Dystocia

Dystocia

Dystocia means “difficult birth.”. It includes all abnormalities that may occur in women during labor.

Causes and risk factors

Dystocia is more common in nulliparous women than in multiparous women. It is more common in the first stage of labor than in the second stage of labor. The causes of abnormal labor have been attributed to uterine contractility, maternal pelvimetry, or position and size of the fetus. In scientific terms, these represent a primary dysfunctional labor, cephalopelvic or fetopelvic disproportion, abnormal fetal head position, and asynclitism. Primary dysfunctional labor refers to insufficient uterine contractility to maintain the progress in labor. In general, an adequate uterine contraction pattern is one in which there are four concerted synchronous contractions every 10 minutes. Cephalopelvic or fetopelvic disproportion – CPD occurs when the fetal birth weight or the fetal head is of sufficient size or orientation to prevent entry into the maternal pelvic inlet. Abnormal positions of the fetal head include occipitoposterior [OP], deep transverse arrest, and deflexion abnormalities such as face and brow presentations. These are fundamental abnormalities in the cardinal movements of labor. The term synclitism refers to the relative orientation of the fetal sagittal suture with the maternal bony pelvis. When asynclitism of the fetal head occurs, the sagittal suture of the head is either deviated posteriorly or anteriorly in relation to the maternal pelvis outlet.

Clinical presentation

Dystocia causes arrest in normal events of labor. They are – A prolonged latent phase occurs when regular painful uterine contractions are present for a long period of time without entering the active phase of labor. An arrest of dilation occurs when there is no cervical change after 2 hours in the active phase of labor in spite of uterine activity. In most cases, arrest of dilation occurs because of ineffective uterine contractions. Uterine contractions may become dysfunctional and lose their synchronous, rhythmic nature. Arrest of descent is observed. Prolonged active phase occurs. A prolonged second stage is diagnosed when the fetal head descends less than 1 cm per hour.

Investigation

Medical history by the patient and clinical examination by the gynecologist helps in diagnosis. Prolonged labor is the sign of fetal dystocia. USG is done. FHS monitoring is continuously recorded. NST is advised to check the well-being of the fetus.

Treatment

Pitocin should be administered first unless there is a clear contraindication to this medication, as this is an effective and safe therapy. Oxytocin may be administered intravenously, subcutaneously, intramuscularly, and buccally. Cesarean section is taken if there is severe dystocia. Other treatment options include intrauterine pressure catheters [IUPC], amniotomy.

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