CERVICAL DYSTOCIA A key note to diagnose a factor of prolonged labour

Helpful for midwives

1. CERVICAL DYSTOCIA
OBSTETRIC
EMMERGENCY
PRESENTED BY:
ABDULBASIRU MANNEH
RM/RN
SECHN/M
26/03/2019

2. DEFINITION
•Dystocia is defined as abnormal or difficult
labour, whereas eutocia describes normal
labour or childbirth, and oxytocia describes
rapid labour. Dystocia itself entails a vast
number of influencing factors that include
both maternal and fetal entities
•AETIOLOGY/CAUSES
•These may be remembered as 'The Powers'
(uterus), 'The Passenger' (fetus) and 'The Parts'
(pelvis). OR due to poor uterine activities

3. Uterine factors
•good contractions start at the fundus and
move down towards the pelvis. If uterine
activity is unco-ordinated or contractions
are short or infrequent then labour will be
difficult and prolonged. Primigravid
mothers may be more at risk of dystocia
as they have a degree of uterine unco-
ordination which is why their labours tend
to be longer. Oxytocin can enhance and
co-ordinate uterine contractions.

4. •Fetal factors: position or lie - e.g., transverse
or breech, macrosomia, shoulder dystocia
(this results from a combination of fetal
factors and pelvic passage factors).
•Pelvic passage factors: a pelvis with a
round brim is very favourable in labour;
however, some women have a long and oval
brim.
•A small pelvic brim should be suspected if the
fetal head has not engaged into the pelvis by
37 weeks of gestation.

5. Cervical dystocia
•This is where the cervix fails to dilate during
labour.
•Rigid cervix: the cervix fails to dilate despite
normal uterine contractions. The first stage is
characterized by severe backache.
•Annular detachment of the cervix: prolonged
pressure of the foetal head on the cervix, in
rare instances, produces an ischaemic area
which inhibits dilatation. Due to pressure the
necrotic ring of the cervix may be expelled

6. •Oedematous anterior lip of the cervix: when the
anterior part of the cervix is nipped or get trapped
between the fetal head and the pelvic brim it may
become swollen. This prolongs the first stage of labour
as an oedematous cervix does not dilate easily.
•uncoodinated uterine activity that was unresponsive
to pitocin administration, the underlining cause might
be trauma, CPD or abnormal lie and in such cases
C/S would be the usuall way of delivery.
.

7. Management (The mode of
delivery is usually C/S)
•Preoperative care
•Nil by mouth or per oral
•IV infusion commenced or continued and
fluids administered as prescribed
•Pre-operative medications are
administered as prescribed
•Insert in-dwelling urinary catheter .

8. •Dress in operating room gown
•Finger nail polish and hair clips removed
•Rings and jewellery removed
•Check birth-care plan to ascertain whether
woman wants placenta returned
•Luggage to be locked in appropriate cupboard
•Continue to monitor maternal vital signs
•Continue to monitor fetal heart rate
•Position the woman in left-lateral
•Administer O2 via mask if clinically
appropriate

9. Postoperative Care
•Postoperative care: After surgery is
completed, the patient should be
transferred into a special care room
(Recovery Room) for a few days. to
receive all the necessary post operative
care.
•Incision wound care: clean with alcohol
and then cover with sterile gauze
Periodically, dress and change dessing
as required to keep the wounds cleaned.

10. •Fluid:pt during the first 24 hours, would
require fluid therapy to correct any
potential electrolytes imbalance or
dehydration and other fluid related
problems
•Diet: start giving semi solid or liquid food
for the first 6-10 hours post-surgery.
•where there was need to feed the pt and
doing that was difficult, then an nasogastric
tube should be pass for feeding

11. •Pain: if the patient is awake and complain
of pain after
​​operations, give analgesic.
•Mobilization: Mobilize the pt gradually to
help the course of healing,to prevent the
occurrence of thrombus and embolism.
Deep breathing exercises, small coughs
and sleeping supine are key

12. •Catheterization: The catheter should
remains in situ until full recovery.
•Giving medicines: Antibiotics and anti-
inflammatory
•Skin care: Examine the skin especially
over the bony prominence
•Monitor vital signs, fluid intake and output

13. •THE END