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DYSTOCIA *Secondary arrest of dilatation- occurs when no
-It is defined as abnormal or difficult labor.
-most common indication of Primary Cesarean
Dystocia is the consequence of FOUR DISTINCT
ABNORMALITIES that may exist singly or in
combination:
1. Abnormalities of the expulsive forces
It is causes by either uterine dysfunction1 or
inadequate voluntary muscle effort during the
second stage of labor2.
UTERINE DYSFUNCTIONS:
The uterine forces is insufficiently strong or
inappropriately coordinated to efface and dilate
the cervix
-Forces are greatest and longest in the Fundus.
-the stimulus starts at one corpu
-a lower limit of contraction 15mmhg is required
to dilate the cervix
-Normal spontaneous contraction often required
60mmhg
TYPES:
a) Hypotonic uterine dysfunction
-more Common
-absence of basal hypertonous, presence of
normal gradient pattern (synchronous) but there
is insufficient contraction to dilate the cervix
-usually occurs in the active phase of labor
Often responds favorably to oxytocin
b) Hypertonic uterine dysfunction or incoordinate
uterine dysfunction
-either basal tone is elevated appreciably or the
the pressure gradient is distorted
-Gradient distortion may result from
contraction of uterus midsegment has more
force than the fundus, from complete
asychronism or Combination of two.
-contraction are painful but ineffective.
-usualy responds to sedation.
Abnormal labor patterns (William’s):
Prolongation disorder
Protraction Disorder
-slower than normal progress
Arrest Disorder
-Cessation of progress in cervical dilatation or
progressive fetal descents halts in labor.
“Whatever you do, work at it with all your HEART, as working for the LORD, and not for men.” - Colossians 3:23
Dilatations in active phase in 2 hours or more.
SECOND STAGE DISORDERS
*Recommended duration:
Nulliparous-limited to 2 hours extended to 3hrs with
conduction analgesia
Multipara-limited to 1 hour extended to 2hrs with
conduction analgesia
*Persistent occiput posterior position-common
cause of prolonged 2nd stage
2. Abnormalities of presentation, position, or
development of the fetus.
3. Abnormalities of the maternal bony pelvis
That is pelvic contraction.
4. Abnormalities of soft tissues of the
reproductive tract
That forms an obstacle to fetal descent
REVIEW….
 Latent phase of labor
-regular uterine contraction during which cervix
undergoes softening and effacement
 Active Phase of Labor
-cervical dilatation rat of 1.2cmm/hr nullipara, 1.5
cm/hr for multipara
-or reach 5cm
-it ends when cervix is fully retracted and is no
longer palpable
-duration=4.9 hours
*Active phase is subdivided into:
1. Acceleration phase-short and variable but
the important in determining the outcome of
labor
Low acceleration phase=lower maimum
slope =prolonged total labor
2. Phase of maximum slope-good measure of
overall efficiency of the uterus. fetal descent
starts here
3. Deceleration phase-reflects fetopelvic
relationship
 Second stage of labor- begins with full cervical
dilatation, ends with fetal expulsion
-median duration; 50mins in nulli; 20mins in
multi but variable
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-Recommended duration: 2 hours in ii. Disorder of Dilatation Division of labor

nullipara and may extended to 3 hours with  Protracted active phase of labor
conduction analgesia; 1hr in multipara and may  Nulliparas-maximum slope dilatation of
extended to 2 hours with conduction analgesia <1.2cm/hr
 Multiaparas- maximum slope dilatation of
<1.5cm/hr
FREIDMAN’S THREE FUNCTIONAL LABOR  Protracted descent- descent of fetal head is less
1. Preparatory-includes latent and acceleration than 1 cm/hr in nulliparous women or 2cm/hr in
-changes takes place in connective multiparous women.
tissue(collagen)
-sensitive to sedation and conduction C. Arrest Disorder…
analgesia Etiologic factors:
D. Cephalopelvic disproportion- 52%
2. Dilatational-occupies phase of maximum
E. Malposition
slope. F. Excessive sedation
-unaffected by sedation or conduction G. Excessive sedation and anaesthesia
analgesia H. Hypotonic uterine dysfunction
3. Pelvic-includes both deceleration phase and
2nd stage of labor iii. Disorder of Pelvic Division of labor
 Prolonged deceleration Phase
 Nulliparas-deceleration phase duration >or equal
More simply, Dystocia due to these abnormalities 3 hrs
can be mechanistically simplified into THREE  Multiapara- deceleration phase dyration of > or
CATEGORIES: “PPP” equal 1 hours
1. ABNORMALITIES OF THE POWERS  Secondary arrest of dilatation-cessation active
-It is the uterine contractility and maternal expulsive phase progression for > or equal 2 hours
 Arrest of descent-Cessation of descent
-Freidman defined 9 types of dysfunctional labor progression >or equal 1hour
(arrow bullets), may occur singly or in combination  Failure of Descent-lack of expected descent
with others during deceleration phase and second stage

