12.2d Dysfunctional Labor (Dystocia) Flashcards
Dystocia
- Lack of progress of labor for any reason
Dysfunctional Labor
- Long, difficult, abnormal labor
CAUSED BY
- Ineffective contractions or bearing down efforts (the powers of labor)
- Abnormal presentation, position, development of fetus
- Pelvic Structure (abnormalities of bone or soft tissue)
Abnormal Uterine Activity
- Hypertonic or Hypotonic contractions (ineffective contractions)
Latent-Phase Disorders
- Issues that occur in latent phase of 1st stage of labor
- Most common is hypertonic uterine dysfunction (painful frequent contractions that are ineffective in causing cervical effacement/dilation)
Active Phase Disorders
- Slow progression of labor or ARREST DISORDERS (no progress in labor)
- Most common cause is hypotonic uterine dysfunction (inadequate activity)
Also caused by CEPHALOPELVIC DISPROPORTION (CPD) and fetal malposition
Secondary Powers
- Mother bearing down
ISSUES DUE TO
- Large amounts of analgesics given
- Anesthesia preventing bearing down
- Exhaustion from bearing down
- Maternal positions against gravity decreases strength and efficiency of contractions
Abnormal Labor Patterns
- Prolonged latent phase
- Protracted active-phase dilation
- Secondary arrest (no progression)
- Protracted descent
- Arrest of descent
- Failure of descent
DUE TO
- Ineffective contractions
- Pelvic contractures
- CPD (Cephalopelvic Disproportion)
- Abnormal fetal presentation
- Early use of analgesics
- Nerve blocks
- Anxiety/Stress
Precipitous Labor
- Labor that lasts over 3 hours from onset of contraction to birth
COMPLICATIONS
- Hypertonic Uterine Contractions (placental abruption, uterine tachysystole, cocaine)
- Uterine Rupture
- Lacerations of Birth Canal
- Amniotic Fluid Embolus (AFE)
- Postpartum hemorrhage
- Hypoxia of Fetus
- Intracranial Trauma related to rapid birth of fetus
Pelvic Dystocia
CAUSED BY
- Contractures of pelvis diameters
- Immature pelvic size (adolescents)
- Pelvic deformities
Soft Tissue Dysotica
- Obstruction of birth passageways from things other than bony pelvis
CAUSES
- Placental Previa
- Leiomyomas (uterine fibroids) in the lower uterine segment
- Ovarian tumors
- Full bladder/rectum
- Cervical edema
- STI (human papillomavirus)
FETAL CAUSES
- Macrosomia
- Malpresentation/position
- Multifetal pregnancy
Complications of Soft Tissue Dystocia
- Asphyxia
- Fetal injury/fracture
- Maternal vaginal lacerations
- Forceps/Vacuum Assisted Birth
- C-section
Fetal Causes of Prolonged Labor
- Ascites
- Large Tumors
- Open NTD (Myelomeningocele)
- Hydrocephalus
Cephalopelvic Disproportion
- Fetus is too big to fit through maternal pelvis
Malposition
- Most common malposition is occipitoposterior
Causes prolonged second stage of labor and severe back pain from occiput against sacrum
Care Management
Assess Risks
- Assess history, signs of physical/physiological responses, factors that can contribute, effacement/dilation/contractions
- FHR, Presentation, Station, Position, Status of Amniotic Membranes
INJURIES
- Anxiety from loss of control, Decreased ability to cope, exhaustion
Malpresentation
Breech is most common
Flank Breech - Hips flexed, knees extended
Complete Breech - Hips and knees flexed
Footling Breech - One foot or both feet present before butt
MALPRESENTATION ASSOCIATED WITH
- Multifetal gestation
- Preterm Birth
- Poly/Oligohydramnios
- Genetic/Neuromuscular Disorders
Malpresentation
- Descent is slow and risk of cord prolapse
- Meconium in amniotic fluid is not a sign of fetal distress, it results from pressure on fetal abdominal wall.
RISKS OF BREECH
- Prolapse of cord, fetal head gets trapped, trauma of head and arms
VAGINAL BIRTH IS POSSIBLE IF
- Weight is between 2000-3800g
- Pelvis is normal
- Fetus head is flexed
Multifetal Pregnancy
- More labor complications
- Higher incidence of fetal complications
- Greater risk of mortality due to LBW resulting from IUGR or Preterm Birth
- Fetus risk of asphyxia
- Cerebral Palsy Risk is Higher
- Congenital Anomalies from dysfunctional labor, and even more risk for c-section
Physiological Responses of Prolonged Labor
- Hormones respond to stress (catecholamines) which increases anxiety and prolongs labor
