COMPLICATIONS /PROBLEMS OF LABOR DURING PREGNANCY / CHILD BIRTH

LABOR DYSTOCIA :

• Difficult labor but refers to abnormally “slow”progress of labor.

•  The labor has failed to progress from phase to phase as expected.

•  The presenting part is not descending & rotating any further.

 

USUAL DILATION :

 

                                              DILATION                                          DESECENT

PRIMIPARA   (1st pregnancy) :        1.2cm/hr                                                           1 cm/hr 

MULTIPARA (multiple pregnancy) : 1.5cm/hr                                                            2cm/hr

CAUSES:

 

There are 3 main causes for the delay of 1st and 2nd stage of labor :

• Inadequate or ineffective contractions of your uterus.

•  Abnormal size or position of the baby. 

•  Abnormalities in the pelvis or the structures that support it.

                 

                         Shape                                                                                                             Diameter

• Gynecoid          : round                                                                                                           average

• Anthropoid       :    long, oval                                                                                                 long

• Android            : heart shaped                                                                                                short

• Platypelloid      : flat, oval                                                                                                     short

FOETAL DISTRESS :

Foetal distress can show up as:

• meconium (a green slimy liquid) in the waters.

• changes in baby's heart rate.

• excessive movements of the baby.

MATERNAL DISTRESS:

 

Physical distress :

• Increase in pulse rate

• Increase in temperature

• Increase in b.p.

• Dehydration

• Ketosis

• Oliguria

Psychological distress:

• Anxiety

• Fear

• Pain

• Depression

MALPRESENTATION:

When the presenting part is other than the
vertex, for e g. Buttocks, arms or face.

• Most common : breech /buttocks
presentation.

 

 

BREECH PRESENTATION:

This is an ultrasonogram of a breech malposition of a baby in womb.

BREECH PRESENTATION:

Breech presentations are normally seen far before the due
date, but most babies will turn to the normal vertex (headdown)
presentation as they get closer to the due date.

• In a EXTENDED breech, the baby's buttocks lead the way
into the pelvis; the hips are flexed, the knee extended.

• In a COMPLETE breech, both knees and hips are flexed
and the buttocks or feet may enter the birth canal first.

• In a FOOTLING OR INCOMPLETE breech, one or both feet
present first with the hips & knees extended.

• Your doctor will determine the presentation
and position of the foetus with a
physical examination.

• Sometimes a sonogram helps in determining
the foetus' position.

• When a baby is in the breech position before
the last six weeks to eight weeks of pregnancy,
the odds are still good that the baby will flip.

• However, the bigger the baby gets and the
closer you get to the due date, the less room
there is to maneuver.

• Doctors estimate that about 90% of feotuses
who are in a breech presentation before 28
weeks will have turned by 37 weeks, and over
90% of babies who are breech after 37 weeks
will most likely stay that way.

MALPOSITION:

• The vertex is less optimally placed .
• Orientation of the baby changes.
• The most common malposition is the
OCCIPITOPOSTERIOR position.
• Commonly the occiput will be at the right side
of the saccrum.

KNOTS OF THE UMBILICAL CORD:

• A true knot may be caused by the movement
of the foetus .
• A false knot may be caused by the blood
vessels being longer than the cord.

HAEMORRHAGE:

• Because of the huge enhanced blood supply

to the uterus which has developed through
pregnancy ,haemorrhage to any stage of
labour is extremely serious.

• Hysterectomy is necessary.

RETAINED PLACENTA:

 • Sometimes placenta may have separated from
the uterine wall but needs assistance to leave
the uterus.

Rx:

• Rubbing the abdomen
 

• Suckling reflex
 

• Manual sweep if placenta 

 

PLACENTA ACCRETA: 

• The placental chorionic villi have invaded the
myometrium such that the separation is very
difficult.

• Hysterectomy may be the safe course.