Chapter: Obstetric and Gynecological Nursing : Abnormal Labour

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Prolonged Labour

Traditionally labour is prolonged if it exceeds 24 hours. When labour is activity managed, It is termed prolonged if delivery is not imminent after 12 hrs of established labour.

Prolonged Labour

 

 

Traditionally labour is prolonged if it exceeds 24 hours. When labour is activity managed, It is termed prolonged if delivery is not imminent after 12 hrs of established labour.

 

NB. The sun should not set twice in woman in labour

 

 

The first Stage

 

The latent phase considered prolonged over 20hrs in primigravidae or over 14 hrs in multigravidae.

 

Primary dysfunctional-labour progress in active phase of labour is slow and the cervix dilate less than 1 cm on hour.

 

Secondary arrest:- After normal progress in early labour, cervical dilation is arrested in active phase.

 

Cause in 1 st stage

 

·        In-efficient uterine contraction (Power) is the most common cause of prolonged labour. The cervix dilates slowly or not at all.

·        Pelvic abnormalities (Passage). A contracted pelvis and pelvic tumors prevent normal progress in labour.

·        The fetus (Passenger):- a large fetus malpostion of the occiput of malpresntation inhibit the progress of labour.

·        Psychological cause:- Abnormally tense or apprehensive women tend to have prolonged labors. The primigravidae more often affected than multigravidae

 

 

Management

 

When progress in labour is slow the cause must be identified week uterine action man be rectified with a syntocinon infusion Caesarian section if nor progress despite good uterine contraction Obvious disproportion or malpresentation of the fetus indicate the need for operative deliveries.

 

Nursing Care

 

Maternal condition: She may be exhausted, dehydrated andketotic and may be suffering severe pain

 

·        Encourage and reassure the mother

 

·        Help to adopt a comfortable position

 

·        Adequate analgesia should be affered because it will enable her to rest.

 

·        Administer IV infusion

 

·        Empty bladder regularly

 

·        Test urine for ketoses

 

·        Record intake and out put

 

·        Allow sips of water

 

·        If membrane ruptured 24 hours before high vaginal swab is taken for culture and sensitivity and antibiotic is started

 

Fetal Condition: -

 

·        Monitor the fetal heart beat

 

·        Observe amniotic fluid (meconium)

 

·        Avoid aspiration at delivery

 

The Second Stage

 

The exception in this phase should be continuous descent and advance of the fetal head.

 

Causes of a prolonged 2nd stage of labour:

 

·        Hypnotic uterine contractions

 

Manegement – syntocinon infusion is commenced in order to stimulate adequate contraction

 

·        Ineffective maternal effort.

 

Fear, exhaustion or lack of sensation may inhabit woman’s ability to push and cause delay, especially in primigravida.

 

·        A rigid perineum.

 

A forceps delivery is performed under local anesthesia.

 

 

·        Reduced pelvic out let.

 

A forceps delivery is performed if possible or, in severs cases, Caesarian section.

·        Large fetus

 

An operative delivery will be necessary.

 

 

Complications of Prolonged labour

 

Maternal:

 

·        edema

·        Laceration

·        Uterine prolapsed, PPH

·        Cystocele or rectocele- over stretching of pelvic floor muscles

·        Retention of urine

·        Urinary tract infection during peripureum.

 

Fetal:

 

·        Difficult instrumental deliveries

 

·        Hypoxia

 

·        Intracranial hemorrhage

 

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