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    Government College of Nursing Jodhpur: Presentation ON Prolonged Labour

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    priyanka
    This document discusses prolonged labor, including its definition as labor lasting more than 18 hours, causes such as issues with uterine contractions, the birth canal, or positioning of the baby, signs and symptoms like slow cervical dilation and fetal distress, risk factors for both mother and baby, diagnosis using a partograph, and management approaches including inducing labor, augmenting contractions, and operative delivery if needed. The conclusion emphasizes the need for consensus on treating prolonged labor to balance normal birth and avoiding unnecessary interventions.

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    Government College of Nursing Jodhpur: Presentation ON Prolonged Labour

    Uploaded by

    priyanka
    5K views6 pages
    This document discusses prolonged labor, including its definition as labor lasting more than 18 hours, causes such as issues with uterine contractions, the birth canal, or positioning of the baby, signs and symptoms like slow cervical dilation and fetal distress, risk factors for both mother and baby, diagnosis using a partograph, and management approaches including inducing labor, augmenting contractions, and operative delivery if needed. The conclusion emphasizes the need for consensus on treating prolonged labor to balance normal birth and avoiding unnecessary interventions.

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    This document discusses prolonged labor, including its definition as labor lasting more than 18 hours, causes such as issues with uterine contractions, the birth canal, or positioning of the baby, signs and symptoms like slow cervical dilation and fetal distress, risk factors for both mother and baby, diagnosis using a partograph, and management approaches including inducing labor, augmenting contractions, and operative delivery if needed. The conclusion emphasizes the need for consensus on treating prolonged labor to balance normal birth and avoiding unnecessary interventions.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    5K views6 pages

    Government College of Nursing Jodhpur: Presentation ON Prolonged Labour

    Uploaded by

    priyanka
    This document discusses prolonged labor, including its definition as labor lasting more than 18 hours, causes such as issues with uterine contractions, the birth canal, or positioning of the baby, signs and symptoms like slow cervical dilation and fetal distress, risk factors for both mother and baby, diagnosis using a partograph, and management approaches including inducing labor, augmenting contractions, and operative delivery if needed. The conclusion emphasizes the need for consensus on treating prolonged labor to balance normal birth and avoiding unnecessary interventions.

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    © All Rights Reserved
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    of 6

    GOVERNMENT COLLEGE OF NURSING

    JODHPUR

    PRESENTATION
    ON
    PROLONGED LABOUR

    SUBMITTED TO: SUBMITTED BY:


    JYOTI BALA JANGID PRIYANKA GEHLOT
    LECTURER M.Sc. NURSING
    GCON, JODHPUR FINAL YEAR
    INTRODUCTION:

    Childbirth is a unique experience for every woman, whether you're a first-time mom or a
    longtime parent. Sometimes, the baby comes really fast. Other times, well, not so fast. 
    Sometimes, labor stalls or occurs much too slowly. Prolonged labor may also be referred to as
    "failure to progress."
    Prolonged labor can be determined by labor stage and whether the cervix has thinned and opened
    appropriately during labor. If your baby is not born after approximately 20 hours of regular
    contractions, you are likely to be in prolonged labor. Some health experts may say it occurs after
    18 to 24 hours.

    DEFINITION:
    The prolonged labour is defined when the combined duration of the first and second stage of
    labour is more than the arbitrary time limit of 18 hours. Labour is considered prolonged when
    the cervical dilatation rate is less than 1 cm/ hr and descent of the presenting part is < 1cm/ hr
    for a period of minimum 4 hours observations. It is calculated from mother’s subjective
    estimate of onset of labour.

    Prolonged latent phase- the latent phase is from onset of regular painful contraction with
    cervical dilation up to 4cm. If cervix is not dilated beyond 4cm for 8 hours of regular
    contraction is considered as prolonged latent phase.
    Prolonged active phase- the active phase is period from cervical dilatation 4-10 cm. Regular
    painful contraction with cervical dilatation more than 4cm longer than 12 hour is considered
    as abnormal.
    Cervix is fully dilated and women have urge to push but no descent is called prolonged
    expulsive phase.
    The second stage is considered prolonged if it lasts for more than 2 hours in primigravida and
    1 hour’s ion multipara.

    CAUSES OF PROLONGED LABOR:


    1. First stage: failure to dilate cervix due to-
     Fault in power- abnormal uterine contraction such as uterine inertia or hypotonic
    uterine dysfunction (common), incordinate uterine contraction or hypertonic uterine
    dysfunction.
     Fault in the passage- contracted pelvis, cervical dystocia, pelvic tumor or even in full
    bladder, minor degree of pelvic contraction.
     Fault in the passenger- malposition (OP) and malpresentation (face, brow),
    congenital anomalies of the fetus (hydrocephalus), deflected head.
    2. Second stage:
     Fault in power: - uterine inertia, inability to bear down, epidural analgesia,
    constriction ring.
     Fault in the passage: - CPD, Contracted pelvis, android pelvis, soft tissue pelvic
    tumour, undue resistance of the pelvic floor or perineum due to spasm or old scarring.
     Fault in the passenger:- malposition, malpresentation , big baby, congenital
    malformation of the baby.