A. Prolongation disorder.. D. Precipitate labor and delivery…

Etiologic factors:
1. excessive use of sedation and conductive E. Precipitate Labor Disorders
analgesia  Precipitate dilatation
2. unfavorable cervix(rigid, thick uneffaces,  Nulliparas- maximum slope dilatation of >or
undilated) equal 5cm/hr
3. false labor  Multiapara- maximum slope dilatation of >or
4. uterine dysfunction equal 10cm/hr
 Precipitate descent
i. Disorder of Preparatory Divisions of labor  Nulliparas- maximum slope dilatation of >or
 Prolonged latent Phase equal 5cm/hr
 Nulliparas-latent phase duration >or equal 20 hrs  Multiapara- maximum slope dilatation of >or
 Multiapara-latent phase dyration of > or equal equal 10cm/hr
14 hours o Causes: abnormally low resistance of the soft
parts of birth canal, from abnormally strong
B. Protraction Disorder… uterine and abdominal contractions, from
Etiologic factors: absence of painful sensation
1. Malposition
2. Excessive sedation
2. ABNORMALITIES INVOLVING THE
3. Conduction analgesia PASSENGER—the fetus.
4. Cephalopelvic disproportion- greater %

“Whatever you do, work at it with all your HEART, as working for the LORD, and not for men.” - Colossians 3:23

i. Different Presentation
 Breech presentation
-common in 1st and 2nd trimester (mostly end of
2nd)
-often turns spontaneously just before labor
-predisposing factors are: uterine relaxation,
great parity, multiple fetuses, hydramnios,
oligohydramnios, hydrocephalus, anencephaly,
previous breech delivery, uterine anomalies and
tumors of the pelvis.
-complications: cord prolapse, increased
perinatal morbidity and mortality due to
difficulty in labor, low birth weight or growth
retardation, fetal anomalies developmental
anomalies after the new born period, placenta
previa, uterine anomalies, multiple fractures,
and increased operative intervention.
 Face presentation
-it results from extension or prevention of
flexion of the head.
-the head is hyperextended so that the occiput is
in contact with the fetal back and the
chin(mentum) is presenting.
-Extensions of the head occurs for1) pelvis is
contracted 2)the face is very large
-predisposing factors: 1) pendulous abdomen in
multiparous women allowing the back of the
fetus to sag forward or laterally 2) Enlargement
of the neck or coils of cord about the neck 3)
anencephalic fetuses
 Transverse lie presentation
-The long axis of the fetus is approx.
perpendicular to that of the mother
-Factors: unusual relaxation of the abdominal
wall, preterm fetuses, placenta previa, abnormal
uterus, & contracted pelvis.
 Compound presentation
-fetuses delivered with prolapsed hand or arm
alongside the head or much less common one or
both of lower extremities alongside the vertex
or a hand alongside a breech
-its causes are conditions that prevent complete
occlusions of the pelvic inlet by the fetal head.
-preterm delivery is twice the expected rate.
 persistent occiput posterior position
-often undergoes spontaneous anterior rotation
followed by uncomplicated delivery.
“Whatever you do, work at it with all your HEART, as working for the LORD, and not for men.” - Colossians 3:23
3
-Transverse narrowing of the midpelvis may
considered the reason for failure of the
spontaneous rotation.
 deep transverse arrest of head
 Shoulder or acromion presentation
-it is usually over the pelvic inlet with the head
lying on the iliac fossa and the breech in the
other.
-it can cause the cord to be withdrawn from the
pelvis and be compressed
-Antepartum factors:1)Maternal obesity with
also often ass with gestation diabetes or overt
diabetes 2)Diabetes mellitus 3)post-term
pregnancy (fetuses after 42 weeks)
-Intrapartum factors: 1) prolonged 2nd stage of
labor 2)oxytocin induction or augmentation of
labor 3) use of mid-forceps or a vacuum
extraction during delivery
-maybe associated with fetal and maternal
morbidity and mortality
-Fetal consequences:1)fractured humerus or
clavicle 2) erb’s palsy or Duchenne brachial
plexopathy (two thirds) 3)abnormal
neurological examination. Asphyxia & death
may occur
-Maternal consequences: postpartum
hemorrhage (major risk) and usually associated
with uterine atony with vaginal and cervical
laceration
ii. Fetal Development Abnormalities
 Macrosomia
-Fetal weight of >4000 grams possibly due to -
1)DM in the mother 2)Multiparity 3) large
parents esp the mother 4)Maternal obesity
5)posdatism 6)previous delivery of infant
weighing more than 4000grams
-Dystocia arises because the head becomes
larger, harder and less moldable woth
increasing weight
 Hydrocephalus-
-Ccephalocentesis and CS delivery are
considered.
 Large fetal abdomen
- for transabdominal decompression
 Conjoined twins
-Three groups: 1) Incomplete double formations
of upper and lower half of the body
(disprosopus dipagus) 2) twins that are united
at the upper and lower end of the body
(craniopagus, ishiopagus of pygopagus)

