PRE – LABOR RISK FACTORS:

Predisposing Factor: Intergenerational association between type 2 DM

of mother’s father/ maternal grandparent and
Direct family history of birthweight of the fetus (subsequent two
Diabetes Mellitus generations)

(+) Type 2 Non –

insulin dependent
Diabetes Mellitus of Genetically determined insulin
the mother’s father resistance in the fetus

↑ Fetal insulin causes

↑ Fetal growth
↑ Weight gain
INTRAPARTUM RISK FACTORS:

Prolonged and Incompatibility of

painful first stage fetal size and MACROSOMIA
of labor pelvis

Use of Administration
epidural of Oxytocin HYPERCONTRACTILITY
anesthesia infusion
(Syntocinin)

Impaction of anterior
fetal shoulder under
maternal symphysis
Maternal exhaustion
Material pubis
reduces power
epinephrine needed during the
levels second stage of labor
decrease after
initiation of
epidural
anesthesia

PROLONGED SECOND STAGE

OF LABOR

Retraction of head
SHOULDER against perineum
(turtle sign)
DYSTOCIA