    SIGN AND SYMPTOMS OF PROLONGED LABOUR:


    • Labor extend for more than 18 hours

    • The rate of cervical dilatation is less than 1cm/hour in primigravida and less than 1.5
    cm/hour in multipara in first stage of labor.

    • There may be slow descent of head or non descend of presenting part even after full
    dilatation of cervix.

    • Patient looks exhausted and distressed

    • Pain may be more on the radiating to the thighs rather than within abdomen due to
    pressure on muscle and ligaments.

    • Pulse rate often high

    • The uterus is tender on palpation does not relax fully between contraction.

    • Variable degree of moulding and caput formation is cephalic presentation.

    • Fetal distress may develop.

    • Membranes may or may not rupture.

    • Ketoacidosis may develop due to prolong starvation.

    RISK FACTORS OF PROLONGED LABOUR:


    Fetal risk factor:

    • Hypoxia due to decreased uteroplacental circulation.

    • Intrauterine infection

    • Intracranial stress or hemorrhage following prolonged stay on perineum

    • Increased operative delivery


    • Increased risk of perinatal loss

    Mother risk factor:

    • Maternal distress

    • Intrauterine infection

    • Trauma and injuries in birth canal eg cervical tear, rupture of uterus

    • PPH

    • Postpartum infection or puerperal sepsis

    • Subinvolution

    DIAGNOSIS OF PROLONGED LABOUR:


    • History of prolonged labour

    • Abdominal examination

    • Per vaginal examination

    • Partograph- recording of maternal and fetal condition.

    • Intranatal radiography.

    MANAGEMENT OF PROLONGED LABOUR:


     Management of Prolonged Latent Phase-

    If the woman has been in the latent phase for more than 8 hours and there is little sign
    of progress, reassess the situation by assessing the cervix as follows:

    • If there has been no change in cervical dilatation or effacement and no fetal distress,
    review the diagnosis. She may not be in labour.

    • If any changes in cervical effacement or dilatation, membrane should be ruptured and


    labour should induced.

    • The woman should assessed every 4 hourly

    • If she has not been enterd in active phase after 8 hours of induction, delivered by
    caesarean section

    • If there is sign of infection immediately augment the labour with oxytocin and
    antibiotics should be given like ampicilin and gentamycin untill delivery.

    • If not delivered vaginally delivered by caesarean section and continue antibiotics plus
    metronidazole for 48 hours
     Management of Prolonged Active Phase-

    • If there is no sign of CPD and good contraction with membrane intact, ruptured the
    membrane artificially.

    • Assess uterine contraction-

    - If contractions are inefficient ( <3contraction in 10 minutes lasting less than 40


    sec) suspect inadequate uterine activity and refer to higher center.

    - If contraction are efficient(3 or more contractions in 10 minute lasting more than 40


    sec) suspect CPD, malposition or malpresentation and refer to higher level.

    • Continue to moniter maternal and fetal wellbeing and progress of labour.

    • Encourage the woman’s birth companion to give adequate support.

    • Explain all procedure to the woman.

    • Provide supportive, encouraging atmosphere for the birth.

    • Encourage her to empty her bladder regularly.

    • Encourage breathing technique.

    Mangement of prolonged expulsive phase-

    • If malpresentation and obvious obstruction have been excluded, augment labour with
    oxytocin.

    • If there is no descent (fetal head is at 0 or -2 station) after augmentation delivery by


    vaccum extraction or forceps or symphysiotomy.

    • Abnormal Uterine Contraction

    Normal labour is characterized by coordinated uterine contraction associated with


    progressive dilatation of the cervix and descent of the fetal head within the specified time
    limit. Any deviation of the normal pattern of uterine contraction affecting the course of
    labour is termed as disordered or abnormal uterine action.

    • Premature attempt of vaginal delivery or attempted instrumental delivery under


    anesthesia.
    SUMMARRY:
    Today we discussed about-
    Definition of prolonged labour, causes of prolonged labour, sign and symptoms of prolonged
    labour, risk factors of maternal and fetal risk factor, diagnosis and management of prolonged
    labour labour.

    CONCLUSION:
     Prolonged labour is a complicated condition negatively affecting obstetric outcome and
    women's experiences. There is a need for consensus in classification and treatment of
    prolonged labour. Careful management of interventions is crucial in order to keep normal
    births normal and avoid mistreatment.

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