What does dystocia mean in labor?
Dystocia means difficult labor and is characterized by abnormally slow labor progress.
What are the three categories of causes for dystocia?
Causes are grouped into three categories:
1. Abnormalities of the powers (poor uterine contractility and maternal expulsive effort).
2. Abnormalities of the passenger (fetus).
3. Abnormalities of the passage (pelvis and lower reproductive tract).
What is hypotonic uterine dysfunction?
Hypotonic uterine dysfunction occurs when uterine contractions have a normal gradient but insufficient pressure to dilate the cervix.
What is hypertonic uterine dysfunction?
Hypertonic uterine dysfunction occurs when the basal tone is elevated or the pressure gradient is distorted, resulting in ineffective contractions.
What is the required contraction pressure to dilate the cervix?
The lower limit of contraction pressure required to dilate the cervix is 15 mm Hg.
What is the definition of prolonged latent phase in labor?
Prolonged latent phase occurs when cervical dilation is <6 cm for >20 hours in primipara or >14 hours in multipara despite regular contractions.
What is the treatment for prolonged latent phase?
Management includes therapeutic rest with narcotics or sedatives, oxytocin administration, or amniotomy. Cesarean delivery is not appropriate.
What is protracted active phase?
Protracted active phase occurs when dilation or descent is less than normal, meaning cervical dilation is slower than expected.
What is arrested active phase?
Arrested active phase is diagnosed if there is no change in cervical dilation after ≥4 hours with adequate contractions or ≥6 hours with IV oxytocin administration.
What is the management of arrested active phase?
Management includes assessing uterine contraction quality. If contractions are hypotonic, administer IV oxytocin. If hypertonic, administer morphine for sedation. If contractions are adequate, proceed to cesarean section.
What is prolonged second stage of labor?
Prolonged second stage occurs when there is no progress in fetal descent or rotation after complete dilation. For primiparous women, it is ≥3 hours without epidural anesthesia and ≥4 hours with epidural anesthesia.
What is the management for prolonged second stage?
If the fetal head is not engaged, proceed to emergency cesarean. If the head is engaged, consider a trial of forceps or vacuum extractor delivery.
What is prolonged third stage of labor?
Prolonged third stage is diagnosed when the placenta is not delivered within 30 minutes after the birth of the fetus.
What is precipitate labor?
Precipitate labor is when the labor terminates with fetal expulsion in less than 3 hours. It can cause maternal trauma, postpartum hemorrhage, and fetal distress.
What is fetopelvic disproportion (CPD)?
Fetopelvic disproportion occurs when the pelvic capacity is diminished, or there is an abnormal fetal size, structure, or position, making vaginal delivery difficult.
What is shoulder dystocia?
Shoulder dystocia occurs when the fetal head delivers but the anterior shoulder is impacted at the symphysis pubis, often seen in fetal macrosomia and maternal diabetes.
What is the management of shoulder dystocia?
Management includes McRobert’s maneuver (hyperflexion and abduction of the maternal thigh), suprapubic pressure, Wood’s corkscrew maneuver, manual delivery of the posterior arm, or Zavanelli maneuver.
What is the definition of obstructed labor?
Obstructed labor is the arrest of the second stage of labor due to mechanical obstruction of the birth passage or the passenger, despite efficient uterine contractions.
What is a pathological retraction ring (Bandl’s ring)?
Bandl’s ring is a constriction or contraction ring between the upper and lower uterine segments, seen with obstructed labor and fetal distress.
What are the indications for operative vaginal delivery?
Indications include fully dilated cervix, ruptured membranes, and adequate uterine contractions. The procedure should be explained to the patient, and consent should be obtained.
What are the contraindications for instrumental delivery (forceps/vacuum)?
Contraindications include unclear position of the fetal head, fetal bleeding diathesis, and inexperienced operators.
What are the criteria for operative vaginal delivery using forceps?
The criteria are:
- Fully dilated cervix,
- Obstruction,
- Ruptured membranes,
- Consent,
- Adequate power (effective contractions),
- Proper placement of forceps,
- Senior help should be available if needed.
What is the definition of a vacuum extractor (ventouse)?
A vacuum extractor is an instrument used in operative vaginal delivery to assist in the extraction of the fetus. It is more likely to cause fetal trauma, such as cephalohematoma and retinal hemorrhage.
What is the difference between forceps and vacuum extractor?
Forceps are more likely to cause maternal genital tract trauma, while ventouse (vacuum extractor) is more likely to cause fetal trauma. However, ventouse appears safer for the mother, while forceps may be safer for the baby.
