Dystocia

Second part: abnormalities of birth

canal
 Pelvic contraction
• Birth canal
– bony canal
– soft canal
• abnormal bony canal: pelvic contraction
– any contraction of the pelvic diameters that dimini
shes the capacity of the pelvis can creat dystocia d
uring labor
 Classification
I. Contraction of the pelvic inlet
II. contraction of the midpelvis and pelvic outle
t
III. general contraction of the pelvis
IV. pelvic deformities
 I. Contracted pelvic inlet
• Anteroposterior d<10cm
• diagonal conjugate d<11.5cm
• external conjugate d<18cm
– simple flat pelvis
– rickets flat pelvis
II. contraction of the midpelvis and p
elvic outlet
contraction of the midpelvis
– Midpelvis: from inferior margin of the symphysis p
ubis through the ischial spines,touches the sacrum
near the junction of the 4th and 5th vertebrae
– contraction: interischial spinous diameter is smalle
r than 8cm(spines are prominent, the pelvic side
walls converge or the sacrosciatic notch is narrow)
 Contracted pelvic outlet
Contracted pelvic outlet
– Defination: diminition of the interischial tuberous
diameter to 8cm or less.
– 2 triangles:
• baseof both: interischial tuberous diameter
• anterior triangle
• posterior triangle
III. General contraction of the pelvi
s
•2cm or more shorter than normal

IV. Pelvic deformities

•osteomalacic pelvis
•obliquely contracted pelvis
 Effects on mather and fetus
• MOTHER:Inlet
– Malpresentation and malposition
– prolonged labor
– insufficient uterine contraction
• midpelvis and outlet
– persistant occipitotransverse or occipitoposterior p
osition
– fistula formation
– intrapartum infection
– threatening rupture or rupture
 fetus
• PROM
• Prolapse
• Distress (HI,IVH)
• Death
• Injury
• Infecion
 Soft birth canal
• Lower segment of uterus
• cervix
• vaginal
 Fetal malposition
• Occipitoanterior position 90%
• malposition 10%
• abnormal cephalic posion 6-7%
• breech presentation 3-4%
• others
Persistant occipitoposterior (transvers
e) position
• Causes
– abnormal pelvis:transverse narrowing of the midp
elvis
– flexion not well
– hypotonic uterine dysfunction
 Breech presentation
• Incidence
– breech presentation is common remote from term.
– 3-4% of singleton deliveries
• Position
– LSA, LST LSP. RSA, RST, RAP
 Causes
• Uterine relaxation
• limited uterine cavity
• fetal head obstructed
 classification
• Frank breech p
– the lower extremities are flexed at the hips and extende
d at the knees, and thus the feet lie in close proximity to
the head.
– It appears most commonly
• complete breech p
– differs in that one or both knees are flexed.
• Incomplete breech p
– one or both hips are not flexed and one or both feet or k
nees lie below the breech, that is, a foot or knee is lower
most in the birth canal.
Incomplete breech presentation
 Effects
• Maternal
– greater frequency of operative delivery
– higher maternal morbidity and slightly higher mor
tality
– PROM
– secondary hypotonic uterine dysfunction
– puerperium infection
– postpartum haemorrhage
– laceration of cervix
 Effects
• Fetus
– PROM
– cord prolapse
– fetal distress even death
– newborn asphyxia
– brachial plexus injury
– IVH
Face presentation
Compound presentation