A female at 37 wks of gestation has mild labour pain for 10 hours and cervix is persistently 1CM dilated but non effaced. What will be next appropriate management ?
Sedation and wait It is a case of prolonged latent phase of the labour Latent phase of the labour Latent phase of the labour is difficult to define. It stas with onset of painful regular uterine contractions and end when the cervix stas dilating at an active rate. A latent phase exceeding 6 hours in primigravida or 4 hours in multigravida is considered prolonged. Secondary arrest of active phase Active phase of the labour is defined as phase when active cervical dilatation occurs. Secondary arrest of cervical dilatation occurs when cervical dilatation ceases after a normal poion of active phase dilatation. This is believed to be due to cephalopelvic dispropoion. Prolonged latent phase The diagnosis of prolonged labour is made when there is little progress in cervical dilatation for several hours.(In the question the cervix is dilated.for I cm for the last 10 hrs). More common than the diagnosis of prolonged latent phase is the need to differentiate whether a patient is in false labour or in the latent phase. This differentiation may be achieved by continuous observation of the patient for at least 2 hours. Patients in false labour will show a pattern of irregular uterine contractions that eventually decrease in frequency and intensity and there are no cervical changes during the observation periods. Whereas patients in latent phase will show persistent regular uterine contractions that usually increase in intensity and frequency. In addition, patient in latent phase will show some cervical changes. A second method used to differentiate false labour from the latent phase of labour is therapeutic rest. 843 For this purpose the patient is given a 15 mg dose of morphine sulfate. Patients in false labour Sleep for a few hours and awake without contractions. Patietns in latent phase continue with contractions and show cervical changes after the sleeping period. The second most common practical problem related to the latent phase of labour occurs when patients have 3 or 4 cm of cervical dilatation and regular uterine contractions and no progress is observed during the following few hours. These patients may be in a late stage of their latent phase or have an early secondary arrest of dilatation. To distinguish between late latent phase and early secondary arrest it is necessary to take into consideration the patient's parity. - Multipara making little progress at 4 cm of dilatation most likely will be in latent phase. - A nullipara under the same circumstances most likely will be in early secondary arrest. The degree of cervical dilatation is also impoant. - 60% of the patient will be in active phase if the cervix is 4 cm dilated and 90% if it is 5 cm. Finally cervical effacement is a good criterion for recognizing patients in active phase. - Most patients will be in active phase if their cervix is dilated 3 cm or more and 100% effaced - If effacement is 50% or less most likely they are in latent phase. Management There are two modes of management for patients with prolonged latent phase. - Therapeutic rest - Oxytoein stimulation.
Sedation and wait
Augmentation with syntocin
Cesarean section
Amniotomy