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)