Abstract:

ABNORMAL LABOR OR DYSTOCIA

Dystocia literally means difficult labor it is characterized by abnormally slow

progress of labor. As generalization, abnormal labor is common whenever
there is disproportion between the presenting part of the fetus and the birth
canal. It is the consequence of the four distinct abnormalities that may exist
singly or combination:

1. Abnormalities of the expulsive forces

2. Abnormalities of the maternal body pelvis, that is pelvic contraction
3. Abnormalities of presentation, position, or development of the fetus
4. Abnormalities of soft tissue of the reproductive tract that form an
obstacle to the fetal decent.

Dystocia can result from several distinct abnormalities involving the cervix,
uterus, fetus, abnormal bony pelvis, or other obstruction in the birth canal.
These abnormalities have been mechanistically simplified by the American
College of Obstetrics and Gynecologist in to three categories:

1. Abnormalities of the power (uterine contractility, and maternal

expulsive effort)
2. Abnormalities involving the passenger (the fetus)
3. Abnormalities of the passage (the pelvis).

Uterine dysfunction

1. Hypertonic 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.

2. Hypertonic uterine dysfunction or incoordinate uterine dysfunction,

either basal tone elevated appreciably or the pressure gradient is
distorted , perhaps by contraction of the midsegment of the uterus
 with more force than the fundus or by complete asynchronism of
the impulses originating in each cornu, or combination of these two.

Contracted pelvic

1. Contracted pelvic inlet

2. Contracted midpelvis
3. Contracted pelvic outlet

Excessive fetal size, abnormal fetal presentation, and position.

Selection of a fetal size threshold to predict fetopelvic disproportion

and, therefore, prevent obstructed labor, is not possible because most cases
of disproportion occur in fetus whose weight is well within the range of the
general obstetrics population. For example, the American College of
Obstetrics an Gynecologists (1997a) has concluded than planned cesarean
delivery, in an attempt to forego shoulder dystocia, is only a reasonable
strategy for diabetic women with estimated fetal weights exceeding 4250 t0
4500 g.

Besides the fetal size, abnormality of the fetal presentation and

position can affect progress of labor. The abnormality of presenting part and
position of the fetus are: face presentation, brow presentation,
transverse lie, compound presentation, persistent occiput posterior
position, persistent occiput transverse position, shoulder dystocia.

Self assessment:

1. What does the definition of abnormal labor or dystocia

2. Explain the causes of dystocia
3. Explain about uterine dysfunction (hypertonus and hypotonus)
4. What does it mean (explain please): Contracted pelvic inlet, midpelvic,
and outlet
5. Explain the abnormalities of the fetal presentation and position
Learning Learning objective PIC Student Day
outcome reference
s
Manage, establish Abnormal labor dr.Tjokord William,
tentative Comprehend the a Gde 21st
diagnosis, provide abnormal labor and Agung 425-466
initial fetopelvic Suwardew
management, disproportion. a,
and/or refer Comprehend the SpOG(K)
patient with abnormal
dystocia presentation, position,
and development of
the fetus.
Apply basic principles
of special
investigation on
patient with abnormal
labor
Recognize clinically,
provide initial
management, refer,
with abnormal labnor.