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Case 106

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A 22-year-old primigravida at 39 weeks of gestation (confirmed by a prior ultrasound study) was admitted to a maternity unit with regular and painful contractions without leakage of amniotic fluid. She had been provided appropriate prenatal care, without any complications reported. On admission, her vital signs were stable and, in 10 minutes, two uterine contractions were felt. One of them was strong and the other was moderate in intensity and lasted 25 seconds. Fetal heart rate was 130bpm. Information regarding the parturient and the labor process were recorded on the partogram herein presented.

Taking into account the labor’s progression recorded on the partogram, we are able to assume that there was:

a) Normal and appropriate labor evolution

25%

b) Prolonged descent

25%

c) Prolonged active phase

25%

d) Secondary arrest of cervical dilatation

25%
   

Comments

 - Labor is a physiological process which comprises the events occurring between its onset and the delivery of the fetus.

- It has classically been divided into three stages: the first one is subdivided into two phases, latent and active (uterine contractions with increasing frequency, intensity and duration and progressive cervical dilatation of at least 1cm/hour). The second stage embraces the interval from complete cervical dilatation and fetal expulsion and the third one refers to the time from fetal to placental expulsion.

- The best criterion for defining labor onset is the presence of regular painful contractions associated with 3-4 cm of cervical dilatation.

- Red flags that might suggest labor abnormalities include: amniotic fluid leakage, uterine bleeding, strong contractions only every 5 minutes and decreased fetal movements. 

- Labor abnormalities are defined as any kind of deviation of the labor pattern observed in spontaneous vaginal deliveries. They occur mainly due to problems in cervical dilation or cephalopelvic disproportions.

- The partogram is a graphical representation which allows for labor monitoring, legal documentation, the diagnosis of abnormalities and institution of appropriate interventions based on the presence of possible deviations.

References

- Federação Brasileira de Ginecologia e Obstetrícia. Manual de Orientação Assistência ao Abortamento, Parto e Puerpério. São Paulo: FEBRASGO; 2010.

- Organização Mundial de Saúde. Parto prolongado e paragem na progressão do trabalho de parto: Manual para professores de Enfermagem Obstétrica. Genebra: OMS; 2005.

- Funai EF, Norwitz ER. Mechanism of normal labor and delivery. Uptodate. Available at: www.uptodate.com/contents/mechanism-of-normal-labor-and-delivery

- Ehsanipoor RM, Satin AJ. Abnormal labor: Protraction and arrest disorders. Uptodate. Available at: www.uptodate.com/contents/abnormal-labor-protraction-and-arrest-disorders

Author

Fabiana Resende – 6th year medical student of UFMG School of Medicine.

E-mail: fabianaresende1[at]gmail.com

Supervisor

Zilma Silveira Nogueira Reis – member of the Department of Gynecology and Obstetrics (UFMG School of Medicine).

E-mail: zilma.medicina[at]gmail.com

Reviewers

Camila Gomes, Daniel Moore and professor Viviane Parisotto

Translated by

Lucas Resende Lucinda, 6th year medical student of UFMG School of Medicine.
E-mail: lucasresendebh[at]hotmail.com

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