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DR SANAM MORADAN Full PROFESSOR SEMNAN UNIVERSITY OF ...
Transcript of DR SANAM MORADAN Full PROFESSOR SEMNAN UNIVERSITY OF ...
DR SANAM MORADAN
Full PROFESSOR
SEMNAN UNIVERSITY OF MEDICAL SCIENCE
Dystocia
Causes of Dystocia
►Uterine Dysfunction
►Abnormal presentation-
Position & development of fetus
►Pelvic contraction.
►Abnormal birth canal(soft tissue abnormalities)
The most common causes of Dystocia:
* uterine Dys function.
&
* pelvic contraction.
The most common causes of primary cesacrean is Dystocia.
Labor diagnosis Uterine contraction → Dilatation & effacemen
Stages of labor:
First stage of labor:
► From labor pain → full Dilatation
Latent.p.
- Tow Phases of cervical dil.
Active.p.
Second stage of labor
Full Dilation → Delivery
Multipara : 20'
Nullipara : 50'
Third Stage of labor.►Delivery of Fetus → Delivery of Placenta
Abnormal labor Patterns
►Prolonged latent phase > 20hr > 14hr
►Rx → rest. Oxytocin or c/s in urgent
problem
Protracted disorders
►Protracted Active phase Dil → n< 1/2 cm/hr
m< 1/5 cm/hr
►Protracted descend → n<1 cm/hr
m< 2 cm/hr
►Rx → Expectant & support.
►C/S with CPD.
Arrest Disorders
1) prolonged deceleration phase → >3 hr >1 hr
2) secondry arrest of Dilat. → >2hr >2hr
3)Arrest of Deseent → >1hr >1hr
4) failure of Descent → No Descend
►Rx →
1) without CPD → rest & relaxation
2) with CPD → C/s
3) With CPD → C/s
4) C/s
Causes of Dystocia
Uterine Dysfunction
►Hypertonic ut . Dysfunction.
►Hypotonic ut . Dysfunction.
Dystocia because Abnl. presentationPosition & Development of fetus
► Breech presentation
1- In term pregnancy is Rare ,about 3-4%
2- Breech presentation
Frank breech
complete breech
Incomplete breech or footling
► Breech delivery → NVD is Difficult
► Because …
►
1. Head compression → fetal distress ,acidosis
2. Trauma to fetus.
3. No molding.
4. In preterm delivery head escape is with trauma.
5. In hyperextention of head trauma to spinal cord is common.
In breech pres. fetal and maternal Morbidity &
mortality is high Than cephalic prese.
► Face presentation:
1. hyperextention of head of fetus
2. 1/600 Delivery.
3. In vaginal exam face is palpable
Etiology
1) marked enlargement of neck
2) coil of cord about the neck
3) anencephalic fetuses.
4) macrosomia of fetus.
5) pelvic contraction.
6) multiparity.
Rx → No CPD with effective labor
Pain → NVD
Brow presentation
► Rarest presentation
► Unstable pres → face or occiput.
Etiology►The same of face presentation
►Rx → small fetus with No CPD → NVD
Transverse lie:
Shoulder presentation:
Etiology
1. multiparity
2. preterm fetus
3. placenta previa.
4. Abnormal uterus.
5. Polyhydramnious.
6. Contracted pelvic
Route of Delivery → C/S.
Compound presentation
► 1/700 pregnancy.
► Preterm delivery is the common cause.
Route of Delivey → NVD
Persistant occiput posterior Position
► %10 No spontanous rotation
► Mid pelvic narrawing is a factor
►Delivey →
►spontanous delivery.
►Forceps delivery.
►Manual rotation.
►Forceps rotation
►Outcome → Prolongation of labor
↑laceration.
Persistent occiput transverse position
►A transient position → oA.
►With or without rotation NVD is possible
Route of Delivery → NVD
1. spontanous Delivery.
2. Forceps Delivery
3. Manual rotation Delivery.
Shoulder Dystocia
►Maneuvers require for delivey of shoulders
►Maternal consequece
1)P.P.hemorrahage(Atonia)
2)vag & cervical laceration.
3) P.P. infections.
Fetal consequences
1- fetal mortality
2- brachial plexus injury & erbe,s palsy.
C5-C6 → shoulder arm palsy.
C7-t1→ hand palsy.
3- clavicular fracture
prediction & prevention of sh.dys.
Risk factors
1) maternal obesity
2) multiparity.
3) diabetes.
4) postterm pregnancy
Macrosomia of fetus → sh.Dystocia.
%50 shoulder dys. In Non obese fetuses
Rx
1) call for help.
2) Drain of bladder.
3) large mediolateral episiotomy.
4) suprapubic pressure.
5) macRoberts maneuver.
6) wood maneuver.
7) Delivery of post arm.
8) others techniques
Hydrocephalus as a cause of Dystocia
►Accumulation of csf in ventricles
►1/2000 fetuses.
►Head circumfrence≥50cm
Diagnosis → sonography.
Rx → cephalocentesis vaginal or abdominal.
Dystocia Due to pelvic contraction
Classifications :
1. contraction of pelvic inlet
2. contraction of midpelvic
3. contraction of outlet.
4. Generally contracted pelvic.
Contracted pelvic inlet
Shortest Ap Diameter <10cm
Largest transverse diameter <12 cm
Or
Diagonal conjugte<11/5 cm
BPD of fetus → 9/5 -9/80
Complication
↑Abnl presentation: Face presentation
Shoulder pres. →↑threetimes.
Cord prolapse → ↑4-6 times
maternal effects
a) Abnormality of cx. Dilatation
b) uterine rupture.
c) fistula formation.
d) intrapartum. Infection
fetal effects
a) Caput succedaneum.
b) molding.
c) cord prolapse.
Rx→ NVD
If NVD impossible → C/S.
Oxytocin is contraindicated
Contracted midpelvic
nl. Diameter of mid pelvic : interspinous →
10/5 cm
Ap Diameter → 11/5 cm
Post . sagittal → 5 cm
Intespinous + postsagittal < 13/5cm
↓ ↓
(Nl : 15/5 cm) contracted mid pelvic
midpelvic
1. Prominent ischial spine
2. Pelvic side wall converge
3. Narrowing of sacrosiatic noth.
Rx
►spontanous delivery.
►Forceps delivery is contraindicated.
Unless pass of BPD from contracted area.
Oxytocin is contraindicated
Contracted pelvic outlet
►Interischial tuberous diameter < 8 cm
►Without mid pelvic contraction has good prognosis.