Labour abnormalities and the partogram

1. ABOR,LABOR ABNORMALITIES AND
THE PARTOGRAM
Definition of labor
Initiation of labor
Transition from pregnancy to labor
Physiology of labor
Abnormalities of labor and Partogram

2. Three parts of partogram
 Fetal part
 Maternal part
 Progress of labor

3. Definition of labor
 Labor is defined as progressive dilatation of uterine
cervix associated with cervical effecement,decent of
the head and regular uterine contraction leading to the
delivery of the baby.
 The role of cervical dilatation as a defining process of
labor is therefore pivotal and is the central feature of
the partograph.

4. Initiation of blabor
 There are several factors and theories explaining
initiation of labour.
 These factors are either autocrine or paracrine factors
which may be produced locally or significantly from the
fetus.these are always produced in a coordinated
fashion leading into parturation.

5. The key component of labour seems to
be fetoplacental unit.
Fetal brain influence on the
fetaplacental endocrinology via the
hypothalamopituitary-adrenoplacental
axis
ACTH stimulate adrenal production of :
 Cortisol which bring about maturation
of the fetal lung with the generation
of the pulmonary surfactant

6.  Cortisol also promotes changes in the
fetal kidney which modify the content
of amniotic fluid and thereby activate
the fetal membrane (amnion and
chorion) hence favour synthesis of
prostaglandin.
 Dehydroepiandrosterone sulphate
which is the key production of
placental estradiol production hence
increase in the level of
oestrogen/progesterone ration in the
favour of estrogen.

7.  Increase in the level of oestrogen will lead to increase
in free ca by increasing of connexin 43 which stimulate
myometrial contraction.
 There is increase in oxytocin receptor, PGE2,PGF2
 There is also increase in cytokine
and chemokine(IL8, Neutrophil
attractant etc)

8.  There is chemical changes which occr in the cervix
under the influence ofPGE2.
 There is degradation of the stromal collagen
III,degradation of the proteoglycan complexes and
water content of the ground substances which is
thought to cement collagen fibrils into the rigid
bundles.

9.  Neutrophils are rich in the protease enzyme which
further breakdown the cervical collagen material hence
the common terminology used in obstetrics RIPENING
OF THE CERVIX.
 Other enzymes released are
metelloproteinase,elastase,hyalurodinase etc.

10. Physiology of labor
Traditional teaching of mechanism of labor has focused on
the four participant which are:
 Power
 Passage
 Passenger
 psychic

11. Power
 This is the force created by uterine
contraction.It always start from the
cornu of the uterus.
 Abnormalities in the power maybe
due to hypotonic or incordination of
uterine contraction which is very
common in prime gravida.
 This abnormality is always
managed by augumenting with
oxytocin.

12. Passage
 A disorder in the passage comes from
abnormalities in the maternal bony pelvis
which may either be due to
disease,trauma leading to deformity.
 Others are younger age or extreme
age,nutritional deficiency like rickets,
short stature.
 Pelvic mass like uterine myoma occupying
the lower segment ,ovarian mass.
 Soft tissue of the birth canal like
cervix,vagina,perineum may be rigid due
to scarring and obstruct progress of
labour.

13. Passenger
 The passenger is the fetus and this may be
uncooperative leading to abnormalities in
labour through being excessively big or being
in the wrong position like POPP,it may also
have abnormal presentation like breech
presentation,arm presentation,shoulder
presentation,face presentation and brow
presentation .
 Also this passenger may assume wrong
attitude which leads to difficult labor (ideally
the passenger should be flexed)
 Multiple passengers with mulpresentation

14. Psychic
 This is psychological preparation of labour.
 If the mind does not want it is difficult to force the
body.

15.  It is easy to make an intervention in a woman with a
disorder in the power but abnormal passage and
power always lead to operative deliveries.

16. Partogram and
Abnormalities of labor
 Partogram is a tool used in the
management of normal labor.it has three
part which are :
 Upper part which is used in the
monitoring of the fetal well-being during
labour.
 There are three things which are
monitored :fetal heart rate(120-160b/m),
state of the liquor(clear,meconium) and
stat of the head ( grade of
moulding).

17. Central portion of the partogram is monitoring the progress
of labor where:
 cervical dilatation in cm is plotted against time
 Descent of the head is plotted
 Frequency and intensity of contraction.

18.  The bottom part of partogram is monitoring maternal
well being
 BP,PR,Temperature,urine output and whether there is
protein or not
 Drugs given to the mother and amount of intravenous
infusion given in that particular time of labour.