PROBLEMS WITH THE

PASSAGEWAY
ABNORMAL SIZE OR SHAPE OF
THE PELVIS

 The Android pelvis is so called

because it resembles the male pelvis.
 The anthropoid pelvis, you will have
discovered, shows very definite
features. The fetus commonly
presents as a direct occipito-anterior
or occipito-posterior position.
The distinct shape of the
platypelloid pelvis with the
kidney shaped brim in which the
anteroposterior diameter is
reduced and the transverse
increased, means the head
must engage with the sagittal
suture in the transverse
diameter.
Cephalopelvic disproportion
(CPD)
 Occurs when a baby’s
head or body is too large to
fit through the mother’s
pelvis.
It is believed that true CPD is
rare, but many cases of “failure
to progress” during labor are
given a diagnosis of CPD. When
an accurate diagnosis of CPD
has been made, the safest type
of delivery for mother and baby
is a cesarean.
The causes of cephalopelvic
disproportion

 Possible causes of cephalopelvic

disproportion (CPD) include:
 Large baby due to:
 Hereditary factors
 Diabetes
 Postmaturity (still pregnant after
due date has passed)
 Multiparity (not the first pregnancy)
Abnormal fetal positions
Small Pelvis
Abnormally shaped pelvis
 The diagnosis of cephalopelvic
disproportion is often used when
labor progress is not sufficient and
medical therapy such as use of
oxytocin is not successful or not
attempted.
CPD can rarely be diagnosed
before labor begins even if
the baby is thought to be
large or the mother’s pelvis is
known to be small.
 During labor, the baby’s head
molds and the pelvis joints
spread, creating more room for
the baby to pass through the
pelvis. Ultrasound is used in
estimating fetal size but not
totally reliable for determining
fetal weight.
 A physical examination that
measures pelvic size can often
be the most accurate method
for diagnosing CPD. If a true
diagnosis of CPD cannot be
made, oxytocin is often
administered to help labor
progresssion or change fetal
postioning.
Shoulder Dystocia

 In a small percentage of births, the

baby’s shoulder will become locked
under the mother’s pubic bone
immediately after delivery of the
head. The doctor or midwife may be
unable to deliver the baby with the
usual hand skills.
 Every doctor and midwife is
trained in the handling of this
emergency, and there are
several different approaches.
 Occasionally, the baby is injured
during the process to free the
captured shoulder. The most
common injury is a stretching and
tearing of the nerves of the baby’s
arm.
 Although most of the these injuries
resolve without future problems,
occasionally the damage to the
nerve is permanent and results in
weakness or paralysis of the arm.
Less frequently, the collarbone
(clavicle) or upper arm bone
(humerus) are broken in an attempt
to free the shoulder.
 Shoulder dystocias are almost always
associated with big babies. However,
the majority of big babies are born
without involving shoulder dystocia.
There is also a relationship between
shoulder dystocia and labor
protractions and
arrests……..especially those which
lengthen the duration of Second Stage
(after the cervix is dilated).
PROBLEMS WITH THE POWERS

Dystocia or Difficult labor

Premature labor
Precipitate labor and birth
Uterine prolapse
Uterine rupture
DYSTOCIA

 Dystocia may arise due to

incoordinate uterine activity,
abnormal fetal lie or presentation,
absolute or relative cephalopelvic
disproportion, or (rarely) a massive
fetal tumor such as
a sacrococcygeal teratoma.
PREMATURE LABOR
 Oxytocin is commonly used to
treat incoordinate uterine
activity, but pregnancies
complicated by dystocia often
end with assisted deliveries,
including forceps, ventouse or,
commonly, caesarean section.
HYPERTONIC UTERINE
DYSFUNCTION
 An elevated tone of the uterus that
generally occurs in the latent phase
of labor. The condition causes
frequent and intense contractions,
but they are not effective. This may
be caused by the mid segment of the
uterus contracting with such a force
that is greater than the fundus or a
lack of nerve .
HYPOTONIC UTERINE
DYSFUNTION

 The number of contractions is

unusually low or infrequent(not
more two or three occuring in a 10-
minute period).The resting tone of
the uterus remains less than 10
mmHg, and the strenght of
contractions does not rise above
25mm Hg.
ABNORMAL PROGRESS IN
LABOR

 Abnormal Labour
 Recognition of prolonged 1st and
2nd stages
 Common causes of prolonged labour
 Complications - maternal
RETRACTION RINGS

 Bandl's ring (also known as

pathological retraction ring) is the
abnormal junction between the two
segments of the human uterus, which is
a late sign associated with obstructed
labor. Prior to the onset of labour, the
junction between the lower and upper
uterine segments is a slightly thickened
ring
 In abnormal and obstructed labours,
after the cervix has reached full
dilatation further contractions cause the
upper uterine segment muscle
fibres myometrium to shorten, so that
the actively contracting upper segment
becomes thicker and shorter.
 The ridge of the pathological ring of
Bandl's can be felt or seen rising as far
up as the umbilicus. The lower segment
becomes stretched and thinner and if
neglected may lead to uterine rupture.
PREMATURE LABOR

 Pregnancy is normally a time of

happiness and anticipation, but it can
also be a time of uncertainty. Many
women have concerns about what is
happening with their baby and wonder
"Is everything okay"? Some women
have concerns about going into labor
early.
 Premature labor occurs in
about 12% of all pregnancies.
However, by knowing the
symptoms and avoiding
particular risk factors, a woman
can reduce her chance of going
into labor prematurely.
PRECIPITATE LABOR AND BIRTH

 Occur when uterine contractions

are so strong that a woman gives
birth with only a few, rapidly
occuring contractions.It is often
defined as a labor that is completed
in fewer than 3 hours.
Is cervical dilatation that
occurs at a rate of 5cm or
more per hour in a primipara
or 10cm or more per hour in
a multipara.
UTERINE PROLAPSE

 Is falling or sliding of the womb (uterus)

from its normal position into the vaginal
area.
 Uterine prolapse is a form of female
genital prolapse. It is also called pelvic
organ prolapse or prolapse of the
uterus (womb).
UTERINE RUPTURE

 Rupture of the uterus during

labor,although rare ,is always a
possibility.It is always serious,because it
accounts for as many as 5% of all
material deaths.
 Uterine rapture occurs when a
uterus undergoes more strain
than it is capable of sustaining.
THANK YOU!!!

SHERYLL B. NELSON