CONTENT

CHAPTER I INTRODUCTION ................................................................................ 1

CHAPTER II CLINICAL SCIENCE.......................................................................... 3
A. Dystocia............................................................................................. 3
1. Definition.................................................................................... 3
2. Etiology....................................................................................... 3
3. Mechanisms of Dystocia............................................................. 7
4. Diagnosis..................................................................................... 7
B. Abnormalities of the Expulsive Forces............................................. 8
1. Types of Uterine Dysfunction..................................................... 8
2. Maternal Pushing Efforts............................................................ 9
C. Fetopelvic Disproportion................................................................... 9
1. Pelvic Capacity............................................................................ 9
2. Fetal Dimensions In Fetopelvic Disproportion........................... 10
D. Shoulder Dystocia.............................................................................. 16
REFERENCE ....................................................................................... 27
 CHAPTER I

INTRODUCTION

Delivery process is actually a process of accommodations between the fetal parts diameters
and the pelvic spaces width. Enhanced by physiological natural delivery forces. Eutocia is a
successfull delivery process due to the womans own natural resulting to a birth of a life healthy
baby with minimal trauma for both the mother and her baby. Dystocia literally means difficult
labor and is characterized by abnormally slow labor progress, 4 hrs of < 0.5 cm/ hr dilatation in
the 1st stage, 1 hr with no descent in the 2nd stage. These abnormalities can be mechanistically
simplified into three categories that include abnormalities of: the powersuterine contractility and
maternal expulsive effort; the passengerthe fetal (fetals lie, fetal presentation, fetal position) ;
and the passagethe pelvis (pelvic in let, mid pelvic & pelvic outlet). Dystocia is the most
common indication for 1 ry CS, 50-60% of CS in USA attributed to dystocia. There has been
dramatic in CS rate with in maternal mortality, morbidity, neonatal morbidity & health care
costs. Reducing Dystocia CS rate.
According to the American College of Obstetricians and Gynecologists (2003), approximately
60 percent of primary cesarean deliveries in the United States are attributable to the diagnosis of
dystocia. Roy (2003) has proposed that this high frequency results from environmental changes
that are developing more rapidly than Darwinian natural selection. Humans are poorly adapted to
the affluence of the modern diet, and one result is dystocia. Evidence in support of this comes from
Barau and associates (2006), who analyzed prepregnancy body mass index (BMI) and the risk of
cesarean delivery.