1. DYSTOCIA
Liezel B. Alfonso, MD

2. DYSTOCIA
 - difficult labor
 - slow labor progress

3. It may be associated with abnormalities
involving:
 - Abnormalities of the Passage
 - Abnormalities of the Passenger
 - Abnormalities of the Powers

4. ABNORMALITIES OF THE EXPULSIVE
FORCES
Types of Uterine Dysfunction:
1) HYPOTONIC UTERINE DYSFUNCTION
- more common
- no basal hypertonus
- uterine contractions have a normal
gradient pattern (synchronous)
- pressure during contraction is insufficient
to dilate the cervix

5.  2) HYPERTONIC UTERINE
DYSFUNCTION
= incoordinate uterine dysfunction
- either basal tone is elevated
- pressure gradient is distorted

6. ACTIVE PHASE DISORDERS
 PROTRACTION DISORDER
 - < 1cm/hr cervical dilatation for a
minimum of 4 hrs
 ARREST DISORDER
 - no dilatation for 2 hrs or more

7. Definitions of Abnormal Patterns of Labor
LABOR PATTERN NULLIPARA MULTIPARA
PROLONGATION DISORDER
Prolonged Latent Phase > 20 hrs > 14 hrs
PROTRACTION DISORDERS
Protracted Active Phase Dilatation
(Phase of maximum slope dilatation)
< 1.2cm/hr < 1.5cm/hr
Protracted Descent (maximum slope
of Descent during the pelvic division)
< 1 cm/hr < 2 cm/hr

8. ARREST DISORDERS:
1. Prolonged Deceleration Phase
(cervical dilatation arrested at
8 to 9 cm)
> 3 hrs > 1 hr
2. Secondary Arrest of Dilatation
(progressive cervical dilatation
stops at the phase of maximum
slope)
> 2 hrs
3. Arrest of Descent (
progressive cervical dilatation
stops at the phase of maximum
slope)
> 1 hr
4. Failure of Descent (station 0) Lack of expected descent during
deceleration phase or second
stage of labor
5. Prolonged second stage > 3 hrs with
regional
anesthesia
> 2hrs without
regional
anesthesia
> 2hrs with
regional
anesthesia
> 1hr without
regional
anesthesia

9. Criteria before the diagnosis of arrest during first-stage
labor is made:
 1) The latent phase has been completed,
and the cervix is dilated 4cm or more.
 2) A uterine contraction pattern of 200
Montevideo units or more in a 10-minute
period has been present for 2 hrs without
cervical change.

10. Second-stage disorders
 - disproportion of the fetus and pelvis
are frequent

11. PRECIPITOUS LABOR AND
DELIVERY
 - extremely rapid labor and delivery
 - result from an abnormally low
resistance of the soft parts of the birth
canal, from abnormally strong uterine
and abdominal contractions
 - Or rarely, from the absence of painful
sensations and thus a lack of
awareness of vigorous labor