Dystocia

1. DYSTOCIA Liezel B. Alfonso, MD

2. DYSTOCIA - difficult labor - slow labor progress

3. It may be associated with abnormalities involving: - Abnormalities of the Passage - Abnormalities of the Passenger - Abnormalities of the Powers

4. ABNORMALITIES OF THE EXPULSIVE FORCES Types of Uterine Dysfunction: HYPOTONIC UTERINE DYSFUNCTION - more common - no basal hypertonus - uterine contractions have a normal gradient pattern (synchronous) - pressure during contraction is insufficient to dilate the cervix

5. 2) HYPERTONIC UTERINE DYSFUNCTION = incoordinate uterine dysfunction - either basal tone is elevated - pressure gradient is distorted

6. ACTIVE PHASE DISORDERS PROTRACTION DISORDER - < 1cm/hr cervical dilatation for a minimum of 4 hrs ARREST DISORDER - no dilatation for 2 hrs or more

7. Definitions of Abnormal Patterns of Labor LABOR PATTERN NULLIPARA MULTIPARA PROLONGATION DISORDER Prolonged Latent Phase > 20 hrs > 14 hrs PROTRACTION DISORDERS Protracted Active Phase Dilatation (Phase of maximum slope dilatation) < 1.2cm/hr < 1.5cm/hr Protracted Descent (maximum slope of Descent during the pelvic division) < 1 cm/hr < 2 cm/hr

8. ARREST DISORDERS: Prolonged Deceleration Phase (cervical dilatation arrested at 8 to 9 cm) > 3 hrs > 1 hr 2. Secondary Arrest of Dilatation (progressive cervical dilatation stops at the phase of maximum slope) > 2 hrs 3. Arrest of Descent ( progressive cervical dilatation stops at the phase of maximum slope) > 1 hr 4. Failure of Descent (station 0) Lack of expected descent during deceleration phase or second stage of labor 5. Prolonged second stage > 3 hrs with regional anesthesia > 2hrs without regional anesthesia > 2hrs with regional anesthesia > 1hr without regional anesthesia

9. Criteria before the diagnosis of arrest during first-stage labor is made: 1) The latent phase has been completed, and the cervix is dilated 4cm or more. 2) A uterine contraction pattern of 200 Montevideo units or more in a 10-minute period has been present for 2 hrs without cervical change.

10. Second-stage disorders - disproportion of the fetus and pelvis are frequent

11. PRECIPITOUS LABOR AND DELIVERY - extremely rapid labor and delivery - result from an abnormally low resistance of the soft parts of the birth canal, from abnormally strong uterine and abdominal contractions - Or rarely, from the absence of painful sensations and thus a lack of awareness of vigorous labor