Dystocia 1

• Favorable Conditions for Normal Labor


  • Power
  • Passage
  • Passenger
• Power


  Adequate contractions, ripe cervix, sufficient intraabdominal pressure
• Passage


  Condition of the birth canal, favorable shape, adequate size, soft tissues not compromising size and shape
• Passenger


  Favorable presentation, favorable position, no abnormal structural development
• Abnormalities in any of the three Ps may lead to abnormal labor
• Complications of Abnormal Labor

  • Chorioamnionitis
  • Anal Sphincter Injuries
  • Postpartum Hemorrhage
  • Common Peroneal Nerve or Sciatic Nerve Injuries
  • Increased Chance of Fetal Caput
  • Increased Chance of Cephalohematoma
  • Increased Chance of Spinal And Brachial Plexus Injury
  • Poor Fetal Outcomes and APGAR Scores
• The parturient’s progress of labor may be assessed as normal or abnormal based on its performance against 2 parameters: Rate of cervical dilatation and Descent of presenting part
• Rate of Cervical Dilatation

  In order to achieve vaginal delivery of an average-sized baby, the cervix should reach full cervical dilatation at 10 cm
• Primigravid cervix


  1.2 cm/hr
• Multiparous cervix


  1.5 cm/hr
• If the cervix does not dilate at expected rates and/or does not reach full dilatation at 10 cms, the parturient is assessed to have an ABNORMAL LABOR or DYSTOCIA
• Descent of Presenting Part

  Occurs at a rate of 1 cm/hr for primigravid and 2 cm/hr for multiparous
• At station +5, the baby is presumed to have been successfully delivered
• Stages of Labor

  • Major Event
  • Functional Divisions of Labor
  • Phases of Labor in Divisions of Labor
• Phases of Labor in Divisions of Labor

  • Preparatory Division of Labor
  • Dilatation Division of Labor
  • Pelvic Division of Labor
• Precipitous Labor


  Labor that progresses rapidly
• A partogram is an important and effective peripartal monitoring tool that documents the status of both mother and fetus
• Partogram


  Documents the status of both mother and fetus, together with the parturient’s progress of labor
• Important Components of Partogram

  • Fetal Condition
  • Progress of Labor
  • Maternal Condition
• Fetal Condition

  • FHR
  • Liquor/amniotic fluid
  • Moulding
• Progress of Labor

  • Cervical dilatation
  • Descent of head
  • Uterine contractions
• Maternal Condition

  • Drugs
  • Vital signs
  • Urine
• The fetal and maternal conditions are documented, together with the progress of labor
• Creating a Partogram


  1. Place paper landscape

  2. Mark borders

  3. Draw X-axis

  4. Draw Y-axis

  5. Label axes

  6. Mark stations

  7. Label partogram
• Labor is defined as having regular uterine contractions affecting progressive cervical dilatation
• The patient is having abdominal tightening for the past five hours with a cervix 2 cm dilated and 80% effaced
• Engagement


  When the most dependent portion of the presenting part reaches the level of the ischial spine
• Station 0


  Assigned when engagement occurs
• Descent

  The second cardinal movement of labor
• At station 0, the fetal presenting part has reached the level of the ischial spines and engagement has taken place
• With her cervix at 10cm, it has achieved full cervical dilatation
• Deceleration phase


  Phase of labor when cervical dilatation is 8 cm
• Pelvic division of labor

  Stage of labor related to the position of the fetal presenting part
• At 5 AM, in her 10th hour of labor repeat IE revealed the cervix to be 9 cm dilated with fetal presenting part at Station +3
• Descent


  Stage when the fetal presenting part has gone below the ischial spines
• Full cervical dilatation


  Achieved when the cervix is at 10 cm
• Second stage of labor


  Stage reached when the cervix is fully dilated
• At 7 AM, in her 12th hour of labor repeat IE revealed the cervix to be 10 cm and the fetal presenting part at Station +5
• After a few minutes of further bearing down she was able to give birth
• Topic of abnormal labor entails problems in 3 P’s (power, passage, and passenger)