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    Abnormal Labor and Dystocia: Dept. of Ob&Gyn, The First Affiliated Hospital He Ke

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    Joan Luis
    This document provides an overview of abnormal labor and dystocia, or difficult childbirth. It defines dystocia and discusses its incidence, abnormal labor patterns like prolonged latent or active phases or arrest disorders. It examines evaluation methods like cervical dilation progress. It also explores the various potential causes of dystocia, including abnormalities of the power (uterine contractions), passage (pelvic structure), and passenger (fetus position or size). Throughout, it provides details on classification, characteristics, signs, and treatment approaches for different dystocia types.

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    Abnormal Labor and Dystocia: Dept. of Ob&Gyn, The First Affiliated Hospital He Ke

    Uploaded by

    Joan Luis
    116 views63 pages
    This document provides an overview of abnormal labor and dystocia, or difficult childbirth. It defines dystocia and discusses its incidence, abnormal labor patterns like prolonged latent or active phases or arrest disorders. It examines evaluation methods like cervical dilation progress. It also explores the various potential causes of dystocia, including abnormalities of the power (uterine contractions), passage (pelvic structure), and passenger (fetus position or size). Throughout, it provides details on classification, characteristics, signs, and treatment approaches for different dystocia types.

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    labor and dystocia

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    abnormal labor

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    This document provides an overview of abnormal labor and dystocia, or difficult childbirth. It defines dystocia and discusses its incidence, abnormal labor patterns like prolonged latent or active phases or arrest disorders. It examines evaluation methods like cervical dilation progress. It also explores the various potential causes of dystocia, including abnormalities of the power (uterine contractions), passage (pelvic structure), and passenger (fetus position or size). Throughout, it provides details on classification, characteristics, signs, and treatment approaches for different dystocia types.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    116 views63 pages

    Abnormal Labor and Dystocia: Dept. of Ob&Gyn, The First Affiliated Hospital He Ke

    Uploaded by

    Joan Luis
    This document provides an overview of abnormal labor and dystocia, or difficult childbirth. It defines dystocia and discusses its incidence, abnormal labor patterns like prolonged latent or active phases or arrest disorders. It examines evaluation methods like cervical dilation progress. It also explores the various potential causes of dystocia, including abnormalities of the power (uterine contractions), passage (pelvic structure), and passenger (fetus position or size). Throughout, it provides details on classification, characteristics, signs, and treatment approaches for different dystocia types.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 63

    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

    Active phase

    Latent phase

    partogram

    II stage

    Prolonged latent phase


    Nulliparas
    Multiparas

    Normal average

    prolonged

    6.4 hr

    >20 hr

    4.8 hr

    > 14 hr

    Protraction disorders
    Dilation

    Descent

    Average

    <1.2 cm/h <1.0 cm/h

    8hr

    Multiparas <1.5 cm/h <2.0 cm/h

    5hr

    Nulliparas

    Arrest disorder

    Nulliparas
    Multiparas

    Dilation

    Descent

    >2h

    >2h

    >1h

    >1h

    Partogram

    Abnormal partogram

    A prolonged latent phase


    B prolonged active phase
    C arrest active phase

    Partogram

    Precipitate labor disorders

    Nulliparas
    Multiparas

    Dilation

    Descent

    >5cm/hr

    >5cm/hr

    >10cm/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

    36.6%

    10.9%

    Flat(platypelloid)
    47.3%

    anthropoid
    5.8%

    gynecoid

    transversely
    contracted
    pelvis

    android

    funnel shaped pelvis

    each pelvic
    plane is 2 cm
    less than
    normal

    generally contracted pelvis

    Deformed
    pelvis
    osteomalacia

    oblique pelvis

    kyphosis

    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

    11.3

    9.5
    13.3

    Cepholic position and the diameter through pelvis


    parietal
    occiput
    presentation 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)

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