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DYSTOCIA

ANDREW ROULDAN B. BUIZON, M.D., FPOGS, FSGOP

Assistant Professor

De La Salle Universit ! "ealt# S$ien$es Instit%te

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DYSTOCIA

Literally means Difficult Labor

Characterized by Abnormally SLO!ro"ress of Labor

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O#er#ie$ of the lecture

I % &ormal and Abnormal Labor

II % Causes of Dystocia

III % Com'lications of Dystocia

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(actors that affect Labor

!o$er% (irst sta"e) uterine contractions

% Second sta"e) uterine contractions * intra+abdominal 'ressure

!assen"er% (etal Attitude, !resentation, !osition

%Ability to ada't throu"h !assa"e

!assa"e% -irth canal

.(or &ormal Labor to ta/e 'lace % &ormal 0!1s

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!ro"nosis for 2a"inal Deli#ery

Po&er% force of uterine contractions

Passen'er)

% !resentation and !osition% Size of fetal head

%Ada'tability of fetal head

Passa'e% size and sha'e of maternalbony 'el#is

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Sta'es of La(or

(irst. + re"ular uterine contractionsfully

Second.+ full cer#ical dilatationdeli#ery baby

Third + deli#ery of baby'lacental deli#ery

(ourth +immediate 'ost'artum

.Sta"es concerned $ithDystocia

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(irst Sta"e of Labor

Latent !hase

Acti#e !hase

%Acceleration !hase !redicti#e of outcome of labor

% !hase of 3a4imum slo'e

3easure of efficiency of the machine

% Deceleration !hase

5eflecti#e of feto'el#ic relationshi'

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6istory of the !arto"ra'h

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(unctional Di#isions of Labor

!re'aratory Di#ision

Dilatational Di#ision

!el#ic Di#ision

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Latent !hase and Acceleration !hase

Ma)or event% cer#ical ri'enin"

%Softenin") chan"es in "round substance

% 7ffacement) obliteration of cer#ical canal

*ervi$al +ilatation% minimal

Fetal +es$ent% minimal to absent Sensiti#e to sedation and conduction

anal"esia

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!el#ic Di#ision

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!hase of 3a4imum Slo'e

Ma)or Event% cer#ical dilatation

*ervi$al Dilatation% most ra'id rate Fetal Des$ent% minimal

8naffected by sedation and conduction

anal"esia

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!el#ic Di#ision

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!el#ic Di#ision

Deceleration !hase to Second Sta"e of labor

Ma)or Event% cardinal mo#ements

*ervi$al Dilatation% ra'id rate Fetal Des$ent% ma4imal

3inimally affected by se+ationbut 9bearin"

do$n1 effort lar"ely affected by $on+%$tionanal'esia

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!el#ic Di#ision

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Cer#ical Dilatation and

(etal Descent

The only characteristics of the 'arturient

useful in assessin" labor : its 'ro"ression

Time #s; Cer#ical Dilatation % si"moid cur#e

Time #s; (etal descent % hy'erbolic cur#e

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Dia'nosis of La(or

r%e La(or False La(or

Re'%larit

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Criteria for Dia"nosis of Labor

?; Documented uterine contractions

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Dia"nosis of &ormal Labor

> cm@hr> ? cm@hrFetal Des$ent

> ?;E cm@hr> ?; cm@hr*ervi$al

Dilatation

H ?B hoursH hoursLatent P#ase

MULTIPARANULLIPARALABOR

PATTERN

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Dia"nosis of Abnormal Labor

> ? hour> 0 hoursDeceleration!hase

> ?B hours> hoursLatent !hase

> ? hour> ? hour&o Descent

> hours> hours&o Dilatation

Arrest Disor+erH cms@hrH ? cm@hrDescent

H ?;E cm@hrH ?; cm@hrDilatation

Protra$tion Disor+er

Prolon'ation Disor+er


PATTERN

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!rolon"ed Latent !hase

It is the only disorder dia"nosable in the

!re'aratory Di#ision of Labor

Criteria)

% &ulli > hrs

% 3ulti > ?B hrs

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7tiolo"y of !rolon"ed Latent !hase

(alse Labor EG of the time

74cessi#e sedation

8nfa#orable cer#i4

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3ana"ement of

!rolon"ed Latent !hase

Thera'eutic 5est% if no C@I to delay for J+? hrs

% Stron" sedati#es

% 8'on $a/in", FEG enter acti#e 'hase ?EG false labor

Amniotomy

% $ill not accelerate latent 'hase

Caesarean section% &ot usually done unless $ith indications

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PATTERN

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!rotraction Disorders

!rotracted Acti#e !hase

!rotracted Descent

7tiolo"y )% 3al'osition

% 74cessi#e sedation @ conduction anal"esia

% Ce'halo'el#ic dis'ro'ortion

3ana"ement)%Au"ment of labor

% CS FG ha#e C!D

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PATTERN

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+hour rule for dia"nosis of arrest in acti#e

'hase of labor has recently been challen"ed

EB $omen included $here CS deli#ery $as

not 'erformed for labor arrest until there $ereat least B hours of a sustained uterine

contraction of >monti#edeo units or a

minimum of J hours o4ytocin au"mentation if

the contraction 'attern could not be achie#ed

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3ana"ement of Abnormal Labor

(ailure of descent

CSCS if * C!DArrest of Descent

oArrest of Dil5est if e4haustedAu"ment if no

C!D!rol Decel

Arrest Disorders

Descent

CS for C!D @

Au"ment

74'ectant @

Su''ort

Dilatation

Protraction Disorders

Au"ment @ CS-ed restLatent !hase

Prolongation Disorders

E/$e0tional

reat1ent

Preferre+

reat1ent

La(or 0attern

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5is/ (actors for Dystocia

Associated $@ lon"er ndsta"e+ e'idural anal"esia

+ occi'ut 'osterior 'osition

+ lon"er ?ststa"e of labor+ nulli'arity

+ short maternal stature

+ birth$ei"ht+ hi"h station at com'lete cer#ical dilatation

ACO !ractice -ulletin

Com'endium B

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DYSTOCIA + Abnormal Labor

Three cate"ories causin" Dystocia)

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&ormal 8terine Contractions

3oderate +

stron"

3ild to

moderate

Intensity

B % J secs0 % B secsDuration

+0 mins0+E mins(reMuency @Inter#al

A$tive P#ase

to

Se$on+ Sta'e

Latent P#asePara1eter

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8T75I&7 DYS(8&CTIO&

"0otoni$ Uterine Dsf%n$tion

3ore common

&o basal hy'ertonus

8terine contractions ha#e a normal

'ressure "radient 'attern

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8T75I&7 DYS(8&CTIO&

"0ertoni$ Uterine Dsf%n$tion

Also called incoordinate uterine

dysfunction

7ither basal tone is ele#ated or

'ressure "radient is distorted by

contraction of the midse"ment of the

uterus $ith more force than the fundus

or by com'lete asynchronism or a

combination of both

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CA8S7S O( 8T75I&7 DYS(8&CTIO&

7'idural anal"esia

Chorioamnionitis

3aternal 'osition durin" labor -irthin" 'osition in ndsta"e labor

illiam1s Obstetrics, ?sted;

Documents

7343625 Ob Dystocia