REVIEW: DYSTOCIA

- Dystocia refers to prolonged or slowly

progressing labor.
- It is common in nulliparous women, as
indicated by the number requiring
augmentation, operative vaginal delivery,
or cesarean section
What is dystocia and its causes?
• Dystocia of fetal origin is generally caused
by fetomaternal disproportion (large fetus),
fetal abnormalities, or abnormal
presentation, position, or posture.
What are the symptoms of dystocia?

• Clinical signs of dystocia include depression,

weakness, restlessness, and abnormal fetal
position, which may be observed as a tail or
limb in the pelvic canal.
TYPES OF DYSTOCIA

• Frank breech: The fetal hips are flexed, and the knees
extended (pike position).
• Complete breech: The fetus seems to be sitting with
hips and knees flexed.
• Single or double footling presentation: One or both
legs are completely extended and present before the
buttocks.
 SHOULDER DYSTOCIA
What is shoulder dystocia?

Shoulder dystocia is a birth injury (also called birth trauma) that happens
when one or both of a baby’s shoulders get stuck inside the mother’s
pelvis during labor and birth. In most cases of shoulder dystocia, babies
are born safely. But it can cause serious problems for both mom and
baby. Dystocia means a slow or difficult labor or birth. 
 CASE SCENARIO
Case Study 3:
A patient arrives in labor at 41 3/7 wks. She is a G3P2 with a previous Hx. of delivering two 9 LB+ babies within the
last 6 years. She remembers that the deliveries were “difficult” and she “tore” and bled a lot. Oprah has a
documented 50 lb weight gain during this pregnancy. She was diagnosed as a gestational diabetic at 26 wks. An
ultrasound was done two weeks ago (at 39 wks.) because her fundal height was 42 cm. EFW was shown at that
time to be 4200 grams. The patient refused to be induced at 39 weeks stating that she had to coordinate getting
family to help and they were in the process of moving to a bigger house. The patient was admitted at 0830 in
active labor at 5 cm/ 90%/-2. She was 8cm/90%/-2 at 1330 and 10/100%/-2 at 1630.

The patient pushed for 2 hours and doesn’t bring the baby down lower than+1 station. The Physician applied
forceps to assist with delivery and descent. The head is delivered with the forceps after 3 contractions. The head
advances slightly then retracted back up “turtling” and the shoulders did not come out. The primary nurse called
for assistance The Physician requests supra-pubic pressure and McRoberts maneuver. The baby is delivered with a
Rubin maneuver after 3 minutes of shoulder dystocia with reduction techniques. The baby is dark blue, floppy
with eyes wide, no respiratory effort and a HR rate of 80.

GUIDE QUESTIONS:
1. What Are The Risk Factors For This Patient? 
2. Discuss extensively the nurses role in shoulder dystocia delivery.
3. Formulate two priority care plan for this patient.