Post on 04-Jun-2018
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DYSTOCIA
ANDREW ROULDAN B. BUIZON, M.D., FPOGS, FSGOP
Assistant Professor
De La Salle Universit ! "ealt# S$ien$es Instit%te
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DYSTOCIA
Literally means Difficult Labor
Characterized by Abnormally SLO!ro"ress of Labor
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O#er#ie$ of the lecture
I % &ormal and Abnormal Labor
II % Causes of Dystocia
III % Com'lications of Dystocia
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(actors that affect Labor
!o$er% (irst sta"e) uterine contractions
% Second sta"e) uterine contractions * intra+abdominal 'ressure
!assen"er% (etal Attitude, !resentation, !osition
%Ability to ada't throu"h !assa"e
!assa"e% -irth canal
.(or &ormal Labor to ta/e 'lace % &ormal 0!1s
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!ro"nosis for 2a"inal Deli#ery
Po&er% force of uterine contractions
Passen'er)
% !resentation and !osition% Size of fetal head
%Ada'tability of fetal head
Passa'e% size and sha'e of maternalbony 'el#is
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Sta'es of La(or
(irst. + re"ular uterine contractionsfully
Second.+ full cer#ical dilatationdeli#ery baby
Third + deli#ery of baby'lacental deli#ery
(ourth +immediate 'ost'artum
.Sta"es concerned $ithDystocia
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(irst Sta"e of Labor
Latent !hase
Acti#e !hase
%Acceleration !hase !redicti#e of outcome of labor
% !hase of 3a4imum slo'e
3easure of efficiency of the machine
% Deceleration !hase
5eflecti#e of feto'el#ic relationshi'
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6istory of the !arto"ra'h
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(unctional Di#isions of Labor
!re'aratory Di#ision
Dilatational Di#ision
!el#ic Di#ision
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!re'aratory Di#ision
Latent !hase and Acceleration !hase
Ma)or event% cer#ical ri'enin"
%Softenin") chan"es in "round substance
% 7ffacement) obliteration of cer#ical canal
*ervi$al +ilatation% minimal
Fetal +es$ent% minimal to absent Sensiti#e to sedation and conduction
anal"esia
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!re'aratory Di#ision
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(unctional Di#isions of Labor
!re'aratory Di#ision
Dilatational Di#ision
!el#ic Di#ision
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Dilatational Di#ision
!hase of 3a4imum Slo'e
Ma)or Event% cer#ical dilatation
*ervi$al Dilatation% most ra'id rate Fetal Des$ent% minimal
8naffected by sedation and conduction
anal"esia
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Dilatational Di#ision
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(unctional Di#isions of Labor
!re'aratory Di#ision
Dilatational Di#ision
!el#ic Di#ision
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!el#ic Di#ision
Deceleration !hase to Second Sta"e of labor
Ma)or Event% cardinal mo#ements
*ervi$al Dilatation% ra'id rate Fetal Des$ent% ma4imal
3inimally affected by se+ationbut 9bearin"
do$n1 effort lar"ely affected by $on+%$tionanal'esia
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!el#ic Di#ision
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Cer#ical Dilatation and
(etal Descent
The only characteristics of the 'arturient
useful in assessin" labor : its 'ro"ression
Time #s; Cer#ical Dilatation % si"moid cur#e
Time #s; (etal descent % hy'erbolic cur#e
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Dia'nosis of La(or
r%e La(or False La(or
Re'%larit
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Criteria for Dia"nosis of Labor
?; Documented uterine contractions
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Dia"nosis of &ormal Labor
> cm@hr> ? cm@hrFetal Des$ent
> ?;E cm@hr> ?; cm@hr*ervi$al
Dilatation
H ?B hoursH hoursLatent P#ase
MULTIPARANULLIPARALABOR
PATTERN
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Dia"nosis of Abnormal Labor
> ? hour> 0 hoursDeceleration!hase
> ?B hours> hoursLatent !hase
