Maternity caurse

1. Federal Democratic Republic of Ethiopia
Ministry of Health
BEmONC – LRP
ETHIOPIA
Best Practices in Maternal and Newborn Care
Abnormal Progress of Labor

2. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Objectives
 Demonstrate ability to use partograph to
recognize abnormal progress of labour
 Identify the causes of abnormal progress of
labour
 Demonstrate ability to provide initial
management
 Refer a woman with prolonged/obstructed
labour
 Discuss the complications of obstructed
labour
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3. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Unsatisfactory Progress of
Labor
 Unsatisfactory progress of labor is defined
as:
 Cervical dilatation to the right of the alert
line on partograph
 Prolonged labour is labour which lasts more
than 12 hours in the active phase.
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4. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Causes of slow progress in labour:
 Powers
 Inadequate contractions (dysfunctional
labour)
 Passage
 Pelvis too small for baby (cephalopelvic
disproportion – CPD)
 Passenger
 Abnormal presentation or position
 Fetal abnormality e.g. hydrocephalus
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5. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Initial management of prolonged
labour
 In first level facility: refer
 In higher level facility:
 Restore normal progress by giving oxytocin by
i/v infusion according to local regime and
 consider rupturing membranes if HIV negative
 Reassess in 2 hours
 If no further progress decide next step
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6. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Remember!
 Slow progress may be due to any of the 3P’s
 The management of slow progress of labor
depends on the cause
 Augmentation with oxytocin may be
dangerous and cause rupture of uterus
and/or fetal distress
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7. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Slow progress in second stage:
 Delay in descent of presenting
part
 Delay in expulsion
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8. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Slow progress in 2nd stage:
Management
 Review maternal condition and refer
 Consider augmentation if in higher level
facility

 If foetal head >2/5 palpable deliver by C/S
 If foetal head < 2/5 palpable assist delivery
by vacuum extraction
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9. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Symptoms & signs of Obstructed
labor(OL)
 Prolonged labor more
than 12 hrs in active
stage or total more
than 24 hrs
 Thirst
 Fever
 Lower abdominal pain
 Anxious & Restless
 Abnormal lie (
transverse)
 Horizontal ridge across
lower abdomen (three
tumor abdomen
comprising distended
bladder, upper & lower
segment of the uterus)
 Moderate to severe
molding
 Caput
 Absent FHB( IUFD/Fetal
distress)
Symptom OL Signs of OL
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10. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Treatment & Advise
 Secure IV line with Normal Saline or Ringer
lactate solution
 Start IV broad spectrum antibiotics
 Insert Catheter
 Recruit two adult fit blood donors who will
donate
 Consult or refer for operative delivery
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11. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
 Sepsis
 Haemorrhage
 Uterine rupture
 Fistula formation
 Obstetrical palsy
 Death
 Birth trauma
 Birth asphyxia
 Intrauterine fetal
death
 Neonatal sepsis
 Perinatal death
Maternal
complications
Foetal complications
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12. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
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13. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Obstructed labour – immediate care
 Assessment
 I/V fluids
 Antibiotics (parenteral)
 Delivery by appropriate method
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14. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Obstructed labour – delivery
options
 Fetus alive  CS if at higher level facility
 Fetus dead  destructive procedure, (?CS
depending on the presentation of the baby & if
there are other C/I for vaginal delivery [e.g
previous scar])
 Ruptured uterus  laparotomy  repair, or
hysterectomy
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15. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
FETAL DISTRESS IN LABOR
 PROBLEMS
 Abnormal fetal heart rate (less than 100
or more than 180 beats perminute).
 Thick meconium-stained amnioticfluid.
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16. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
MANAGEMENT
 GENERAL MANAGEMENT
 Prop up the woman or place her on her
left side.
 Stop oxytocin if it is being administered.
 Open IV line to hydrate.
 Look for possible causes like cord
prolapse.
 Start intranasal oxygen

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17. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Plan delivery
 If the cervix is fully dilated and the fetal
head is not more than 1/5 above the
symphysis pubis or the leading bony edge
of the head is at or below 0 station, deliver
by vacuum extraction or forceps;
 If the cervix is not fully dilated or the fetal
head is more than 1/5 above the
symphysis pubis or the leading bony edge
of the head is above 0 station,
consult/refer for delivery by C/S.
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18. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Abnormal Progress of Labour
Summary:
 Unsatisfactory progress of labor can be
detected if cervical dilatation is to the right
of the alert line on partograph
 Prolonged labour is labour which lasts more
than twelve hours in the active phase.
 Causes of slow progress in labour could be
problem in power, passenger or passage
 Cases of prolonged labour need to be
referred to a higher level and managed
according to the cause
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