Partus Lama

dan Induksi
Persalinan
dr.Rahmanita Sinaga,
MKed(OG),SpOG
Bagian obstetri dan ginekologi
Fakultas Kedokteran Universitas Muhammadiyah sumatera
Utara
2020
 ABNORMAL PATTERNS OF LABOR 

The progress of labor is evaluated primarily through estimates of

cervical dilatation and descent of the fetal presenting part.
Friedman abnormal patterns of labor:

(1) prolonged latent phase

(2) protraction disorders (protracted active-phase dilatation and protracted

descent)

(3) arrest disorders (prolonged deceleration phase, secondary arrest of

dilatation, arrest of descent, and failure of descent)

(4) precipitate labor disorders.

1. Prolonged Latent Phase

• The duration of the latent phase averages 6.4 hours in

nulliparas and 4.8 hours in multiparas.

Causes :
• excessive sedation or sedation given before the end of the
latent phase.
• labor beginning with an unfavorable cervix.
• uterine dysfunction characterized by weak, irregular,
uncoordinated, and ineffective uterine contractions.
• fetopelvic disproportion.
Treatment options:

• 85% of patients spontaneously enter the active phase of labor.

• 10% of patients false labor allowed to return home to

await the onset of true labor if fetal status is reassuring.

• 5% of patients uterine contractions remain ineffective in

producing dilatation no contraindication
induction/augmentation
2. Protraction Disorders

• Protracted active-phase dilatation is characterized by an

abnormally slow rate of dilatation in the active phase, ie, less
than 1.2 cm/h in nulliparas or less than 1.5 cm/h in multiparas.

• Protracted descent of the fetus is characterized by a rate of

descent under 1 cm/h in nulliparas or under 2 cm/h in
multiparas.
The second stage of labor:
 normally averages 20 minutes for parous women
and 50 minutes in nulliparous women
 Protracted when it exceeds 2 hours in nulliparas
or 1 hour in multiparas, or 3 and 2 hours
respectively in the presence of conduction
anesthesia.
The underlying pathogenesis of protracted labor is probably
multifactorial.

 Fetopelvic disproportion.
 minor malpositions such as occiput posterior.
 improperly administered conduction anesthesia.
 excessive sedation.
 pelvic tumors obstructing the birth canal.
Treatment of protraction disorders
 Cesarean section is indicated in the presence of confirmed
fetopelvic disproportion.

 In the absence of fetopelvic disproportion  conservative

management support and close observation, and therapy
with oxytocin augmentation  good prognosis for vaginal
delivery.
 
3. Arrest Disorders
The four patterns of arrest in labor:
(1) prolonged deceleration, with deceleration phase lasting more
than 3 hours in nulliparas or more than 1 hour in multiparas.
(2) secondary arrest of dilatation, with no progressive cervical
dilatation in the active phase of labor for 2 hours or more.
(3) arrest of descent, with descent failing to progress for 1 hour
or more.
(4) failure of descent, with descent failing to occur during the
deceleration phase of dilatation and during the second stage.
Causes:
• About 50% of patients with arrest disorders demonstrate
fetopelvic disproportion.
• Various fetal malpositions (eg, occiput posterior, occiput
transverse, face, or brow).
• inappropriately administered anesthesia, or excessive
sedation.

• fetopelvic disproportion cesarean section

• If fetopelvic disproportion is not present and uterine
activity is less than optimal oxytocin stimulation is
generally effective in producing further progress.
4. Precipitate Labor Disorders

 Precipitate dilatation occurs if cervical dilation occurs at a

rate of 5 or more centimeters per hour in a primipara or at 10
cm or more per hour in a multipara.

 Precipitate descent occurs with descent of the fetal

presenting part of 5 cm or more per hour in primparas and 10
cm or more per hour in multiparas.
Causes:
1-extremely strong uterine contractions
2-low birth canal resistance.

• If oxytocin administration is the cause of abnormal

contractions, it may simply be stopped.
• If excessive uterine activity is associated with fetal heart rate
abnormalities, and this pattern persists despite discontinuation
of oxytocin, a b-mimetic such as terbutaline or ritodrine can be
given and magnesium sulfate also .
• Lacerations of the birth canal are common.
INDUCTION OF LABOR
 Induction stimulation of contractions before
the spontaneous onset of labor, with or without
ruptured membranes.

 Augmentation refers to stimulation of

spontaneous contractions that are considered
inadequate because of failed cervical dilation and
fetal descent
Indication

 When the benefits to either mother or fetus

outweigh those of continuing the pregnancy.

Most common :
 Preeclampsia or gestational hypertension
 membrane rupture without labor
 nonreassuring fetal status,
 postterm pregnancy
Contraindication
 Similar to those that preclude spontaneous labor
or delivery.
 Fetal factors : macrosomia, multifetal gestation,
severe hydrocephalus, malpresentation, or
nonreassuring fetal status.
 Maternal contraindications : prior uterine incision
type, contracted or distorted pelvic anatomy,
abnormal placentation, and conditions such as
active genital herpes infection or cervical cancer.
Risks
 Cesarean delivery
 Chorioamnionitis
 Uterine atony
 Uterine rupture
 Preeinduction : Cervical Rippening
 Cervical "Favorability“
Prostaglandin E1
 Misoprostol—is a synthetic prostaglandin E1 ,
approved as a 100- or 200-g tablet for prevention
of peptic ulcers.
 It has been used "off label" for preinduction
cervical ripening and may be administered orally
or vaginally
 Vaginal, 25 µg; repeat 3–6 hr
 Oral, 50–100 µg; repeat 3–6 hr
Mechanical Techniques : Transcervical Catheter
Mechanical Techniques :
Hygroscopic Cervical Dilators
 Cervical dilatation for early pregnancy
termination
 Laminaria insertion
 Dilators are attractive because of their low cost
and easy placement and removal.
 Membrane Stripping for Labor
Induction
 Strippingwas safe and decreased the incidence of
postterm gestation  significantly increased serum levels
of endogenous prostaglandins with stripping (McColgin
and associates, 1993).
Labor Induction and Augmentation with
Oxytocin
AMNIOTOMY
 Artificialrupture of the membranes
 Risk of cord prolapse, care should be taken to
avoid dislodging the fetal head.
 The fetal heart rate should be assessed before and
immediately after amniotomy.