Dystocia

Dr E Bechem
Plan
Introduction
Mechanism of dystocia
Dysfunctional uterine activity
Cervical dystocia
Cephalopelvic disproportion
Conclusion
Introduction
Dystocia is difficult labour
Characterised by slow progress in labour
Frequent cause of caesarean section and neonatal
complications
Mechanism of dystocia
Factors responsible for initiation of labour are
unknown, but several theories
Progesterone withdrawal theory
Uterine stretch theory
Oxytocin induction theory
Foetal cortisol theory
The mechanism of labour is the ability of the foetus to
successfully negotiate the pelvis during labour and
delivery
Mechanism is dependent of 3 factors
The power
The passage
The passenger
Dystocia is the consequence of four distinct abnormalities that
may exist singly or in combination:
 Abnormalities of the expulsive forces, either uterine forces
insufficiently strong or inappropriately coordinated to efface
and dilate the cervix—uterine dysfunction—or inadequate
voluntary muscle effort during the second stage of labor.
 Abnormalities of presentation, position, or development of the
fetus.
 Abnormalities of the maternal bony pelvis—that is, pelvic
contraction.
 Abnormalities of soft tissues of the reproductive tract that
form an obstacle to fetal descent
Dysfunctional uterine activity
Disorder of uterine contractions during labour
Two types
 Hypotonic uterine dysfunction
 Hypertonic uterine dysfunction or incoordinate uterine
dycfunction
Disorders can be either protracted disorder or arrest
disorders
Causes of uterine dysfunction
 Epidural anaesthesia during labour
 Chorioamnionitis
 Idiopathic
Precipitated labour
 Labour with active phase less than 3 hours
 Maternal consequences: PPH, maternal exhaustion
 Foetal: acute foetal distress, neonatal asphyxia,
intracranial trauma
Cervical dystocia
Diagnosis in labour
Adequate uterine contractions
Inefficient cervical dilatations
Diagnosed using pathogram
Causes: idiopathic, cervical stenosis, cervical tumour,
lower uterine segment tumour
Management: caesarean delivery
Cephalopelvic disproportion
This is an inadequation between the maternal pelvis
and foetal head
Diagnosed in labour using pathogram
With adequate uterine contractions and progressive
cervical dilatation there is poor descent
Causes
 maternal: contracted pelvis, borderline pelvis, soft
tissue tumour
 Foetal: macrosomia, malposition, poor flexion during
cardinal movement in labour, deep transverse arrest
Management: emergency caesarean delivery
Complication:
 Obstructed labour
 Uterine rupture
 PPH
 Obstetrical fistula
 Foetal distress
 Still birth
 Neonatal asphyxia
 Early neonatal death
Obstructed labour
Is a complication of CPD
When CPD goes unnoticed the foetal head is impacted
into the maternal pelvis
Resulting in compression of maternal soft tissue
against the bony pelvis
Consequences:
 Obstruction of blood vessel: vulva oedema
 Obstruction of organs: VVF, RVF
 Obstruction of nerves: obstetrical neuropathy
 symphysiotomy
Conclusion
Labour is most difficult moment in pregnancy
Dystocia most frequent cause of Caesarean delivery
CPD most frequent cause of emergency CS in
Cameroon
Obstruction labour is due to negligence