6abnormallaboranddystocia 100609040011-phpapp02

Abnormal labor and Dystocia

Dept of ObampGyn The first affiliated hospital

He Ke

Definition

Difficult labor or childbirth

Abnormal slow progress

of labor

Incidence

The most common

indication for primary

cesarean section

Abnormal patterns

Prolonged latent phase

Protraction disorders (active phase)

Arrest disorders (active phase)

Precipitate labor disorders

Evaluation index

Cervical dilation

Descent of the fetal presentation

Friedmanrsquos curve

Latent phase

Active phaseI II stage

产程图partogram

Prolonged latent phase

1048698 Nulliparas

Multiparas

prolonged

gt20 hr

gt 14 hr

Normal average

64 hr

48 hr

Protraction disorders

1048698 Nulliparas

Multiparas

Descent

lt10 cmh

lt20 cmh

Dilation

lt12 cmh

lt15 cmh

Average

8hr

5hr

Arrest disorder

1048698 Nulliparas

Multiparas

Descent

gt2h

gt1h

Dilation

gt2h

gt1h

Partogram

A 潜伏期延长 prolonged latent phaseB 活跃期延长 prolonged active phaseC 活跃期停滞 arrest active phase

Abnormal partogram

Partogram

Precipitate labor disorders

1048698 Nulliparas

Multiparas

Descent

gt5cmhr

gt10cmhr

Dilation

gt5cmhr

gt10cmhr

Classification of Dystocia

Abnormalities of the Power

Abnormalities of the Passage

Abnormalities of the Passenger

Characteristics of the power

Intensity is greater in the fundus Average 24mmHg Well synchronized Frequency Duration 60s regular Rhythm and force Basal resting pressure 12-15mmHg

Fetal monitoring

External and internal monitor

Uterine dysfunction

Hypotonic

Hypertonic

Uncoordinated

Inadequate

expulsive efforts

Hypotonic dysfunction

Insufficient

Irregular

Infrequent

Response well to

oxytocin

Most in primigravidas

in active phase

Hypotonic dysfunction etiology

Malfunction

Malpresentation

Extrinsic factors

Hypertonic and uncoordinated dysfunction

Resting tone

Dyssynchronous

Frequent intense contracti

on

Constriction ring

Tocolysis

Decrease oxytocin

Cesarean section

Sedation

Pathological retraction ring

Constriction ring

Hypertonic Dysfunction

Inadequate expulsive efforts

Second stage

Assisted delivery might be needed

Analgesic anesthetic agents wear

off

Abnormalities of the Passage

Bony pelvic (most common)

Soft tissue obstruction

Abnormal placenta location

Bony pelvic abnormalities

Inlet

Midpelvic-outlet

Generally contracted pelvic

Deformed pelvic

Three level of bony pelvis

Contracted pelvis

Contraction of pelvic inlet

APlt10cmtransverselt12 cm Contraction of mid-pelvis

interischial spinous diameter lt10cm Contraction of pelvic outlet

interischial tuberous diameter lt8cm

Three anteroposterior diameters of the pelvic inlet

Diameter of the inlet and midpelvis

Fetopelvic disproportion

正常骨盆 入口呈心型 出口呈漏斗型funnel shaped pelvis

473 58

366109

gynecoidandroid

Flat(platypelloid) anthropoid

前后径狭 窄

横径 狭窄transversely

contracted

pelvis

女性男性

each pelvic plane is 2 cm less than normal

均小骨盆 generally contracted pelvis

osteomalacia oblique pelvis

kyphosis

成人

行走之前 行走之后

Deformed pelvis

Soft tissue dystocia

Congenital anomalies

Scarring of birth canal

Pelvic masses

Birth canal

Pelvic mass

Pelvic mass

Low ndashlying placenta

Abnormalities of the Passenger

Malposition and malpr

esentation

Fetal macrosomia

Shoulder dystocia

Fetal malformation

133

95

113

Cepholic position and the diameter through pelvis

occiput

presentation

parietal

presentation

brow

presentation

face

presentation

Malpresentation

Breech presentation

Transverse fetal lie

Shoulder presentation

Examination

Fetal macrosomialarge for gestational age(LGA) ge4000

g

Shoulder dystocia

Brachial Plexus Injury

Fetal malformation

Operative delivery

1)forceps

operations

Operative delivery Vacuum

Operative delivery Cesarean Section

Reference Williams obstetrics

(22nd edition)High risk pregnancy (2nd edition)