6 abnormal labor and dystocia

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6 abnormal labor and dystocia

  1. 1. Abnormal labor and Dystocia Dept. of Ob&Gyn, The first affiliated hospital He Ke
  2. 2. Definition <ul><li>Difficult labor or childbirth </li></ul><ul><li>Abnormal slow progress of labor </li></ul>
  3. 3. Incidence <ul><li>The most common indication for primary cesarean section </li></ul>
  4. 4. Abnormal patterns <ul><li>Prolonged latent phase </li></ul><ul><li>Protraction disorders (active phase) </li></ul><ul><li>Arrest disorders (active phase) </li></ul><ul><li>Precipitate labor disorders </li></ul>
  5. 5. Evaluation index <ul><li>Cervical dilation </li></ul><ul><li>Descent of the fetal presentation </li></ul>
  6. 6. Friedman’s curve
  7. 7. Latent phase Active phase I II stage 产程图 partogram
  8. 8. Prolonged latent phase <ul><li>􀁺 Nulliparas </li></ul><ul><li>Multiparas </li></ul><ul><li>prolonged </li></ul><ul><li>>20 hr </li></ul><ul><li>> 14 hr </li></ul>Normal average 6.4 hr 4.8 hr
  9. 9. Protraction disorders 􀁺 Nulliparas Multiparas Descent <1.0 cm/h <2.0 cm/h Dilation <1.2 cm/h <1.5 cm/h Average 8hr 5hr
  10. 10. Arrest disorder 􀁺 Nulliparas Multiparas Descent >2h >1h Dilation >2h >1h
  11. 11. Partogram
  12. 12. A 潜伏期延长 prolonged latent phase B 活跃期延长 prolonged active phase C 活跃期停滞 arrest active phase Abnormal partogram
  13. 13. Partogram
  14. 14. Precipitate labor disorders 􀁺 Nulliparas Multiparas Descent >5cm/hr >10cm/hr Dilation >5cm/hr >10cm/hr
  15. 15. Classification of Dystocia <ul><li>Abnormalities of the Power </li></ul><ul><li>Abnormalities of the Passage </li></ul><ul><li>Abnormalities of the Passenger </li></ul>
  16. 16. Characteristics of the power <ul><li>Intensity is greater in the fundus </li></ul><ul><li>Average 24mmHg </li></ul><ul><li>Well synchronized </li></ul><ul><li>Frequency </li></ul><ul><li>Duration 60s </li></ul><ul><li>regular </li></ul><ul><li>Rhythm and force </li></ul><ul><li>Basal resting pressure 12-15mmHg </li></ul>
  17. 17. Fetal monitoring
  18. 18. External and internal monitor
  19. 19. Uterine dysfunction <ul><li>Hypotonic </li></ul><ul><li>Hypertonic </li></ul><ul><li>Uncoordinated </li></ul><ul><li>Inadequate expulsive efforts </li></ul>
  20. 20. Hypotonic dysfunction <ul><li>Insufficient </li></ul><ul><li>Irregular </li></ul><ul><li>Infrequent </li></ul><ul><li>Response well to </li></ul><ul><li>oxytocin </li></ul><ul><li>Most in primigravidas </li></ul><ul><li>in active phase </li></ul>
  21. 21. Hypotonic dysfunction etiology <ul><li>Malfunction </li></ul><ul><li>Malpresentation </li></ul><ul><li>Extrinsic factors </li></ul>
  22. 22. Hypertonic and uncoordinated dysfunction <ul><li>Resting tone </li></ul><ul><li>Dyssynchronous </li></ul><ul><li>Frequent intense contraction </li></ul><ul><li>Constriction ring </li></ul><ul><li>Tocolysis </li></ul><ul><li>Decrease oxytocin </li></ul><ul><li>Cesarean section </li></ul><ul><li>Sedation </li></ul>
  23. 23. Pathological retraction ring
  24. 24. Constriction ring
  25. 27. Hypertonic Dysfunction
  26. 29. Inadequate expulsive efforts <ul><li>Second stage </li></ul><ul><li>Assisted delivery might be needed </li></ul><ul><li>Analgesic / anesthetic agents wear off </li></ul>
  27. 30. Abnormalities of the Passage <ul><li>Bony pelvic (most common) </li></ul><ul><li>Soft tissue obstruction </li></ul><ul><li>Abnormal placenta location </li></ul>
  28. 31. Bony pelvic abnormalities <ul><li>Inlet </li></ul><ul><li>Midpelvic-outlet </li></ul><ul><li>Generally contracted pelvic </li></ul><ul><li>Deformed pelvic </li></ul>
  29. 32. Three level of bony pelvis
  30. 33. Contracted pelvis <ul><li>Contraction of pelvic inlet </li></ul><ul><li>AP<10cm;transverse<12 cm </li></ul><ul><li>Contraction of mid-pelvis </li></ul><ul><li>interischial spinous diameter <10cm </li></ul><ul><li>Contraction of pelvic outlet </li></ul><ul><li>interischial tuberous diameter <8cm </li></ul>
  31. 34. Three anteroposterior diameters of the pelvic inlet
  32. 35. D iameter of the inlet and midpelvis
  33. 36. Fetopelvic disproportion
  34. 37. 正常骨盆 入口呈心型 出口呈漏斗型 funnel shaped pelvis 47.3% 5.8% 36.6% 10.9% gynecoid android Flat(platypelloid) anthropoid 前后径 狭 窄 横径 狭窄 transversely contracted pelvis 女性 男性
  35. 38. each pelvic plane is 2 cm less than normal 均小骨盆 generally contracted pelvis
  36. 39. osteomalacia oblique pelvis kyphosis 成人 行走之前 行走之后 Deformed pelvis
  37. 40. Soft tissue dystocia <ul><li>Congenital anomalies </li></ul><ul><li>Scarring of birth canal </li></ul><ul><li>Pelvic masses </li></ul>
  38. 41. Birth canal
  39. 42. Pelvic mass
  40. 43. Pelvic mass
  41. 44. Low –lying placenta
  42. 45. Abnormalities of the Passenger <ul><li>Malposition and malpresentation </li></ul><ul><li>Fetal macrosomia </li></ul><ul><li>Shoulder dystocia </li></ul><ul><li>Fetal malformation </li></ul>
  43. 46. 13.3 9.5 11.3
  44. 48. ★ ★ Cepholic position and the diameter through pelvis occiput presentation parietal presentation brow presentation face presentation
  45. 49. Malpresentation
  46. 51. Breech presentation
  47. 52. Transverse fetal lie
  48. 53. Shoulder presentation
  49. 54. Examination
  50. 55. Fetal macrosomia large for gestational age(LGA) ≥4000g
  51. 56. Shoulder dystocia
  52. 58. Brachial Plexus Injury
  53. 59. Fetal malformation
  54. 60. Operative delivery <ul><li>1)forceps </li></ul><ul><li>operations </li></ul>
  55. 61. Operative delivery Vacuum
  56. 62. Operative delivery Cesarean Section
  57. 63. Reference <ul><li>Williams obstetrics (22nd edition) </li></ul>High risk pregnancy (2nd edition)

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