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Dystocia = Difficult / Abnormal labor

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DIFFICULT / ABNORMAL LABOR Greek 'dys ... A combination of these factors Dystocia Dysfunctional uterine contractions Hypotonic uterine contracions ... – PowerPoint PPT presentation

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Title: Dystocia = Difficult / Abnormal labor


1
Dystocia Difficult / Abnormal labor
  • Greek'dys' 'difficult, painful, disordered,
    abnormal' 'tokos' meaning 'birth'.

Dr. E Gdansky
2
DystociaIncidence
  • Overall?Retrospective/Unreported in normal
    vaginal delivery
  • Primiparous women 25 have dystocia
  • Most common indication for primary CS
  • 50 of CSs are related to dystocia

3
First Stage of Labor
Duration Primip. 6-18 Multip. 2-10
4
DystociaAbnormal patterns of labor
Primipara Multipara
Prolonged latent phase (Normal mean 6.4 h) gt20 h (Normal mean 4.8 h) gt14 h
Protracted dilatation lt1.2 cm/h lt1.5 cm/h
Protracted descent lt1 cm/h lt2 cm/h
Protracted 2nd stage (Normal mean 50 min) gt2 h (1 h) (Normal mean 20 min) gt1 h (1 h)
Arrest of dilatation gt2 h gt2 h
Arrest of descent gt1 h gt1 h
Precipitate labor lt3 h from onset of contractions
5
DystociaClassification
  • Powers
  • Passage
  • Passenger
  • Contractions
  • Expulsive forces
  • Maternal pelvis
  • The fetus (Malposition/Malpresentation)

A combination of these factors
6
Dystocia
  • Causes
  • Treatment
  • Dysfunctional uterine contractions
  • Hypotonic uterine contracions
  • Malpresentation (Asynclitism, OP, DTA, face,
    braw)
  • Cephalo-pelvic disproportion CPD
  • Epidural
  • Pelvic tumor
  • Sedation
  • Hydration
  • Augmentation of labor(amniotomy, oxytocin)
  • Instrumental delivery
  • Cesarean section

7
Dystocia Abnormalities of the passage
Inlet
Mid-pelvis
Outlet
Current Diagnosis Treatment Obstetrics
Gynecology - 10th Ed. (2007)
8
Dystocia Abnormalities of the passage
  • Bony pelvis- Gynecoid (50)- Android (33
    white, 15 black)- Anthropoid (50 black, 20
    white)-Platypelloid (lt3)

A-P mid-pelvis
True conjugate
Obstetric
Diagonal
9
Dystocia Abnormalities of the passage
  • Classification
  • Contraction of the pelvic inlet
  • Contraction of the mid-pelvis and pelvic outlet
  • General contraction of the pelvis
  • Pelvic deformities

traumatic fracture, rickets, chondrodystrophic
dwarfism, kyphosis scoliosis,exostosis, bone
neoplasia
10
Dystocia Abnormalities of the passage
  • Conjugate- diagonal (lt11.5)- obstetric (lt10
    cm)- true
  • Transverse diameter (lt12 cm)
  • Interspinous diameter (lt8 cm)
  • Intertuberous diameter (lt8 cm)
  • Pelvimetry
  • X-ray
  • US
  • MRI
  • Clinical pelvimetry

11
Dystocia Abnormalities of the passage
  • Soft tissue (uterine or vaginal congenital
    anomalies, scarring of the birth canal)
  • Pelvic mass / neoplasia
  • Placental location (low implantation / previa)

12
DystociaObstructed labor
  • Bandls retraction ring Uterine rupture
  • Vescicovaginal rectovaginal fistula
  • Pelvic floor injury
  • Increased neonatal morbidity mortality

13
DystociaAbnormalities of the powers
  • Normal contractions- Fundal dominance-
    Intensity gt24 mmHg (40-60 mmHg)- Synchronized-
    Basal pressure 12-15 mmHg- Frequency 3-5/10
    min- Duration 60-90 sec- Rhytm force are
    regular
  • Hypotonic (causes excessive sedation, early
    epidural, over-distended uterus)
  • Hypertonic(causes abruptio, oxytocin, CPD,
    fetal malpresentation, latent phase of labor)

14
Dystocia Abnormalities of the powers
  • External/ internal Tocodynamometer
  • Montevideo unit gt200 mmHg is sufficient for
    normal progress

15
Dystocia Abnormalities of the powers
  • Hypotonic ? Amniotomy Oxytocin
    augmentation
  • Hypertonic ? Decrease/stop oxytocin Tocolysis
    Sedation in latent phase Oxytocin (?)

16
Dystocia Management of Labor
  • In any case of CPD (relative or absolute) or
    failure treat abnormal progress ? CS
  • Second stage disorder with no evidence of CPD
    can, in certain conditions, be treated with
  • Vacuum - Assisted Delivery
  • Forceps Delivery

17
Dystocia Precipitate labor
  • lt3 h from onset of contraction
  • Primipara Multipara
  • Precipitate dilatation gt5 cm/h 10 cm/h
  • CausesExtremely strong contractions low birth
    canal resistanceOxytocin ( associate with
    placental abruption)
  • TreatmentStop oxytocinbeta mimetics
    (terbutaline / ritodrine)

18
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