ABNORMAL LABOR

WILLIAMS OBSTETRICS, 24 TH EDITION

Ligo, Aiszel Angeli

Mancol, Joyce Lindsay
SWU MHAM College of Medicine Inc.

OUTLINE

DYSTOCIA

ABNORMALITIES OF THE EXPULSIVE FORCES

PREMATURELY RUPTURED MEMBRANES AT TERM

PRECIPITOUS LABOR AND DELIVERY

FETOPELVIC DISPROPORTION

PELVIC CAPACITY

FACE PRESENTATION

BROW PRESENTATION

TRANSVERSE LIE

COMPOUND PRESENTATION

COMPLICATIONS WITH DYSTOCIA

DYSTOCIA
difficult labor
abnormally slow labor progress
4 distinct abnormalities:
1. Abnormal expulsive forces
2. Abnormalities of presentation, position, or development of the
fetus
3. Abnormalities of the maternal bony pelvis
4. Abnormalities of soft tissues of the reproductive tract
3 categories:
Powers passenger passage

DYSTOCIA DESCRIPTORS
Cephalopelvic Disproportion - disparity between the fetal head
size and maternal pelvis
Failure to progress - lack of progressive cervical dilatation or
lack of fetal descent

MECHANISM OF DYSTOCIA

ABNORMALITIES OF THE EXPULSIVE FORCES

Types of Uterine Dysfunction:
1. Hypotonic uterine dysfunction - no basal hypertonus and
uterine contractions have a normal gradient pattern (synchronous),
but pressure during a contraction is insufficient to dilate the cervix.
2. Hypertonic uterine dysfunction (incoordinate uterine
dysfunction) - either basal tone is elevated appreciably or the
pressure gradient is distorted.

 Reported Causes of Uterine Dysfunction

1. Epidural Analgesia
2. Chorioamnionitis
3. Maternal Position During Labor
4. Birthing Position in Second-Stage Labor

PREMATURELY RUPTURED
MEMBRANES AT TERM

PRECIPITOUS LABOR AND DELIVERY

Precipitous labor and delivery - extremely rapid labor and delivery.

It may result from:

- abnormally low resistance of the soft parts of the birth canal
- abnormally strong uterine and abdominal contractions
- absence of painful sensations

< 3 hours.

PRECIPITOUS LABOR AND DELIVERY

Maternal Effects
- uterine rupture
-extensive lacerations of the cervix, vagina, vulva, or perineum
-uterine atony

Fetal and Neonatal Effects

-intracranial trauma
-Erb or Duchenne brachial palsy
-fall

PRECIPITOUS LABOR AND DELIVERY

Treatment:
- oxytocin agents being administered should be stopped immediately

FETOPELVIC DISPROPORTION

Pelvic Capacity
arises from diminished pelvic capacity, excessive fetal size, or more usually both
There may be a contraction of the pelvic inlet, the midpelvis, or the pelvic outlet, or a
generally contracted pelvis may be caused by combinations of these.

CONTRACTED INLET

Anteroposterior diameter is < 10 cm

Greatestctransverse diameter is < 12 cm

Diagonal conjugate is < 11.5 cm

PELVIC CAPACITY

FACE PRESENTATION

BROW PRESENTATION

TRANSVERSE LIE

COMPOUND PRESENTATION

COMPLICATIONS WITH DYSTOCIA