Abnormal Labor


Uterine tachysystole:
- > 6 contraction / 10 min.
- Tx: Slow Pitocin rate.

Uterine hypertonus: A single contraction lasting longer than 2 minutes

Uterine hyperstimulation: When either condition leads to a nonreassuring fetal heart rate pattern.


Cervical Dilation

< 3 cm > 4 cm
Dx:
LATENT Phase
Mgmt:
Observation, Ambulate,
Sedation
Dx: ACTIVE Phase
Normal Dilation Rate? (1.2 cm/1.5 cm per hr)
YES NO
Mgmt:
-Conserv.
-Allow VD.
Adequate UC quality?
(q2-3 min, 45-60 sec., 50mmHg, >200 MVU) measure with IUPC
YES NO
Mgmt:
Emerg. C-Section.
Step 1:  AROM, IV Oxytocin

Normal Dilation Rate?  (1.2 cm/1.5 cm per hr)

YES NO
Mgmt:
-Conservative
-Allow VD.
Mgmt: Emergecy C-Section

Failure to progress:

(Failure to progress 1cm every 2 hrs after 4 cm dilates)
Stage Definition Treatment
STAGE 1
Latent Phase
Failure to have progressive cervical change:
- Prima: > 20 hrs
- Multi: > 14 hrs
Therapeutic rest via parenteral analgesia; Oxytocin; Amniotomy; Cervical ripening.
STAGE 1
Active Phase
 
Failure to have progressive cervical change after reaching 3-4 cm. Amniotomy; oxytocin; C-section if the previous interventions are ineffective.
STAGE 2 Arrest of fetal descent:
- Prima: > 3 hrs
- Multi: > 2 hrs
- Close observation
-↓ in epidural rate & continued Oxytocin.
- Assisted vaginal delivery (forceps or vacuum).
- C-section.

Questions Criteria Mgmt
What phase of labor is pt in? LATENT: < 3 cm ACTIVE: > 3 cm
Prolonged LATENT Multipara > 14 hr
Primipara > 20 hr
Ambulate, Sedate
Prolonged ACTIVE Mult <1.5; Prim < 1.2
(rate of dilation cm/hr)
Consider 3 P's
Pelvic
Passenger
Powers
Arrest of ACTIVE No change in 2-3 hrs
Are contractions adequate (powers)? Freq: q 3 min
Dur: 45-60 sec
Intens: 50 mm Hg
YES: C-Section
NO: AROM, IV Oxy.
After IV Oxytocin contrac. adequate? Mult >1.5; Prim > 1.2
(rate of dilation cm/hr)
YES: Conservative
NO: C-Section