Diagnosing abnormal progress of labor involves assessing maternal and fetal factors, labor patterns, cervical dilation, and descent of the fetus.
Get the full solved assignment PDF of MME-302/As-5 of 2024 session now.
In a primary healthcare (PHC) setup, where resources may be limited, diagnosing and managing abnormal labor progress requires a systematic approach focused on early recognition, appropriate interventions, and timely referral when necessary. Here’s how abnormal progress of labor can be diagnosed and managed in a PHC setting:
Diagnosing Abnormal Progress of Labor:
- Maternal Assessment:
- Evaluate the mother’s clinical condition, including vital signs, pain level, hydration status, and overall well-being.
- Inquire about the duration and intensity of contractions, maternal fatigue, and coping mechanisms during labor.
- Fetal Assessment:
- Monitor fetal heart rate patterns using intermittent auscultation or electronic fetal monitoring (EFM) if available.
- Assess for signs of fetal distress, such as persistent tachycardia, bradycardia, or variable decelerations.
- Cervical Examination:
- Perform a digital cervical examination to assess cervical dilation, effacement, station, and position of the presenting part.
- Document cervical findings, including cervical dilatation progress, in centimeters and fetal station in relation to the maternal pelvis.
- Labor Progress Evaluation:
- Evaluate the frequency, duration, and strength of uterine contractions using palpation or a partograph if available.
- Assess the rate of cervical dilation and descent of the fetal head over time to determine labor progress.
- Labor Patterns:
- Identify abnormal labor patterns, such as prolonged latent phase, protracted or arrested active phase, or prolonged second stage of labor, based on established criteria and labor curve norms.
Managing Abnormal Progress of Labor in PHC:
- Non-pharmacological Interventions:
- Encourage maternal mobility, position changes, hydration, and comfort measures (e.g., warm baths, relaxation techniques) to promote optimal labor progress and maternal comfort.
- Provide emotional support, reassurance, and encouragement to the mother and her support person(s) to enhance coping and reduce anxiety during labor.
- Amniotomy (Artificial Rupture of Membranes):
- Consider performing amniotomy to augment labor progress if membranes are intact and cervical dilation is ≥ 3-4 cm, based on clinical assessment and obstetric indications.
- Monitor for signs of umbilical cord prolapse, fetal heart rate changes, or infection risk following amniotomy.
- Oxytocin Augmentation:
- Initiate oxytocin augmentation if uterine contractions are inadequate or labor progress is delayed despite conservative management.
- Administer oxytocin infusion according to a standardized protocol, titrating the dose based on uterine response and fetal well-being, while monitoring for uterine hyperstimulation or adverse effects.
- Positional Maneuvers:
- Encourage maternal position changes, such as upright positions (e.g., walking, squatting) or lateral positioning, to optimize pelvic dynamics, enhance uterine contractions, and facilitate fetal descent.
- Nutritional Support:
- Offer oral fluids, light snacks, and glucose-containing beverages to maintain maternal hydration, energy levels, and nutritional status during labor.
- Avoid routine restriction of oral intake unless contraindicated (e.g., high-risk pregnancies, maternal complications).
- Continuous Labor Support:
- Provide continuous one-to-one support from a trained birth attendant, doula, or skilled birth companion to offer physical assistance, emotional support, and advocacy for the mother’s preferences and needs during labor.
- Monitoring and Reassessment:
- Monitor maternal and fetal well-being regularly throughout labor, including vital signs, uterine contractions, fetal heart rate patterns, and cervical progress.
- Reassess labor progress, maternal condition, and fetal status at regular intervals to guide ongoing management decisions and determine the need for escalation or referral.
- Documentation and Communication:
- Document labor assessments, interventions, maternal preferences, and fetal responses accurately in the maternal health record.
- Communicate effectively with the healthcare team, including obstetricians, midwives, and referral facilities, to facilitate continuity of care, collaboration, and timely decision-making in managing abnormal labor progress.
Referral and Transfer:
- Criteria for Referral:
- Consider referral to a higher level of care, such as a secondary or tertiary hospital, if labor progress does not improve despite conservative measures, oxytocin augmentation, or amniotomy, or if signs of maternal or fetal compromise develop.
- Communication with Referral Center:
- Contact the receiving facility to provide a detailed handover report, including relevant clinical information, labor progress, interventions performed, and indications for transfer.
- Arrange for safe and timely transportation of the mother to the referral center, ensuring appropriate maternal and fetal monitoring during transfer.
- Continuity of Care:
- Maintain communication with the receiving facility to ensure seamless continuity of care, ongoing support, and collaboration in managing the mother and her baby’s care upon arrival.
In a primary healthcare setting, managing abnormal progress of labor requires a proactive approach to monitoring, intervention, and supportive care, while recognizing limitations in resources and expertise. By adhering to evidence-based practices, promoting maternal autonomy, and fostering interdisciplinary collaboration, PHC providers can optimize maternal and fetal outcomes and promote safe and satisfying childbirth experiences for women in their care.