Dystocia Flashcards
(39 cards)
Give a definition of dystocia
Labor abnormalities that interfere with the progression of normal spontaneous labor.
Characterized by abnormally slow labor progress
What are the 4 abnormalities associated with dystocia.
what are the 3Ps according to ACOG?
- Abnormalities in the pelvis
- abnormalities in the fetal position
- abnormalities in the expulsive forces (uterine dysfunction)
- Abnormalities in the maternal tissue
simplified to 3 P’s
Powers
Passenger
Passage
What are the common clinical findings in Dystocia? Name them and describe each one (3).
- Ineffective labor:
- -cephalopelvic disproportion (CPD) = disparity between fetal head size and maternal pelvis
- -failure to progress = lack of progressive cervical dilatation - Inadequate cervical dilatation or fetal descent
- -Protracted labor = SLOW PROGRESS
- -Arrested labor = NO PROGRESS - Fetopelvic Disproportion
- -Fetal size is too big
- -Pelvis is not adequate
- -Position of the fetus is not appropriate for delivery
What is the status of the Uterus and Cervix at the end of pregnancy but before the second stage of labor?
- the lower uterine segment is THICK
- the Cervix is UNDILATED
- The fundal muscles are not yet powerful
At the end of pregnancy and before the second stage of labor, what factors will influence the progression of labor?
- Uterine contraction (muscles)
- Uterine Resistance (undilated cervix and thick lower uterine segment)
- Forward pressure of leading fetal part
At what stage of labor does cephalopelvic disproportion become more apparent? why?
2nd stage of labor
because this is when the fetus will begin descending through the pelvic cavity.
What are two causes of uterine muscle dysfunction?
Uterine overdistention
Obstructed labor (CPD, etc.)
Should you give oxytocin if there is ineffective labor? (cephalopelvic disproportion & inadequate cervical dilation)
NO, giving oxytocin might cause uterine rupture during ineffective labor
How would you diagnose Arrest of labor at the FIRST and SECOND stage??
FIRSTT STAGE
Wait for adequate time to pass before diagnosing arrest of labor
Adequate labor: greater than 6cm dilation WITH 4 hours of adequate contractions
–wait 6 hours if there is no cervical or inadequate contraction before proceeding with diagnosis
SECOND STAGE labor arrest DIAGNOSIS
no progress for 4 hours in nulliparous women WITH epidural. 3 hours if WITHOUT epidural
NO CS should be done until these timings have passeed if he maternal and fetal heart rates are reassuring
What brings about cervical dilatation, propulsion and expulsion of the fetus?
Uterine contractions on the FIRST stage of labor
What is the treatment for hypotonic uterine dysfunction?
dilute oxytocin (parang 1unit lang ata)
When is CS delivery warranted?
When oxytocin fails or its use is inappropriate (hindi ung uterus ung cause but CPD)
In the latent (early) phase of the first stage of labor, how many hours does it usually last? At what cervical dilatation does this phase last?
what type of contractions can be seen here? describe
20 hours.
6cm dilatation
Irregular (5-30 mins, lasting 30 sec) and Regular contractions (3-5 minutes, lasting 1+ minutes)
When does the active phase of the first stage of labor begin? What type of contractions happen here?
what is the cervical effacement at the beginning of this stage?
6-10cm cervical dilatations
Intense contractions (0.5-2 minutes lasting 60-90 seconds)
80% cervical effacement at the beginning
What are the two types of uterine dysfunctions?
Give a couple of differences and their treatment
Hypotonic vs Hypertonic happens in active phase vs latent phase Synchronous vs asynchronous Problem is that it cant dilate the cervix vs Problem is due to asynchronous contractions. Treatment: Oxytocin VS Sedation
What are causes in Uterine dysfunction?
Epidural anesthesia
Chorioamnionitis
Maternal position in labor
What are the THREE abnormal labor patterns? Give the “time limit” for each stage as well as treatment for both nullipara and multiparas
- Prolongation Disorders
- -Prolonged LATENT PHASE -> >20hr VS >14hrs
- –treatment is bed rest (if very prolonged, oxytocin administration) - Protraction Disorders
- -Protracted active phase dilatation = <1.2cm dilatation/hr VS <1.5cm/hr (MINIMUM OF 4 HOURS)
- –treatment is Expectant and support, if persists, oxytocin and amniotomy
- -Protracted Descent (Baby slowly moving) = <1cm/hr VS <2cm/hr
- –treatment is Expectant and support - Arrest Disorders
- -Prolonged deceleration phase >3hr VS >1hr
- -Secondary arrest of dilatation >2hr VS >2hr
- -Arrest of descent >1hr vs >1hr
- -Failure of descent = no decent in the deceleration phase or the second stage of labor (di gumalaw at all si baby)
- –TREATMENT = Evaluate for CPD if yes, CS, if no (just uterine dysfunction) then oxytocin
What are the cervical dilatation ranges in the acceleration phase, phase of maximum sloe, and deceleration phase?
3-5 in accel phase
5-9 in maximum slope
9-10 in deceleration phase
When does fetal descent actually begin?
According to the descent curve already at the first stage of labor at the latent phase there is already fetal descent
When does active descent begin in Friedman’s curve?
at the phase of maximum slope
At what cervical dilatation can protracted descent be diagnosed?
only at 8-9cm cervical dilatation. Remember, protracted descent also means that during the phase of maximum slope (of the descent curve), the descent is still slow
that is protracted descent
Differentiate Arrest of descent vs Failure of descent
Failure of descent is when the leading part of the fetus does not pass station 0 (which is the point of reference) while arrest of descent is when the fetus initially descends, but the arrests at a certain position below station 0
What is the treatment for protracted cervical dilatation?
Oxytocin and amniotomy
When should you do CS for active phase arrest?
Cervical dilatation at 6cm WITH ruptured membranes.
Fail to progress for 4 hours despite adequate contractions
OR
6 hours of adequate oxytocin administration with inadequate contractions or no cervical change
