الفهرس 
Normal laborOnly 14 pages are availabe for public view
 |  | from | 157 |  |  |
| | | from | 157 | | |
Abstract
Prolongation of labor presents a picture of mental exhausting, physical morbidity and may lead to surgical intervention. Mother is exposed to higher risk of infection, dehydration, ketosis and obstructed labor. The fetus on other hand is exposed to the dangers of infection, asphyxia, and excessive cranial molding.
Slow labor progress was first identified by O’Driscoll as the earliest anomaly of active phase of labor that should be treated promptly to avoid its further progression to complications. The principle in “active management of labor” (AML) is for immediate treatment of the slow labor progress with oxytocin augmentation to avoid complications; so vaginal examination (VE) must be done hourly to allow very early pick up of the slow progress, almost as soon as it is occurring. Delaying treatment of slow labour progress for any time was not acceptable in the practice of AML, because it was viewed that such delay will result in irreversible fetomaternal damage.
Instrumental vaginal delivery ,which can be vacuum or forceps, is carried out for the sake of mother, fetus or both to prevent the complications of prolonged labour while there are reports that suggest increased maternal and neonatal morbidity following failed trial of instrumental vaginal delivery.
Cesarean section is another choice of management of prolonged labour . In spite of the safety of cesarean delivery , that has dramatically improved over time with recent advances in medicine, there are still risks associated with this operation, e.g. hemorrhage, visceral injury, thromboembolism, infections, and risks to subsequent pregnancies, including miscarriage, antepartum hemorrhage, uterine rupture, preterm labor and neonatal mortality.
Improved outcome after obstructed labour requires early detection of abnormal progress of labour, and appropriate clinical responses dependent on regular cervical assessment. To achieve this aim, various graphical representations of cervical dilatations and fetal descents have been suggested.
Partograph ( or partogram ) is a tool that graphically represents key events during labour , this tool is recommended for routine monitoring of labour to provide an early warning system .The partograph helps the care provider to identify slow progress in labour early , and to initiate appropriate interventions to prevent prolonged and obstructed labour.
It was initially introduced by Friedman, and was known as “cervicograph“. Then was modulated by Philpot, and endorsed by WHO as simple and accurate instrument for early recognition of complications of labour. It gained popularity since 1970`s and today most labour and delivery wards use it in both developing and developed countries.
At the maternal part of partogram, there is an “alert line” which is drawn from the point of cervical dilatation noted at the first vaginal examination (VE) in active labour which denotes a dilatation rate (1 cm/hr). The value of this line is to separate women in labour into two groups; first one whose cervical dilatation is more than 1 cm/hr (who are highly unlikely to require operative intervention), and second group whose cervical dilatation is less than 1 cm/hr (who are more likely to require operative intervention). Moreover, the alert line on the partogram is an indicator which helps predict the need for neonatal resuscitation.
Another line is called “action line” which is parallel and 4 hours to the right of the alert line. In case that the cervical dilatation is crossing it, so the medical team must evaluate the woman`s progress in labour and provoke appropriate intervention.
Birth trauma (injury) is defined as an event occurring during the labour and delivery process that involves actual or threatened serious injury or death to the mother or her baby . As the birthing woman experiences intense fear , helplessness , loss of control and horror.
Injuries to the infant that result from mechanical forces (i.e, compression, traction) during the birth process are categorized as mechanical birth trauma. Factors responsible for mechanical injury may coexist with hypoxic-ischemic insult; one may predispose the infant to the other. Nearly one half are potentially avoidable with recognition and anticipation of obstetric risk factors.
The most common types of birth injuries are Erb`s palsy ( which is due to Brachial plexus injury) , Subgaleal ( subaponeurotic ) haemorrhage; which is a haemorrhage outside the skull and below the scalpe) and Transient tachypnea of newborn (TTN); which is the commonest respiratory disease with term babies.
Despite of the advance in healthcare, birth injury is still considerable. Early detection of abnormal labor progression, along with prevention of prolonged labour, helps in reducing maternal and perinatal mortality.
The aim of this study was to compare between the percentage of birth trauma in two arms of study groups; group I (women that crossing alert line of partograph). group II (women that crossing alert action of partograph).
The results of our present study can be summarized as follows:
There was no statistically significant difference between group I and group II regarding maternal age and Gravida.
The percentage of Perineal tear was statistically lower among women that crossing alert line of partograph (group I) than women that crossing action line of partograph (group II).
APGAR score >7 was statistically higher among women that crossing alert line of partograph (group I) than women that crossing action line of partograph (group II).
Percentage of NVD was statistically higher among group I than group II.