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Dystocia

Dystocia literally means difficult labor and is characterized by abnormally slow progress of labor. Generally, abnormal labor is common whenever there is disproportion between the presenting part of the fetus and the birth canal.
 

Common Clinical Findings in Women With Ineffective Labor

  1. Inadequate cervical dilatation or fetal descent
  2. Protracted labor-slow progress
  3. Arrested labor-no progress
  4. Inadequate expulsive effort-ineffective "pushing"
  5. Fetopelvic disproportion
  6. Malpresentation or malposition of fetus
  7. Ruptured membranes without labor
  8. Recommendation of the ACOG is that the cervix should be dilated to 4 cm or more before a diagnosis of dystocia is made.

Types of Uterine Dysfunction

  1. It is possible to define two types of uterine dysfunction.
  2. In the more common hypotonic uterine dysfunction, there is no basal hypertonus and uterine contractions have a normal gradient pattern (synchronous), but the slight rise in pressure during a contraction is insufficient to dilate the cervix.
  3. In the other, hypertonic uterine dysfunction or in coordinate uterine dysfunction, either the basal tone is elevated appreciably or the pressure gradient is distorted.
     
    Gradient distortion may result from contraction of the mid-segment of the uterus with more force than the fundus or from complete asynchronism of the impulses originating in each cornu, or from a combination of these two.
  4. ACOG has suggested that, before the diagnosis of arrest during first-stage labor is made, both of these criteria should be met:
  5. The latent phase has been completed, with the cervix dilated 4 cm or more.
  6. A uterine contraction pattern of 200 Montevideo units or more in a 10-min period has been present for 2 h without cervical change.
  7. Criteria for Diagnosis of Abnormal Labor Due to Arrest or Protraction Disorders

Labor Pattern

Nullipara

Multipara

Protraction disorder

 

 

Dilatation

<1.2 cm/h

<1.5 cm/h

 

 

Descent

<1.0 cm/h

<2.0 cm/h

Arrest disorder

 

 

No dilatation

>2h

>2h

No descent

>1 h

>1 h


Abnormal Labor Patterns, Diagnostic Criteria

 

Labor Pattern

Nullipara

Multipara

 

Prolonged latent phase

>20h

>14h

 

Arrest disorders:

 

 

 

1. Prolonged deceleration phase

>3h

>1h

 

2. Secondary arrest of dilatation

No dilatation >2 h

No dilatation >2 h

 

3. Arrest of descent

No descent> 1 h

No descent >1 h

 

Prolonged second stage

>2h

>1 h

Without epidural analgesia

 

>3h

>2h

With epidural analgesia

 

Factors contributing to arrest and delatation are:

  • Excessive sedation
  • Epidural analgesia
  • Fetal malposition
  • CPD

Recommended therapy for protracted disorders is expectant management and for arrest is oxytocin in absence of any cephalopelvic disproportion.
 

Also Know
 

Participitate labour: Nulliparous: Dilatation and descent> 5 cm/hr.

 

Multiparous: Dilatation and descent> 10 crn/hr





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