions due to lack of relaxation and anoxia of uterine cells, contractions are strong but ineffective
• Hypotonic contractions


  Contractions are strong but they are ineffective and are not achieving cervical dilatation
• Hypotonic contractions are most commonly seen in the latent phase of labor
• Hypotonic contractions are painful because the myometrium becomes tender from constant lack of relaxation and the anoxia of uterine cells
• Uncoordinated Contractions: More than one pacemaker may be initiating contractions or receptor points in the myometrium may be acting independently of the pacemaker
• Uncoordinated contractions can occur so closely together that they can interfere with the blood supply to the placenta
• The woman has difficulty to rest between contractions or to breathe effectively with contractions
• Oxytocin administration may help to stimulate a more effective and consistent pattern of contractions with a better, lower resting tone
• Dysfunctional Labor in the First Stage: Prolonged Latent Phase when true labor lasts for more than about 8 hours without entering into the active first stage
• In dysfunctional labor in the first stage, the uterus tends to be in a hypertonic state
• In dysfunctional labor in the first stage, relaxations between contractions are inadequate and contractions are only mild
• Management of Prolonged Latent Phase

  1. Helping the uterus to rest

  2. Providing adequate fluid for hydration

  3. Pain relief with a drug such as morphine sulfate

  4. Provide environment suitable for rest

  5. Amniotomy and Oxytocin infusion may be necessary

  6. CS birth as last resort
• Dysfunctional Labor in the Second Stage: Prolonged Descent if the rate of descent is less than 1cm/hr in nullipara and 2cm/hr in multipara
• In dysfunctional labor in the second stage, contractions have been good, effacement and beginning of dilatation has occurred and dilatation stops
• Management of Prolonged Descent in the Second Stage

  1. If CPD is ruled out by UTZ, rest and fluid intake also applies

  2. If membranes are intact, rupturing them at this point may be helpful

  3. Oxytocin infusion for the uterus to contract effectively

  4. Semi-fowlers position, squatting, kneeling or more effective pushing may speed descent
• Precipitate Labor: Cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10cm per hour in a multipara
• Precipitate birth occurs when uterine contractions are so strong a woman gives birth with only a few, rapidly occurring contractions
• Precipitate labor is often defined as a labor that is completed in fewer than 3 hours
• Precipitate labor usually occurs in grand multiparity
• Complications of precipitate labor include premature separation of the placenta, lacerations of the perineum, risk of hemorrhage for the woman, and risk of subdural hemorrhage for the baby due to the rapid release of
• Complications of rapid labor

  • Premature separation of the placenta
  • Lacerations of the perineum
  • Woman is at risk for hemorrhage
  • Baby is at risk for subdural hemorrhage due to the rapid release of pressure on the head
• Induction and Augmentation of Labor

  1. Induction of labor - labor is started artificially

  2. Augmentation of labor - assisting labor that has started spontaneously but is not effective
• Conditions required before induction of labor

  • The fetus is in longitudinal lie
  • The cervix is ripe, or ready for birth
  • A presenting part is engaged
  • There is no CPD
  • The fetus is estimated to be mature by date
• Risk factors for Prolapsed Umbilical Cord

  • PROM
  • Fetal presentation other than cephalic
  • Placenta previa
  • Intrauterine tumors preventing the presenting part from engaging
  • A small fetus
  • CPD preventing firm engagement
  • Hydramnios
  • Multiple gestation