Dystocia Flashcards
NORMAL LABOR (REVIEW)
● Contractions that result in a more normal
progression of labor (moderate to strong)
● 2-4 contractions in 10 min in early labor & 4- 5/ 10
min in later phases.
● long, difficult, or abnormal labor
● caused by various conditions associated with the
five factors affecting labor
● described as abnormal uterine contractions that
prevent the normal progress of cervical dilatation,
effacement and fetal descent
DYSTOCIA/DYSFUNCTIONAL LABOR
● Resulted in a prolonged labor
● Typically irregular in strength, timing, or both
● often arrest cervical dilatation
DYSTOCIA (UNCOORDINATED UTERINE CONTRACTION)
COMMON CAUSES OF DYSFUNCTIONAL LABOR
- Inappropriate use of analgesia
- Pelvic bone contraction that has narrowed the
pelvic diameter so that the fetus cannot pass - Poor fetal position (posterior rather than anterior)
- Failure of the uterine muscle to contract properly
● Ineffective uterine contractions of poor quality
● Occur in the latent phase of labor
● Contractions usually become more frequent, but
their intensity may decrease
HYPERTONIC CONTRACTIONS/ HYPERTONIC UTERINE DYSFUNCTION
MEDICAL MANAGEMENT
- Bedrest
- Administration of analgesics such as morphine,
meperidine (Demerol), nalbuphine (NUBAIN) or
sedatives such as zolpidem (ambien) - Tocolytic drugs – terbutaline (brethine)
NURSING ASSESSMENT
● Evaluate the relationship between intensity of the
pain being experienced & the degree to which the
cervix is dilating & effacing
● Fewer than 2-3 contractions in a 10 min period
● Develops in the active phase
● Contractions are coordinated but too weak,
infrequent & brief
HYPOTONIC CONTRACTIONS/ HYPOTONIC UTERINE DYSFUNCTION
MEDICAL MANAGEMENT
● Improving the quality of the uterine contractions
● Ultrasound or x-ray examination to rule out CPD
● Assessing FHR & labor pattern, characteristics of
AF if membranes are ruptured and maternal
well-being Medical Management
FIRST STAGE OF LABOR
● Major dysfunction that occurs in the 1 st stage of
labor
● According to Friedman, it is a latent phase that is
longer than 20hrs in a nullipara & 14hrs in
multipara.
● Uterus tends to be hypertonic
PROLONGED LATENT PHASE
MEDICAL MANAGEMENT
● Help the uterus to rest & administer adequate
fluid to the woman to prevent dehydration
● Administration of morphine may relax
hypertonicity, this usually allows labor to become
effective & begin to progress.
● Usually associated with CPD or fetal malposition
● If cervical dilatation does not occur at a rate of at
least 1.2cm/hr in nulliparas or 1.5cm/hr in a
multipara, or if the active phase last longer than
12hrs in a primigravida or 6hrs in multigravida
PROTRACTED ACTIVE PHASE
A deceleration phase has become prolonged
when it extends beyond 3hrs in a nullipara or 1
hr in a multipara
PROLONGED DECELERATION PHASE
No progress in cervical dilatation for more than 2
hrs.
SECONDARY ARREST OF DILATATION
SECOND STAGE OF LABOR
Occurs if the rate of descent is less than
1.0cm/hr in a nullipara or 2.0cm/hr in a
multipara
PROLONGED DESCENT
MANAGEMENT
● If membranes have not ruptured, rupturing them
at this point may be helpful.
● IV oxytocin may be used to induce the uterus to
contract effectively.
● no descent for 1 hr in a multipara or 2 hrs in a
nullipara
● The most likely cause for arrest of descent during
the 2nd stage is CPD
● CS birth usually is necessary
ARREST OF DESCENT
● can occur at any point in the myometrium and at
any time during labor (1st , 2nd , and 3rd stage).
● a line of demarcation between the upper and lower
uterine segment present during normal labor and
cannot usually be felt abdominally.
PHYSIOLOGIC RETRACTION RING
● The most common form of constriction ring
responsible for dysfunctional labor.
● Occurs at the junction of the upper & lower uterine
segments.
● Occurs during the second stage of labor as a
horizontal indentation across the abdomen.
★ It is usually caused by obstetric manipulation or
by the administration of oxytocin.
PATHOLOGIC RETRACTION/BANDL’S RING
MANAGEMENT
● Identified by sonography
● Administration of IV morphine sulfate or the
inhalation of amyl nitrate may relieve the retraction
ring
● Tocolytic
● CS
