Dystocia

Dystocia difficult labor, abnormally slow labor progress

Abnormalities of expulsive forces

Fetal abnormalities
Abnormalities of the maternal bony
pelvis
abnormalities of soft tissues's
reproductive tract

Abnormalities of expulsive force

Uterine
dysfunction

Abdominal
Muscle
dysfunction

Uterine Dysfunction
Hypotonic uterine dysfunction
There is no tonus and the pressure
from contraction cant dilate the
cervical

Hypertonic uterine dysfunction

Asynchrony of the impulses and more
forceful contraction of the uterine mid
segment than the fundus

Hypotonic uterine dysfunction

The contraction : infrequent, poor intensity,
Caused by:
Over sedation
CPD
Malposition
Overstretching of the uterus

Hypertonic uterine dysfunction

The contraction: more frequent, ineffective, painful,
uterus doesnt relax between contraction
Caused by:
Overuse oxytocin

INFECTION
Because of the association of prolonged labor with
maternal intrapartum infection, some clinicians have
suggested that infection itself contributes to abnormal
uterine activity
Specifically, 40 percent of women developing
chorioamnionitis after requiring oxytocin for
dysfunctional labor later required cesarean delivery for
dystocia

Management
Hypotonic
uterine
dysfunction

ruling out CPD

Augmentation with oxytocin

Hypertonic
uterine
dysfunction

Discontinue infusion of oxytocin

Rehydration
Oxygen
SC

Abdominal Muscle dysfunction

Affect in second stage
Caused by:
Exhaustion
Cardiorespiratory disease
History of operation

SHOULDER DYSTOCIA
RISK FACTOR:
-post term pregnancy
-maternal obesity
-multipara
-fetal macrosomia
-poorly controled maternal diabetes

 Diagnosis :
-head recoils against perineum (turtle sign)
-failure to delivery with expulsive effort

Treatment
Ask for help
Lift the buttocks
Anterior Correction :
Rubin
Mazzanti

Rotate (Woods screw maneuver)

Manual removal of the posterior arm
Episiotomy
Roll Over (Gaskin maneuver)

 Do not pull the baby as this will impact the shoulder

further -> brachial plexus injury
Do not cut the umbilical chord if its around the babys
neck, while there is a chance that baby receiving
oxygen which gives you more time with resuscitation
afterwards

 Lift the anterior buttocks (MC Robert Maneuver)

Abduct the maternal thighs and sharply flex them onto
her abdomen
.

 Anterior Correction : use rubin and mazzanti maneuver

at the same time
The Rubin maneuver consists of inserting the fingers of
one hand vaginally behind the posterior aspect of the
anterior shoulder of the fetus and rotating the shoulder
toward the fetal chest.

 Mazzanti maneuver : ask the asistant to push the

suprapubic area. The doctor must know the relative
position of the shoulders so that he/she may instruct the
asistant to push at the location of the posterior aspect
of the shoulder. With one preferable palms of the hand
on the top of the other hand, the anterior shoulder is
depressed toward the face of the baby.

 Rotate (woods screw maneuver) : continue the rubin

maneuver, and add the other hands to apply pressure
the anterior aspect of the posterior shoulder of the fetus
and rotating them 180 degrees

 Manual removal of the posterior arm :

Splint humerus of the posterior arms, pressure in
antecubital fossa to flex arm, sweep arm over the chest,
grasp wrist, deliver arm

episiotomy
Is a surgical cut in the muscular area between the
vagina and the anus (this area called perineum) made
just before delivery to enlarge the vaginal opening

Roll over (gaskin maneuver)

If the shoulder still stucked

Zavanelli maneuver : the manual return of the head of a
partially born fetus with intractable shoulder dystocia to
the vagina. This is followed by cesarean section.
If the baby has died you could break the anterior
clavicle by using NGT and deliver the baby