OB Power

• DYSFUNCTIONAL LABOR -Sluggish contractions. Force of labor is less than usual
• DYSFUNCTIONAL LABOR - Can occur at any point in labor but classified as primary
• INEFFECTIVE UTERINE FORCE - Uterine contractions basic force that moves the fetus through the birth canal
• INEFFECTIVE UTERINE FORCE - Interplay of adenosine triphosphate and the influence of major electrolytes (calcium, sodium and potassium); and proteins (action and myosin), epinephrine and norepinephrine, progesterone and prostaglandin
• INEFFECTIVE UTERINE FORCE -When they have less strength than usual or are rapid but ineffective ====Dysfunctional labor occur
• Hypertonic Uterine Contractions -Occurs most often in Primigravida’s. Marked by an increase in resting tone to more than 15mmHg
• Hypertonic Uterine Contractions -Contractions are ineffectual, erratic, uncoordinated, and involve only a portion of the uterus. Increase in frequency of contractions, but intensity is decreased. do not bring about dilation and effacement of the cervix. Most commonly seen in latent phase of labor
• Hypertonic Uterine Contractions - CAUSES

  -Muscle fibers of the myometrium do not repolarize (relax after contraction)

  -More painful than usual

  -Myometrium becomes tender from constant lack of relaxation

  -Results to anoxia of uterine cells
• Hypertonic Uterine Contractions - SIGNS AND SYMPTOMS

  -PAINFUL contractions in resting tone uterine muscle anoxia

  -causing constant cramping pain

  -Dilatation and effacement of the cervix does not occur

  -Prolonged latent phase

  -Fetal distress occurs early

  -Anxious and discouraged
• Hypertonic Uterine Contractions - DANGER

  -Lack of relaxation between contractions may not allow optimal uterine artery filling

  · Can lead to fetal anoxia
• HYPOTONIC UTERINE CONTRACTIONS

  -Number of contractions is unusually infrequent

  · Not more than 2-3 in 10-min period

  -Resting tone remains less than 10 mmHg

  -Strength of contractions does not rise above 25mmHg
•  

  HYPOTONIC UTERINE CONTRACTIONS

  -Apt to occur during:

  ·         the active phase of labor

  ·         After administration of anesthesia

  ·         Bladder or bowel distention

  ·         Increases length of labor
• HYPOTONIC UTERINE CONTRACTIONS - Signs and Symptoms

  -Weak contractions – become mild

  -Infrequent (every 10 – 15 minutes +) and brief

  -Can be easily indented with fingertip pressure at peak of contraction

  -Prolonged ACTIVE Phase

  -Psychological trauma – frustrated
• HYPOTONIC UTERINE CONTRACTIONS - Treatment

  -Ambulation

  -Nipple Stimulation

  ·  causes release of endogenous Pitocin which can stimulate contractions

  -Enema
• Amniotomy - artificial rupture of the membranes
• AROM-Cot - amniotomy finger cot for the artificial rupture of membranes
• Pitocin – for augmentation of labor

  -Use only if CPD is not present

  -Give 20 units /1000 cc fluid

  -hang as a secondary infusion, never as primary
• Pitocin - GOAL:

  -Achieve contractions every 2 - 3 minutes of good

  intensity with relaxation between
• ABNORMAL PROGRESS IN LABOR

  Prolonged Labor

  -A labor lasting more than 18-24 hours
• Prolonged Labor

  -Normally:

  Cervical dilation

  ·         Primigravida 1.2 cm / hr

  ·         Multigravida 1.5 cm / hr
• Prolonged Labor

  -Descent

  1 cm. / hr in primigravida

  2 cm./ hr. in multigravida
• ABNORMAL PROGRESS IN LABOR

  Rapid delivery

  -Delivery/delivery outside normal setting

  -Everything is OUT OF CONTROL

  -mom is frightened, angry, feels cheated
• BANDL’S RING

  -Hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent
• BANDL’S RING

  -Usually appears during the 2nd stage of labor

  -Palpated as horizontal indentation across the abdomen
• BANDL’S RING

  -A warning sign that severe dysfunctional labor is occurring
• BANDL’S RING - Pathophysiology

  -Formed by excessive retraction of the upper uterine segment

  -if not relieved

  ·         uterine rupture

  ·         neurologic damage to fetus

  ·         placental stage

  ·         maternal hemorrhage
• BANDL’S RING - Causes:

  -Uncoordinated contractions (early labor)

  -Obstetric manipulation/administration of oxytocin (pelvic division)

  -fetus and placenta are gripped by the retraction ring and cannot advance
• Precipitate dilatation

  -A cervical dilatation that occurs at a rate of 5 cm or more per hour (Primi)/10 cm or more (Multi)
• Precipitate birth

  -Uterine contractions are so strong a woman gives birth with only a few, rapidly occurring contractions (labor completed in fewer than 3 hours)
• PRECIPITATE LABOR - Complications

  -If the baby delivers too fast, does not allow the cervix to dilate and efface which leads to cervical lacerations
• PRECIPITATE LABOR - Prevention

  -Monitoring progress of labor

  ·         Active phase dilation is: NULLIPARA - 5cm/hr (1 cm every 12 minutes) or MULTIPARA – 10 cm/hr (1 cm every 6 minutes)
• Means labor is started artificially

  -When labor is ineffective induction , augmentation is used to strengthen them
• Augmentation

  ·         Refers to assisting labor that has started spontaneously but is not effective
• Cervical Ripening - Hygroscopic suppositories

  ·  Suppositories of seaweed that swell on contact with cervical contractions

  ·   It gradually and gently urges dilatation (laminaria technique)

  ·   Held in place by a gauze sponges saturated with povidone-iodine or anti-fungal cream
• Induction of Labor by Oxytocin

  ·         A synthetic form of naturally occurring pituitary hormone

  ·         Always administered intravenously if hyperstimulation occurs it can be discontinued quickly
• Cervical Ripening - Insertion of prostaglandin (dinoprostone)

  ·         Inserted into the posterior fornix of the vagina, by the cervix

  ·         If placed in the evening, ripening will occur in the morning

  ·         Woman should remain in side-lying position (prevent leak or loss of medication)
• Oxytocin Induction

  -Should be started 12 hours after prostaglandin administration
• Hyperstimulation

  -          5 or more contractions in a 10-minute period

  -          Contractions lasting more than 2 minutes in duration

  -          Occurring within 60 seconds or each other
• PRETERM LABOR

  -Labor that occurs after 20 weeks but before 37 weeks
• Tocolytics

  -Uses: Stop or arrest labor