Abnormal labor and Dystocia

Dept. of Ob&Gyn, The first affiliated hospital

He Ke
Definition
Difficult labor or childbirth
Abnormal slow progress
of labor
Incidence
The most common
indication for primary
cesarean section
Abnormal patterns

Prolonged latent phase
Protraction disorders (active phase)
Arrest disorders (active phase)
Precipitate labor disorders

Evaluation index
Cervical dilation
Descent of the fetal presentation
Friedmans curve
Latent phase
Active phase I
II stage

partogram
Prolonged latent phase
Nulliparas

Multiparas


prolonged

>20 hr

> 14 hr

Normal average

6.4 hr

4.8 hr

Protraction disorders
Nulliparas

Multiparas


Descent

<1.0 cm/h

<2.0 cm/h

Dilation

<1.2 cm/h

<1.5 cm/h
Average

8hr

5hr
Arrest disorder
Nulliparas

Multiparas


Descent

>2h

>1h
Dilation

>2h

>1h
Partogram
A prolonged latent phase
B prolonged active phase
C arrest active phase
Abnormal partogram
Partogram
Precipitate labor disorders
Nulliparas

Multiparas


Descent

>5cm/hr

>10cm/hr
Dilation

>5cm/hr

>10cm/hr
Classification of Dystocia
Abnormalities of the Power
Abnormalities of the Passage
Abnormalities of the Passenger
Characteristics of the power
Intensity is greater in the fundus
Average 24mmHg
Well synchronized
Frequency
Duration 60s
regular
Rhythm and force
Basal resting pressure 12-15mmHg
Fetal monitoring

External and internal monitor
Uterine dysfunction
Hypotonic
Hypertonic
Uncoordinated
Inadequate
expulsive efforts
Hypotonic dysfunction
Insufficient
Irregular
Infrequent
Response well to
oxytocin
Most in primigravidas
in active phase
Hypotonic dysfunction etiology
Malfunction
Malpresentation
Extrinsic factors
Hypertonic and uncoordinated
dysfunction
Resting tone
Dyssynchronous
Frequent intense
contraction
Constriction ring
Tocolysis
Decrease oxytocin
Cesarean section
Sedation

Pathological retraction ring
Constriction ring

Hypertonic Dysfunction
Inadequate expulsive efforts
Second stage
Assisted delivery might be needed
Analgesic / anesthetic agents wear
off

Abnormalities of the Passage
Bony pelvic (most common)
Soft tissue obstruction
Abnormal placenta location
Bony pelvic abnormalities
Inlet
Midpelvic-outlet
Generally contracted pelvic
Deformed pelvic

Three level of bony pelvis
Contracted pelvis
Contraction of pelvic inlet
AP<10cm;transverse<12 cm
Contraction of mid-pelvis
interischial spinous diameter <10cm
Contraction of pelvic outlet
interischial tuberous diameter <8cm
Three anteroposterior diameters of
the pelvic inlet
Diameter of the inlet and midpelvis
Fetopelvic disproportion



funnel shaped pelvis
47.3%
5.8%
36.6%
10.9%
gynecoid
android
Flat(platypelloid)
anthropoid




transversely
contracted
pelvis


each pelvic
plane is 2 cm
less than
normal
generally contracted pelvis
osteomalacia
oblique pelvis
kyphosis



Deformed
pelvis
Soft tissue dystocia
Congenital anomalies
Scarring of birth canal
Pelvic masses
Birth canal
Pelvic mass
Pelvic mass
Low lying placenta
Abnormalities of the Passenger
Malposition and
malpresentation
Fetal macrosomia
Shoulder dystocia
Fetal malformation
13.3
9.5
11.3


Cepholic position and the diameter through pelvis
occiput
presentation
parietal
presentation
brow
presentation
face
presentation
Malpresentation
Breech presentation

Transverse fetal lie
Shoulder presentation
Examination
Fetal macrosomia
large for gestational age(LGA)
4000g
Shoulder dystocia
Brachial Plexus Injury
Fetal malformation
Operative delivery
1)forceps
operations
Operative delivery Vacuum
Operative delivery Cesarean Section
Reference
Williams obstetrics
(22nd edition)


High risk pregnancy
(2nd edition)