But, the term originated at a time when the main indication for cesarean delivery was overt pelvic contracture due to rickets ( Olah, 1994). Of these, cephalopelvic disproportion is a term that came into use before the 20th century to describe obstructed labor resulting from disparity between the fetal head size and maternal pelvis. Commonly used expressions today such as cephalopelvic disproportion and failure to progress are used to describe ineffective labors. More simply, these alterations can be mechanistically simplified into three categories that include abnormalities of the powers-uterine contractility and maternal expulsive effort of the passenger-the fetus and of the passage-the pelvis and lower reproductive tract.Ībnormalities shown in Table 23-1 often interact singly or in combination to produce dysfunctional labor. Or, soft tissue abnormalities of the reproductive tract may form an obstacle to fetal descent. Last, structural changes can contract the maternal bony pelvis. Second, fetal abnormalities of presentation, position, or anatomy may slow progress. Also, voluntary maternal muscle effort during second-stage labor may be inadequate. First, uterine contractions may be insufficiently strong or inappropriately coordinated to efface and dilate the cervix- uterine dysfunction. Similar to the factors described by Williams, dystocia arises from three distinct abnormality categories. It literally means difficult labor and is characterized by abnormally slow labor progress. The aim of this initiative is to lower the incidence of MOH in maternity units by developing a standardised approach to measurement, audit, policies and procedures and training modules.The term dystocia as described by Williams in the first edition of this text still applies today. In this context, a joint venture between NWIHP and the National Perinatal Epidemiology Centre – the Major Obstetrics Haemorrhage Project - has commenced.

NWIHP further notes that a MOH audit in 2011-2013 showed good practices being followed in Irish maternity units, however, standardising these practices and sharing learning would be beneficial. NWIHP notes that major obstetric haemorrhage (MOH) and, specifically, the incidence of postpartum haemorrhage is increasing in Irish maternity units and there is a need to reduce this increasing trend. Debriefing the woman (and her birth partner) is important, allowing time to discuss the events surrounding the haemorrhage, and should be offered to the woman and her birthing partner following a PPH.Īccording to the National Women and Infants Health Programme (NWIHP), for every woman who dies of pregnancy-related causes, twenty or thirty others experience morbidity, potentially causing permanent damage to their normal functioning. Clear information of what is happening should be provided from the outset of the PPH event. Therapeutic interventions should be directed towards the causative factor, endeavouring to identify the source of bleeding and arrest it.Ĭommunication with the woman and her birth partner is essential. Visual estimation often underestimates blood loss and other methods of measuring of blood loss should be employed. When PPH occurs, timely management is crucial, in addition to effective communication and teamwork. Continuous monitoring of the woman’s clinical condition, observations, uterine tone and vaginal blood loss in the immediate postpartum period is essential. It is important to be aware of the physiological increase in circulating blood volume during pregnancy meaning that the signs of hypovolemic shock may be less sensitive in pregnancy. Be vigilant for early signs of haemorrhage That said, most cases of PPH have no identifiable risk factors, therefore vigilance and early recognition of haemorrhage is required in all settings. If risk factors for PPH are identified, these should be highlighted in the woman’s healthcare record and be included at clinical handovers.Ī care plan covering the third stage of labour should be discussed with the woman and documented in the healthcare record.

Be aware of risk factorsĪll health professionals involved in the care of women in labour should be aware of the risk factors for PPH (see table). All maternity units should have a multi-disciplinary protocol for the management of PPH, with regular skill drills to practice and enhance a coordinated response to this obstetric emergency.

Definition of precipitate labour