STEP 1 UNFAMILIAR TERMS

1. Secondary Uterine Inertia: uterine contraction that is initially vigorous, then decrease in vigor
and progress of labor ceases
2. Augmentation: artificially or induced labor by stimulating uterine contraction
3. Singleton: single baby

STEP 2 DEFINING PROBLEMS

1. What is the normal physiology of labor and delivery?

2. What are the indications of induction?
3. What are the things to be considered to determine progress of labor?
4. What are the possible complications for unprogressive labor?
5. What is the cause of unprogressive labor?
6. What is primary uterine inertia?
7. What are the risk factors of uterine inertia?

STEP 3

1. What is the normal physiology of labor and delivery?

- Stage I cervical dilates approx. 4cm
o Latent
o Active
Accelerate 3 cm to 4cm require 3 hrs
Maximum dilatation from 4 to 9 cm, 1 hr per cm
Decelerate from 9 to 10 cm require 2 hrs
Increase CO by 15%
- Stage II delivery of the fetus, after cervical dilates to 10 cm
Increase CO by 50%
- Stage III delivery of the placenta
- Stage IV hemostasis (2 hrs post-stage II)
Stage I and II there is an increase of prostaglandin, oxytocin, prolactin induce uterine
contraction
Followed by decrease of progesterone
In multipara, the maximum dilatation of active stage I 1 to 2 cm per hour

2. What are the indications of induction?

- Arrested labor
- Low level of oxytocin
- Uterine inertia
- Tired mother
- Ruptured amniotic sac but labor hasnt started (24 to 48 hrs)
- Post-term pregnancy
 - Abruptio placenta
- Post-partum hemorrhage (stop bleeding)

3. What are the things to be considered to determine progress of labor?

- The frequency and duration of uterine contraction
- The dilatation of cervix
- The descend of the fetal head
- Amniotic sac rupture
4. What are the possible complications for unprogressive labor?
- Fetal distress
- Meconium aspiration syndrome
- Fetal death
5. What is the cause of unprogressive labor?
- Macrosomia
- Narrow hip CPD
- Inadequate contraction
- Hormonal imbalance
6. What is primary uterine inertia?
- Occurs when uterus fails to contract with sufficient force to effect continuous dilatation of
the cervix or descend / rotation of fetal head
7. What are the risk factors of uterine inertia?
- Hormonal imbalance
- Maternal mental disorder (stress)

STEP 4

1. What is the normal physiology of labor and delivery?

- Stage I cervical dilates approx. 4cm
o Latent
Cervical dilation up to 4 cm requires approx. 8 hrs
o Active
Accelerate 3 cm to 4cm require 3 hrs
Maximum dilatation from 4 to 9 cm, 1 hr per cm
Decelerate from 9 to 10 cm require 2 hrs
Increase CO by 15%
Difference in cervix
o Ripe effaced, soft, and dilated
o Unripe no effacement, closed, and stiff mengejan not recommended
rupture cervix

- Stage II delivery of the fetus, after cervical dilates to 10 cm

Increase CO by 50%
 Sign and Symptoms
o Vomiting
o Dilatation of anus
o Bloody discharge
o Bulging of perineum
o Rupture of membrane
o Increased pressure in rectum or vagina
Uterine constriction lasts for 10-15 minutes

- Stage III delivery of the placenta

o Oxytocin(10 IU) or misoprostol (200mcgx3tab) or methyergometrin maleate
(hemorrhage) as soon as fetus delivered
o To induce placenta delivery
o Placental will be expulsed in 6 to 15 minutes accompanied with bleeding (100-200
ml)

- Stage IV hemostasis (2 hrs post-stage II)

o If bleeding exceed 500 ml abnormal
o Monitor maternal vital sign every 15 minutes in first hour, 30 minutes in 2 hours
o Monitor uterine contraction
o Episiotomy reparation
o Monitor hemorrhage

Stage I and II there is an increase of prostaglandin, oxytocin, prolactin induce uterine

contraction
Followed by decrease of progesterone
In multipara, the maximum dilatation of active stage I 1 to 2 cm per hour

2. What are the indications of induction?

- Arrested labor
- Low level of oxytocin
- Uterine inertia
- Tired mother
- Ruptured amniotic sac but labor hasnt started (24 to 48 hrs)
- Post-term pregnancy
- Abruptio placenta
- Post-partum hemorrhage (stop bleeding in stage IV)
o Oxytocin
o Misoprostol
o Compression
 3. What are the things to be considered to determine progress of labor?
- The frequency and duration of uterine contraction
o >3x per 10 minutes, lasting for >40 seconds
Spontaneous
- The dilatation of cervix
o From 4cm to 10cm
- The descend of the fetal head
o From 5/5 to 0/5
- Amniotic sac rupture

4. What are the possible complications for unprogressive labor?

- Fetal distress
- Meconium aspiration syndrome
- Fetal death

5. What is the cause of unprogressive labor?

- Macrosomia
- Narrow hip CPD
- Inadequate contraction
- Hormonal imbalance

6. What is primary uterine inertia?

- Occurs when uterus fails to contract with sufficient force to effect continuous dilatation of
the cervix or descend / rotation of fetal head

7. What are the risk factors of uterine inertia?

- Hormonal imbalance
- Maternal mental disorder (stress)

STEP 5 LEARNING OBJECTIVES

1. Physiology of progress of labor

2. Concept of patient involvement and management
3. Partograph
4. Pathology of labor and delivery (uterine inertia, unprogressive labor, etc)