labour dystocia

Question 1

When is labour considered abnormal?

Answer 1

1- multiple gestation
2- poor progress
3- malpresentation
4- fetal compromise
5- post term
6- complicated by hemorrhage
7- previous Caesarian delivery

Question 2

Abnormally slow labour progress is secondary to what?

Answer 2

1- power problems -> inefficient uterine contraction
2- passengers -> abnormal presentation or position
3- passages -> abnormal pelvic bones, narrow pelvis

Question 3

What are the causes of labour dystocia?

Answer 3

Maternal
- nulliparity, advanced maternal age
- obesity
- pelvis apart from gynecoid type
- weak contractions

Fetal
- malpresentation (face, brow)
- malposition (OP)
- macrosomia
- anomaly: hydrocephalus, sacrococcygeal teratoma

Intrapartum
- chorioamniotis
- poor maternal pushing
- polyhydramnios
- neuroaxial analgesia

Question 4

What is cephalopelvic disproportion?

Answer 4

Disparity between the fetal head size & maternal pelvis

Question 5

What are the types of labour dysfunction disorders?

Answer 5

Uterine contraction <180 Montevideo unit in active phase

Protraction
- labour is progressing but very slowly

Arrest
- labour progress stopped

Question 6

What are the different types of uterine dysfunction?

Answer 6

• hypotonic dysfunction -> pressure during contraction is not sufficient
• hypertonic dysfunction -> basal tone is elevated appreciably or the pressure gradient is distorted

Question 7

What are the risk factors for uterine dysfunction?

Answer 7

• neuraxial analgesia
• chorioamnionitis
• higher station at the start of labour

Question 8

How is a prolonged latent phase diagnosed?

Answer 8

• > 20 hours for nulliparous
• > 14 hours for multiparous

Treat with rehydration, reassurance, analgesia, amniotomy & oxytocin

Question 9

When does active labour begin?

Answer 9

At 6cm & after

Question 10

How is protraction disorder diagnosed?

Answer 10

<1cm/h for 4 hours -> amniotomy & place internal monitors to check uterine contractility

If contractions are inefficient
- analgesia
- rehydration
- oxytocin augmentation

Question 11

How is active phase arrest disorder diagnosed?

Answer 11

• no cervical change after 4 hours of efficient uterine contraction
  Or
• no cervical change after 6 hours with no adequate contraction despite augmenting with oxytocin infusion

managed by Caesarian delivery

Question 12

How is arrest of labour diagnosed while lady is pushing?

Answer 12

Nulliparous
- without analgesia -> 3 hours
- with analgesia -> 4 hours

Multiparous
- without analgesia -> 2 hours
- with analgesia -> 3 hours

Question 13

How are disorders of second stage of labour managed?

Answer 13

1- oxytocin augmentation if uterine contractions are inefficient
2- instrumental delivery: if fetal head is deeply engaged
3- C section if station of presenting part is high

Do not wait for fetal compromise

Question 14

What are the causes of precipitous labor & what are the complications caused?

Answer 14

Labour that occurs in less than 3 hours due to
- strong contraction
- low resistance of the pelvic floor
- absence of pain

May lead to stony postpartum