ABNORMAL LABO

TJOKORDA GDE AGUNG SUWARDEWA

Maternal-fetal Medicine
Department Obstetric & Gynecology
Sanglah Hospital
Denpasar

TOPICT

INTRODUCTION
NORMAL LABOR
ABNORMAL LABOR
PATTERN OF LABOR
CAUSES OF DYSTOCIA
MECHANISM OF DYSTOCIA

INTRODUCTION
CPD or contracted maternal pelvis is one of the major
causes of arrest of progress or obstructed labor.
It is associated with significant maternal and perinatal
morbidities.
Several modalities have been proposed to measure the
maternal pelvic size antenatally in order to predict labor
outcome

Dushyant Maharaj . Assessing Cephalopelvic Disproportion: Back to the Basics .

Volume 65, Number 6 OBSTETRICAL AND GYNECOLOGICAL SURVEY Copyright
2010 by Lippincott Williams & Wilkins

NORMAL LABOR

The first stage of labor

Latent phase (0 cm - 3 cm) ....... 8 hours
Active phase (3 cm - 10 cm)
Acceleration (3cm-4cm) . . . . . . . . 1cm/2 hours
Maximal slope (4cm-9cm) . . . . . . . 5cm/2 hours
Deseleration (9cm-10cm) . . . . . . 1cm/2 hours

NORMAL LABOR
The second stage of labor (the period of
expulsion) last from complete cervical dilatation
till the delivery of the infant
The third stage of labor (the placental stage)
begins immediately after delivery of the infant
and end with the delivery of the placenta
The fourth stage of labor is defined as the
early postpartum period of approximately 2
hours after delivery of the placenta.

ABNORMAL LABOR
Dystocia:
abnormally slow
progress of labor

Abnormality of the
expulsive forces
Abnormality of
presentation,
position, or
development of the
fetus
Abnormality of the
maternal bony pelvis

Binici K, Yldrm G, Yldrm G, Tekirda A., Can

Transvaginal Ultrasound Predict Cephalopevic
Disproportion,
J Turkish-German Gynecol Assoc, Vol. 7(2); 2006:105-109

Abnormality of soft
tissues of genital
tract that form an
obstacle to fetal

ABNORMAL LABOR
A latent phase of labor is abnormal
>20 hours in primigravid patients
>14 hours in multigravid patients

To
Slow
?

A prolonged latent phase does not itself pose a danger to the mother or fetus
Some patients who are initially thought to have a prolonged latent phase turn out only
to have false labor.

ABNORMAL LABOR
When the rate of cervical dilatation is less than
1,2 cm/hour in primigravid patients
1,5 cm/hour for multiparas

When descend of presenting part is less than

1,0 cm/hour for primigravidas
1,5 cm/hour for mutiparas

PATTERNS OF LABOR

When the rate of cervical dilatation are:

1,2 cm/hour in primigravid patients
1,5 cm/hour for multiparas

When descend of presenting part are:

1,0 cm/hour for primigravidas
1,5 cm/hour for mutiparas

Freidman
Slow progress
No progress
Arrest of descent

WHO

Three P causes of
Dystocia

Power
Passenger
Passageway

ABNORMAL OF THE EXPULSIVE FORCE

(POWERS)
Normal contraction pressure required
to dilate the cervix is 15 - 60 mmHg.
Two types of uterine dysfunction
Hypotonic uterine dysfunction
Hypertonic uterine dysfunction or
incoordinate uterine dysfunction

weak

Strong-incoordinate

WEAKEN OF PUSHING IN SECOND

STAGE OF LABOR (POWERS)

OMG

I am
tired
Exhausted mother

ANTERIOR

FETAL POSITIONS
FONTANEL
DEXTRA /
RIGHT

OCCIPUT

ROA

OA

SINISTRA /
LEFT

POSTERIOR

LOA

Fetal position reflects the orientation of the fetal head or but within the
birth canal.

ANTERIOR

FETAL POSITIONS
DEXTRA /
RIGHT

LO

OP

LOP

ROP

SINISTRA /
LEFT

POSTERIOR

BREECH

ABNORMAL PRESENTATION

Fetal presentation (lowest part) means the part of the fetus that is "presenting"
at the cervix:
Cephalic presentation means head first. This is the normal presentation.
Breech presentation means the fetal butt is coming out first.
Transverse lie means the fetus is oriented from one side of the mother to the other
and neither the head nor the butt is coming out first.
Compound presentation means that a fetal hand is coming out with the fetal head.
Shoulder presentation means that the fetal shoulder is trying to come out first.

Fetal "presentation" is different from fetal

"position." Fetal position refers to the orientation
of the fetus within the birth canal (eg, looking
toward the mother's pubic bone (OP), or look
toward the mother's coccyx (OA), etc.)

ABNORMAL
PRESENTATION

SHOULDER DYSTOCIA
Predispositions:
Large fetuses
It can occur with babies in any size

Turtle sign (suspect shoulder dystocia): after delivery

of the head, the fetal head partially withdraws back
into the birth canal.

MECHANISM OF
DYSTOCIA
LARGE

FETAL
FETAL MALPOSITION/
MALPRESENT

DYSTOCIA
DYSTOCIA

BIRTH
BIRTH ANATOMY
CANN
CANN CONTRACTED
AL
AL

POWE
POWE
RS
RS
Hyperton
us
Hypotonu
s

PELVIC ANATOMY

Four main types are recognized:

(1) Gynecoid, a rounded inlet;
(2) Android, a heart-shaped inlet;
(3) Anthropoid, a long, narrow, oval inlet
(4) Platypelloid, an ovoid inlet with its long axis transverse

MEASUREMENT OF
PELVIC BONE

Dushyant Maharaj, Assessing Cephalopelvic Disproportion: OBSTETRICAL AND GYNECOLOGICAL

SURVEY Volume 65, Number 6
Copyright 2010 by Lippincott Williams & Wilkins Wellington Regional Hospital, Wellington, New Zealand

MEASURE OF PELVIC SIZE

Dushyant Maharaj, Assessing Cephalopelvic Disproportion: OBSTETRICAL AND GYNECOLOGICAL

SURVEY Volume 65, Number 6
Copyright 2010 by Lippincott Williams & Wilkins Wellington Regional Hospital, Wellington, New Zealand

PROLONGED LATENT PHASE

Latent phase labor is considered abnormal (

prolonged latent phase), if it lasts longer than:
20 hours in a woman having her first baby, or
More than 14 hours in women who have already had a baby
in the past.

Therapy:
Rest
Ambulation
Hydration
Analgesia
Oxytocin
stimulation

PROLONGED OF ACTIVE
PHASE

During active labor (after 4 cm), the cervix should progressively dilate at a rate of:
1.2 cm/hour (for first pregnancy)
1.5 cm/hour (for subsequent prgnancy).

If active labor progresses more slowly than this, an protracted active" has occurred.
The secondary arrest of labor, in which there is no further progress for at least 2 hours.

WHO: 1 cm/h
Causes: (3P)
1. power
2. passage
3. passenger

CONCLUSION
Abnormal

Power
Normal

Abnormal

Passa
ge
Normal

Abnormal

Passen
ger
Normal

ABNORMAL LABOR

NORMAL LABOR