Paper of Obstetric Lecturer : Dr. H.

Adil Zulkarnain, SpOG(K) Nama Nim : Ari Puji Astuti : 030111b005

2. Sign and Symtom

Labor extends for more than 18 hours. 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. Ketosis may develop due to prolonged starvation.4

Prolonged Labour
1. Definition

When the combined duration of the first and second stage of labour is more than the arbitrary time limit of 18 hours, it is termed prolonged labor. 3. Causes of Prolong Labor The prolongation encompasses delayed dilatation of the cervix (in the first stage) and/or inadequate Any one or combination of the basic elements descent of the presenting part (during the first or involved in labor are responsible, both in the First second stage).1 Stage - failure to dilate the cervix and the Second Stage - Sluggish or non-descent of the foetus in the Labor that lasts more than 24 hours is by definition second stage is due to called prolonged labor. The exact time of the onset of labor is often hard to diagnose. The best Fault in power include Inability to bear down, definition of the onset of labor is the time at which abnormal uterine contraction or in-coordinate the woman has contractions that lead toward the uterine contraction. birth of her baby. 2 Fault in the passage includes - contracted pelvis, pelvic tumor, eg:fibroid or even full Prolonged labour is most often defined as onset baldder. of regular, rhythmical painful contractions Fault in the passenger includes - malposition accompanied by cervical dilation where labour is and malpresentation, congenital anomalies of longer than 24 hours. This definition however has the foetus (hydrocephalus - common) Too limitations, and therefore it is more useful in terms often deflexed head, minor degrees of pelvic of management to refer to prolonged stage of contraction and disordered uterine action have labour, i.e. prolonged latent phase of labour or got sinister effects in causing non-dilatation of prolonged active phase of labour. Latent phase the cervix. being the onset of regular painful contractions with Others - Injudicious early administration of cervical dilation up to 4 cm, and should not be sedatives and analgesics before the actual longer than 8 hours. Prolonged active phase is, active labor begins. 1 regular painful contractions with cervical dilation of more than 4 cm should not last longer than 12 hours without full assessment in a facility able to offer management and treatment of complications.3

4. Dangers of Prolong Labor

a. Foetal The foetal risk is increased due to the combined effects of: 1. Hypoxia 2. Intrauterine infection 3. Intracranial stress or bleeding following prolonged stay in thepenineum and/or supermoulding of the head 4. Increased operative delivery. b. Maternal There is increased incidence of : Distress Postpartum haemorrhage Trauma to the genital tract - concealed (undue stretching of the perineal muscles which may be the cause of prolapse at a later period) or revealed such as cervical tear, rupture uterus Increased operative delivery Puerperal sepsis Subinvolution.

The position of the baby and the presenting part must be accurately diagnosed. Engagement and station should be noted. If there is failure of descent, the cause needs to be determined. Is it the cervix, the pelvis, the fetus, the size of the head, weak uterine contractions, etc.? The uterine contractions are assessed for strength, efficiency, frequency, length, interval, and changes. Pelvic adequacy and signs of CPD are assessed.

7. Management of prolonged Labor

Encouragement is provided for the laboring woman. She will need extra support to get through a long labor. Hydration is maintained. The woman may eat and drink as desired during early labor. The bladder is emptied every hour. The urine is checked for ketones every 4 hours to make sure she is not showing signs of exhaustion. Vaginal exams are performed conservatively under sterile conditions. The condition of the baby is monitored by checking FHT's and watching for meconium. The baby is closely monitored for signs of stress. Sources: 1 http://www.justeves.com/ipl/prolonged_labor.sht ml 2 http://www.caroldenny.com/index.php?option=c om_content&view=article&id=126:prolongedlabor&catid=65:special-circumstances-andcomplications&Itemid=78 3 World Health Organization. 2008. Education Material for Teacher of Midwifery: Managing Prolonged and Obstructed labour. WHO 4 http://www.nursinglectures.com/2011/03/prolonged-labour-andnursing-care.html

5. Prevention of Prolonged Labor

Good prenatal care reduces the incidence of prolonged labor. The baby's position is checked for vertex presentation with good head flexion. False labor is treated by rest. Labor is not induced or forced when the cervix is not ripe. This includes natural labor i inductions, rupture of membranes, or drugs. The woman should try to be well rested at the beginning of her labor. If she knows she is in early labor, she should not wear herself out. A tired uterus will not contract as efficiently.

6. Assessment of Labor
The woman's progress is monitored and assessed regularly. The woman's general condition is observed for signs of fatigue: hydration, energy, nourishment, temperature, pulse.