3)conjoined twins united at the trunk
(thoracopagus and dicephalus)
3. ABNORMALITIES OF THE PASSAGE—
the pelvis.
i. Bony Dystocia
*FETOPELVIC DISPROPORTION
- the state where there is an discrepancy between
the size of the fetus and that of the pelvis
-arises from diminished pelvic capacity, excessive
fetal size, or more usually, a combination of both
-may due to an average-sized baby in a woman
with small pelvis or a normal pelvis with a big
baby
*CONTRACTED PELVIS defined as:
Anatomically, one in which the essential
diameters of one or more planes are shortened by
atleast 0.5 cm.
Obstetrically, it extends to include any alteration
of size and shape of the pelvis so as to alter the
mechanism of labor in an average-sized body.
-causes high incidence of malpresentation
-Face and shoulder presentation are 3x more
common
Contracted Inlet
-if its anteroposterior diameter is less than 10.0
cms or if its greatest transverse diameter is less
than 12.0 cm.
Contracted Midpelvis
-if the sum of the interischial spinous diameter
(10.5 cm) and the posterior sagittal diameter of the
midpelvis (5cm) falls to 13.5 cm and below.
-Or if interischial spinous diameter (10.5 cm) is
less than 10cm, it is suspected. If it is smaller than
9cm, it is definite.
-This is more common than contracted inlet with
frequently associated deep transverse arrest of fetal
head.
Contracted outlet
- if interischial tuberous diameter is less than 8cm
-usually associated with midpelvic contraction
*Maternal effects:
-early rupture of membranes occurs w/
associated dry labor and predisposing to
infection.
-early rupture of membrane predisposed
dysfunctions with prolonged labor by the absence
of pressure by the fetal head against the cervix and
lower uterine segment
“Whatever you do, work at it with all your HEART, as working for the LORD, and not for men.” - Colossians 3:23
4
-Fistula formation (vesicovaginal, vesico-
cervical, rectovaginal) results from necrosis of
soft tissue from excessive pressure in the pelvic
sidewall which usually common in very prolonged
second stage of labor.
*Fetal effects:
-rupture of membrane predisposed to infection of
fetus
-large Caput succedaneum frequently developed
in the dependent part of fetal head but typically
disappears few days after birth.
-Caput formation is associated with Molding or
overlapping bones under the pressure of uterine
contractions in which severe molding may cause
tentorial tears and fatal intracranial
hemorrhage.
-Fractures of the skull either shallow grooves or
spoon shaped depression on both sides of coronal
sutures
-Cord prolapse and prolapse of extremity from
the contraction of the pelvis.
ii. Soft tissue Dystocia
 Uterine abnormalities
-Prolapse of the uterus
-uterine torsion is the rotation of the uterus on
its long axis by more than 45 degrees
-Diffuse ballooning of wall of uterus may lead
to sacculation
 Cervical abnormalities
-Cervical stenosis: Cervix may become
stenosed after following of overzealous or
extensive cauterization that dilation and
effacement may not occur during labor.
 Vaginal abnormalities
-Septum can be present that divides the vagina.
- longitudinal septum-extend from the cervix to
the vulva
- Incomplete septum-either from upper of lower
portion of vaginal canal
- Transverse septum- upper vagina is divided
from the lower half
 Pelvic masses
-Gartner duct cyst may protrude into vagina
and through introitus
-Uterine myomas
-Cystocele and rectocele may blocked the
normal descent of fetus through birth canal
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Common Clinical Findings in Women with

ineffective Labor:
 Inadequate cervical dilatation or fetal descent
 Protracted labor—slow progress
 Arrested labor—no progress
 Inadequate expulsive effort—ineffective
"pushing"
 Fetopelvic disproportion
 Excessive fetal size
 Inadequate pelvic capacity
 Malpresentation or position of fetus
 Ruptured membranes without labor

SOURCE:
Williams Obstetrics
Bprints-Obygyne
Panlilio
PS: No management here! Pls refer to your
books for further understanding. “diff causes of
dystocia ang topic ko” 

Name of the Contributor:

Mondirah Panda

“Whatever you do, work at it with all your HEART, as working for the LORD, and not for men.” - Colossians 3:23