Dysfunctional Labor (Dystocia) Flashcards
Dystocia: overview
Long, difficult, or abnormal labor
- most common indication for c-birth
- five factors affect labor
The powers
The passage
The passenger
Maternal position
Psychologic responses
Abnormal uterine activity: hypertonic uterine dysfunction
- therapeutic rest
Hypertonic uterine dysfunction - frequent and painful contractions that are ineffective in causing cervical dilation or effacement. Force of contractions are in the midsection of the uterus rather than in the fundus, the uterus is unable to apply downward pressure to push the presenting part against the cervix. women are exhausted, and complain of loss of control
Therapeutic rest: warm bath, shower, narcotic to ensure rest
Abnormal uterine activity - hypotonic uterine dysfunction
Initially makes normal progress into the active phase of first-stage labor but then the contractions become weak and inefficient or stop altogether
Treatment: ambulation, hydrotherapy, ROM, nipple stimulation, oxytocin
Secondary powers problems
Problems with bearing-down efforts: due to large amounts of analgesic. sleepy and doesn’t have the energy
Abnormal labor patterns
- Updated, evidence-based awareness of “normal” labor
- individualized to each woman. only guidelines
Precipitous labor
- labor that lasts less than 3 hours from the onset of contractions to the time of birth
Complications for mother: uterine rupture lacerations of birth canal, postpartum hemorrhage
complications for fetus: should dystocia, hypoxia, even intracranial trauma
Fetal Causes of Dystocia
- anomalies
- cephalopelvic disproportion (CPD), also called fetopelvic disproportion (FPD)
- Malposition (OP-Position) - face to pubis (longer turning must take place)
- Malpresentation (breech)
- multifetal pregnancy
Fetal Causes of Dystocia
- anomalies
- cephalopelvic disproportion (CPD), also called fetopelvic disproportion (FPD)
- Malposition (OP-Position) - face to pubis (longer turning must take place)
- Malpresentation (breech)
- multifetal pregnancy
Alterations in pelvic structure
Pelvic dystocia: contractures of pelvic diameters that reduce the capacity of the bony pelvis, inlet, midpelvis, or outlet
Soft-tissue dystocia: results from obstruction of the birth passage by an anatomic abnormality other than that of bony pelvis
Position of the woman causing dystocia
maternal position alters relationship between uterine contractions, fetus, and mother’s pelvis
Psychologic responses
- hormones and neurotransmitters released in response to stress can cause dystocia
- sources of stress and anxiety vary
Obstetric Procedures: induction of labor
- the chemical or mechanical initiation of uterine contraction before their spontaneous onset for the purpose of bringing about birth
- labor may be induced either electively or for indicated reasons
Elective induction of labor
- labor is initiated without a medical indication
- many are for the convenience of the woman or her primary health care provider
- risks: increased rates of c/s, increased neonatal morbidity, increased cost
- elective induction of labor should not be initiated until the woman reaches 39 completed weeks of gestation
High priority for induction
PET (preeclampsia toxemia): high BP, edema, proteinuria that can lead to seizures.
- other disease processes, when the mother has stable antepartum hemorrhage, if baby is having difficulties, term pregnancy but the membranes ruptures.
- IUGR, oligohydramnios, PROM, post-term, GDM (more than 38 wks), uncomplicated twins post 38 wks, LGA baby
Bishop’s Score
A rating system used to evaluate inducibility or cervical ripeness
- dilation
- effacement
- station
- cervical consistency
- cervical position