> ? hour> ? hour&o Descent
> hours> hours&o Dilatation
Arrest Disor+erH cms@hrH ? cm@hrDescent
H ?;E cm@hrH ?; cm@hrDilatation
Protra$tion Disor+er
Prolon'ation Disor+er
MULTIPARANULLIPARALABOR
PATTERN
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!rolon"ed Latent !hase
It is the only disorder dia"nosable in the
!re'aratory Di#ision of Labor
Criteria)
% &ulli > hrs
% 3ulti > ?B hrs
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7tiolo"y of !rolon"ed Latent !hase
(alse Labor EG of the time
74cessi#e sedation
8nfa#orable cer#i4
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3ana"ement of
!rolon"ed Latent !hase
Thera'eutic 5est% if no C@I to delay for J+? hrs
% Stron" sedati#es
% 8'on $a/in", FEG enter acti#e 'hase ?EG false labor
Amniotomy
% $ill not accelerate latent 'hase
Caesarean section% &ot usually done unless $ith indications
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Dia"nosis of Abnormal Labor
> ? hour> 0 hoursDeceleration!hase
> ?B hours> hoursLatent !hase
> ? hour> ? hour&o Descent
> hours> hours&o Dilatation
Arrest Disor+erH cms@hrH ? cm@hrDescent
H ?;E cm@hrH ?; cm@hrDilatation
Protra$tion Disor+er
Prolon'ation Disor+er
MULTIPARANULLIPARALABOR
PATTERN
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!rotraction Disorders
!rotracted Acti#e !hase
!rotracted Descent
7tiolo"y )% 3al'osition
% 74cessi#e sedation @ conduction anal"esia
% Ce'halo'el#ic dis'ro'ortion
3ana"ement)%Au"ment of labor
% CS FG ha#e C!D
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Dia"nosis of Abnormal Labor
> ? hour> 0 hoursDeceleration!hase
> ?B hours> hoursLatent !hase
> ? hour> ? hour&o Descent
> hours> hours&o Dilatation
Arrest Disor+erH cms@hrH ? cm@hrDescent
H ?;E cm@hrH ?; cm@hrDilatation
Protra$tion Disor+er
Prolon'ation Disor+er
MULTIPARANULLIPARALABOR
PATTERN
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+hour rule for dia"nosis of arrest in acti#e
'hase of labor has recently been challen"ed
EB $omen included $here CS deli#ery $as
not 'erformed for labor arrest until there $ereat least B hours of a sustained uterine
contraction of >monti#edeo units or a
minimum of J hours o4ytocin au"mentation if
the contraction 'attern could not be achie#ed
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3ana"ement of Abnormal Labor
(ailure of descent
CSCS if * C!DArrest of Descent
oArrest of Dil5est if e4haustedAu"ment if no
C!D!rol Decel
Arrest Disorders
Descent
CS for C!D @
Au"ment
74'ectant @
Su''ort
Dilatation
Protraction Disorders
Au"ment @ CS-ed restLatent !hase
Prolongation Disorders
E/$e0tional
reat1ent
Preferre+
reat1ent
La(or 0attern
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5is/ (actors for Dystocia
Associated $@ lon"er ndsta"e+ e'idural anal"esia
+ occi'ut 'osterior 'osition
+ lon"er ?ststa"e of labor+ nulli'arity
+ short maternal stature
+ birth$ei"ht+ hi"h station at com'lete cer#ical dilatation
ACO !ractice -ulletin
Com'endium B
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DYSTOCIA + Abnormal Labor
Three cate"ories causin" Dystocia)
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&ormal 8terine Contractions
3oderate +
stron"
3ild to
moderate
Intensity
B % J secs0 % B secsDuration
+0 mins0+E mins(reMuency @Inter#al
A$tive P#ase
to
Se$on+ Sta'e
Latent P#asePara1eter
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8T75I&7 DYS(8&CTIO&
"0otoni$ Uterine Dsf%n$tion
3ore common
&o basal hy'ertonus
8terine contractions ha#e a normal
'ressure "radient 'attern
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8T75I&7 DYS(8&CTIO&
"0ertoni$ Uterine Dsf%n$tion
Also called incoordinate uterine
dysfunction
7ither basal tone is ele#ated or
'ressure "radient is distorted by
contraction of the midse"ment of the
uterus $ith more force than the fundus
or by com'lete asynchronism or a
combination of both
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CA8S7S O( 8T75I&7 DYS(8&CTIO&
7'idural anal"esia
Chorioamnionitis
3aternal 'osition durin" labor -irthin" 'osition in ndsta"e labor
illiam1s Obstetrics, ?sted;