ABNORMAL LABOUR

DEFINITION
• Any deviation from the normal labour called
abnormal.
CHARACTERISTICS:
 Labour in case with presentation other than
vertex or having some complication even with
vertex presentation.
 Modify the nature of termination.
 Adversely affecting the health of the mother
and baby
 Etiologic categories
• The “passage,” or pelvic architecture;
• Passenger,” or fetal size, presentation, and
position
• The “powers,” or uterine action and cervical
resistance; and
• The “patient” and “provider.”
 The “passage,” or pelvic architecture
• Pelvic Inlet
• Midpelvis
• Pelvic Outlet
• Contracted Pelvis
• Soft Tissue Dystocia
• Pelvimetry
DISPROPORTION DURING LABOUR
• Pelvic sidewalls are convergent
• Ischial spines are prominent
• Diagonal conjugate is <11.5 cm
• Subpubic arch angle is <90 degrees
• Sacrum is flat
• No descent of vertex .
 PASSENGER—THE FETUS
• The size, presentation, and position of the
fetus are important factors in the conduct of
labor. Pelvic size and configuration and
excessive soft tissue may influence the fetal
position and presentation.
• Although the macrosomic infant is at greater
risk for dystocia, most cases of abnormal labor
occur among fetuses weighing less than 4000
g.
• The biparietal diameter (BPD), the smallest transverse
dimension of the fetal skull, averages approximately
9.5–9.8 cm among term fetuses. The shortest
anteroposterior dimension is the suboccipitobregmatic
diameter, which also averages approximately 9.5 cm.
• The fetal head can overcome minor degrees of pelvic
contracture by molding.
• The bones of the skull overlap at major suture lines,
which can decrease the BPD by 0.5 cm without fetal
injury. Severe molding may lead to tentorial tears and
intracranial hemorrhage
• Prolonged, severe pressure between the fetus and
birth canal may lead to fetal scalp necrosis or skull
fracture.
• The mother may develop a vesicovaginal,
vesicocervical, or rectovaginal fistula.
• Other risks of fetopelvic disproportion include cord
prolapse, prolonged labor with an increase in
maternal and fetal infections, uterine rupture,
postpartum hemorrhage, abnormal presentation or
position, and maternal and neonatal trauma.
 Malposition and Malpresentation

• compound presentations
• brow presentation
• Persistent occiput posterior position
• occiput transverse position
• Fetal Anomalies:Hydrocephalus,
Encephaloceles,conjoined twins
• Fetal Macrosomia
• Estimation of Fetal Weight.
 POWER—UTERINE CONTRACTILITY
• contractions occur approximately every 3–5 minutes
with a pressure of 20–30 mmHg above resting tone.
• In active labor, contractions are usually every 2–4
minutes with pressures 30–50 mmHg above resting
tone. With pushing, the pressures may rise to 100–150
mm of hg
• In addition to increased frequency and tone, the
duration of contractions lengthens from 30 to 60
seconds in early labor to 60–90 seconds in later labor.
• Functional dystocia has been associated with
two different types of abnormal contraction
patterns. A hypertonic pattern typically has
elevated resting pressures, increased
contraction frequency, and decreased
coordination.
• Hypotonic uterine dysfunction is more
common and frequently responds to oxytocin.
The contractions are synchronous but weak or
infrequent or both.
 PROVIDER/PATIENT

• Physicians may be influenced by the patient’s

attitude, the time of day, anesthesia support,
the medicolegal climate, and their own
training and experience.
• The patient’s level of anxiety and pain
tolerance also may influence the character
and duration of labor.
• Medications given during labor may alter uterine
contractility.
• β-Mimetics, calcium channel blockers, magnesium sulfate,
and antiprostaglandins have been used to inhibit labor.
• Ethanol has a direct depressant effect on smooth muscle
and inhibits oxytocin release.
• Theophylline and caffeine may lead to longer labors..
Pentobarbital and thiopental in anesthetic doses may stop
labor, whereas phenobarbital has little effect. Atropine and
scopolamine relax the lower uterine segment and decrease
the frequency of contractions
• Epidural anesthesia may cause a transient
decrease in contractility for 10–30 minutes.
• Obesity
• Advancing Maternal Age
• Oxytocin
 Stages of labour
• First stage of labour
• Second stage of labour
 CONCLUSION
• There is no known test that can differentiate normal
from abnormal labor.
• The management of abnormal labor taxes one’s clinical
skills under the best of circumstances. Such cases are
complicated by patients who demand and expect a
painless and fast delivery resulting in a perfect infant.
• A thorough documentation of events, especially in the
face of maloccurrence, cannot be stressed enough.
• A key to the optimal management of abnormal labor
remains intensive observation with conservative, well-
chosen, and carefully executed interventions.