Primary Dysfunctional Labor

Primary Dysfunctional Labor.

Definition

 - refers to inadequate uterine contractility to maintain appropriate progress in labor
 - adequate uterine contraction pattern is one in which there are four to five concerted synchronous contractions every 10 minutes
- poor progress during active phase of labor : cervical dilation <1cm/hour for 2 consecutive hours

Diagnosis 

• Using partogram
• Usually mother in primary dysfunctional labor will have these shown in partogram, the one shown below is one of the examples.

https://www.slideshare.net/MohdHanafi1/13-partogram

Partogram reading samples can be like this:

• Contraction inadequate and deviated in the first 3 hours
• Station remain high after 10 hour in labor
• Cervical contraction arrested beyond action line

Make sure you diagnose them correctly and able to differentiate between prolong latent phase, primary dysfunctional labor and secondary arrest:

Causes:

1. Maternal factors:

• Inadequate pelvis size
• Liquor volume low
• Pelvis contraction inadequate
• increase stress

2.  Fetal factors:

• Malposition if the baby
• Macrosomic fetus
• Malpresentation
• Fetal Anomaly

3. Placental factors

4. Physical restrictions (position in bed)

5. Premature or excessive analgesia particularly during latent phase

Management:

• Admit mother and keep her under close observation
• Monitor the mother and baby vital signs
• IV line fluid and Oxygen supply
• Order blood test - Full blood count, amylase, urine and electrolytes
• Order CTG and ultrasound to confirm baby position
• Full abdominal examination and vaginal examination

Further Management:

• Oxytocin 
• Constant monitoring using CTG 
• Maintain mother's oxygen level
• Reposition the mother
• IV fluid 
• C-section (if no changes 2-4 hours after maximum oxytocin dose achieved)