Dystocia mechanic (Obstructed Dystocia).pdf

Dystocia mechanic ( Obstructed Dystocia)

1. Dystocia mechanic (Obstructed Dystocia)
Lecture by: Prof.Srey Sopha
Prepared by: DES.Deng Makara

2. content
•Definition
•Incidence
•Risk factor
•Cause
•Morbid anatomical changes
•Effects on the mother and fetus
•Prevention
•Complication
•Actual treatment
•Obstetric management

3. Definition
•Dystocia mechanic (Obstructed Dystocia): is
failure of descent of fetalpresenting part in birth cannal
due to mechanical reasons in spite of good uterine
contractions .
•Dynamic dystocia : is caused by insufficiency of uterus
contraction or ineffective contraction.

4. Incidence
•In the developing countries, the prevalence is about 1–2% in
the referral hospitals

5. Risk factor
§Malnutrition
§Previous caesarean or stillbirth, previous prolonged labour
§Young age of mother (under 17 years of age)
§Female genital mutilation(FGM)
§Custom of early marriage
§Previous obstructed labour

6. Cause
•ØFault in the passage
•ØFault in the passenger

7. Cause
Fault in the passage
(1) Bony
◉Contracted pelvis
◉Cephalopelvic disproportion
(2) Soft tissue obstructions:
◉Cervical dystocia due to prolapse or previous
operative scarring
◉Broad ligament fibroid
◉Impacted ovarian tumor
◉The non-gravid horn of a bicornuate uterus below
the presenting part.
Fault in the passenger
1) Transverse lie
(2) Brow presentation
(3) Congenital malformations of the fetus—
hydrocephalus (commonest), fetalascites, double
monsters
(4) Big baby, occipito-posterior position
(5) Compound presentation
(6) Locked twins.

8. bicornuate uterus

9. Broad ligament fibroid

10. Fetus hydrocephalus

11. Double Monsters

12. Compound presentation

13. Locked twins

14. Morbid anatomical changes
◉Uterus: formation of Bandl’sring
◉Bladder: patient fails to empty the bladder. The bladder walls get
traumatized, which may lead to blood stained urine, a common finding
in obstructed labor. The base of the bladder and urethra, which are
nipped in between the presenting part and symphysis pubis may
undergo pressure necrosis. The devitalized tissue becomes infected
and later on may slough off resulting in the development of
genitourinary fistula.

15. Uterus Bandl’sring

16. Morbid anatomical changes

17. Morbid anatomical changes

19. Effects on the mother

20. Areas fistula

21. Effects on the fetus
(1) Asphyxia
(2) Acidosis
(3) Intracranial hemorrhage
(4) Infection.
•All these lead to increased perinatal loss.

22. Prevention

23. Complication
◉Uterine rupture
◉Fistula-faecal, urinary and its psychosocial effects
◉Cervical and vaginal scarring and stenosis Pressure sores
and contractures
◉Foot injury
◉Sepsis
◉PPH, amenorrhea, infertility
◉Fetalloss and maternal death

24. Actual treatment
•Principles are:
(1) To relieve the obstruction at the earliest by a safe delivery procedure(2) To combat dehydration and ketoacidosis(3) To control sepsis.
•Preliminaries:
(1)Fluid electrolyte balance and correction of dehydration and ketoacidosis
(2)A vaginal swab
(3)Blood sample
(4)Antibiotic

25. Obstetric management
◉Before proceeding for definitive operative treatment,
rupture of the uterus must be excluded.
◉There is no place of “wait and watch”, neither any scope of
using oxytocin to stimulate uterine contraction.

26. Continue Obstetric management
**Abdominal delivery
**When do we use Caesarean Section(
abdominal delivery)
•If cephalopelvic disproportion is confirmed
•If precondition for instrumental delivery not
fulfilled
•Malpresention–breech presentation
•Definite uterine rupture
**Symphysiotomy -rarely used today
◎For relatively mild obstruction
◎If the fetusis alive & cervix is fully dilated
**Episiotomy
◎If the cause of obstruction is tight peritoneum
**Instrumental delivery
◎If the fetusis alive, and the cervix is fully dilated
and if the head is at the level of ischial spine or
below.
• Forceps
• Vacuum

28. References
•Integrated Management Of Pregnancy And Childbirth
MSD manuals professional
https://core.ac.uk/download/pdf/70344038.pdf
•DC Dutta’s textbook of OBSTETRICS 2015
•UpToDate App
•AMBOSS App