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	Complications in the first stage of labour Fetal Distress Prolonged Labour Cephalopelvic Disproportion Complications in the second stage of labour Delayed Second Stage Shoulder Dystocia Complications in the third stage of labour Postpartum Haemorrhage Retained Placenta Maternal Injuries	Consultations on this website are by email only. Pay a nominal fee of USD20.00 per question through Paypal
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PROLONGED LABOR Labor is said to be prolonged when the combined duration of both the first stage and second stages of labor is more than 18 hours. It is more common in a first pregnancy and in women over the age of 35 years. Causes of Prolonged Labor Malpresentations: The normal position of the fetus is longitudinal with the fetal spine parallel to the mother's spine. The fetus lies in a completely flexed position with the chin touching the chest and the arms and legs flexed in front. The fetus normally faces the mother's back for a smooth delivery. Any change in this position can cause prolongation in the duration in labor. A breech presentation in which the fetus is in the buttocks down position, a face presentation in which the fetus faces the mother's abdomen, or a deflexed position of the head in which the neck of the fetus is less flexed or even straight or extended can all cause prolonged labor. Cephalopelvic Disproportion (CPD) CPD is said to occur when the size of the fetal head is bigger then the size of the maternal pelvic passage or birth canal. In most pregnant women in labor, ligaments and joints tend to become more flexible, enabling them to relax more at the time of labor. The baby's skull bones are also capable of overlapping each other normally to some extent, decreasing the size of the head('moulding'. So, it is difficult to estimate by physical examination alone if CPD is actually present. But if labor is unduly prolonged and no other cause is detected, a diagnosis of CPD is usually made. True CPD occurs only when the baby is very big, as in a diabetic mother or a physically very small-built mother, or if the mother has had a fractured pelvis at some time. Problems with Uterine Contraction: The uterine muscle may fail to contract properly when it is grossly distended as in twin pregnancy and hydramnios (excess liquor amnii). Presence of tumours like fibroids in the uterine musculature can also affect uterine contraction. Use of Sedatives and Anesthesia: Excessive use of painkillers or anesthesia can cause inefficient uterine action. They can also decrease the pain of normal labour and prevent voluntary effort by the mother to deliver the baby during the second stage of labor. Cervical dystocia or stenosis: The term cervical dystocia is used when the cervix fails to dilate properly and remains at the same position for more than 2 hours. The cervix may fail to dilate when it is fibrosed due to previous operations like cone biopsy or due to the presence of tumors like cervical polyps and fibroids. Signs and Symptoms of Prolonged Labour Labor extends for more than 18 hours. Patient looks exhausted and distressed. Dehydration may be present. Mouth may be dry due to prolonged mouth breathing. Pain may be more on the back radiating to the thighs rather than inside the abdomen. This is due to pressure over the muscles and ligaments. Labor pains may initially be severe, frequent and prolonged but later decrease and become very mild as the muscles become fatigued. Pulse rate is often high. The large intestines are dilated and can be palpated along both sides of the uterus as large, thick structures filled with air. They give off the hollow sound of drums on tapping. The uterus is tender on palpation and does not relax fully between contractions. Ketosis may develop due to prolonged starvation. Fetal distress may develop. Membranes may or may not rupture early. In early rupture, there is a risk of infection of the uterine contents if proper antibiotics are not prescribed. Risks of Prolonged Labour Fetal Risks: Fetal Distress due to decreased oxygen reaching the fetus. Intracranial hemorrhage or bleeding inside the fetal head. Increased chances of operative delivery like Cesarian sections. Longterm risks of the baby developing cerebral palsy. Maternal Risks: Intrauterine infections Trauma and injuries in the maternal birth passage (See Maternal Injuries.) Postpartum hemorrhage. Postpartum infection. Management / Treatment of Prolonged Labour With the discovery of various drugs capable of accelerating labour, prolonged labour is a rarity nowadays. After 3cms of dilation, the cervix should dilate at the rate of 1cm per hour. If there is lack of dilation for a reasonable period of time, then an oxytocin drip is started. Drugs like epidosin causes softening of tissues in the cervix. If the cervix fails to dilate in spite of adequate uterine contraction, epidosin or buscopan can be safely given to cause softening of the cervix. Intensive clinical monitoring should be done, recording the pulse, BP, fetal heart sound (FHS) and dilation of the cervix at intervals of two hours. FHS should be checked even more frequently if necessary. If, in spite of the above procedures, labour fails to get accelerated or if foetal distress develops, Cesarian Section should be done. Bookmark this page Digg it! Stumbleupon Facebook del.icio.us OTHER TOPICS IN "NORMAL LABOR": Complications in the first stage of labour Fetal Distress Cephalopelvic Disproportion Complications in the second stage of labour Delayed Second Stage Shoulder Dystocia Complications in the third stage of labour Postpartum Haemorrhage Retained Placenta Maternal Injuries Web www.gynaeonline.com Go Top

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