仁济医院
RENJI HOSPITAL
dystocia
Teng Yincheng
RENJI HOSPITAL 2
Definition
Dystocia literally means difficult
labor and it is characterized by
abnormally slow progress of labor
It is the consequence of four distinct
abnormalities that may exist
singly or combination
RENJI HOSPITAL 3
?Abnormal of the powers(uterine contractility
and maternal expulsive effort)
?Abnormalities of passenger(the fetus)
?Abnormalities of the passage(the birth canal)
Categories of dystocia
RENJI HOSPITAL 4
Abnormalities of the powers
Uterine dysfunction
hypotonic primary
uterine inertia secondary
Uterine hypertonic
Dysfunction
uterine hypercontractility
RENJI HOSPITAL 5
Abnormalities of the powers
RENJI HOSPITAL 6
Abnormalities of the powers
-----uterine inertia
1.Etiology of uterine inertia
?Cephalopelvic disproportion or Fetal
malposition
?Abnormal of uterine muscle
?Imbalance of endocrine system
?Administration of analgesia
?psychical-factors
?Others fatigue
RENJI HOSPITAL 7
Abnormalities of the powers
-----uterine inertia
2.Clinical findings
Failure to progress
?Lack of progressive cervical dilatation
Prolonged latent phase
Prolonged active phase
Protracted active phase
Prolonged second phase
?Lack of fetal decent
Prolonged descent
Protracted descent
Prolonged labor
RENJI HOSPITAL 8
Abnormalities of the powers
-----uterine inertia
3.diagnosis
Palpation,
strength
duration
frequency
Tocodynamometer
Vaginal examination
RENJI HOSPITAL 9
RENJI HOSPITAL 10
RENJI HOSPITAL 11
Abnormalities of the powers
-----uterine inertia
4.Effect on maternal and fetus
maternal fatigue
acidosis
infection
postpartum hemorrhage
cesarean section rate
fetus birth injury distress
prolapse of umbilical cord
stillbirth
RENJI HOSPITAL 12
Abnormalities of the powers
-----uterine inertia
5.management
hypotonic general management
physical methods
drugs
Hypertonic Sedative
RENJI HOSPITAL 13
Abnormalities of the powers
----- hypercontractility
1.Clinical findings and diagnosis
Precipitate delivery
Constriction ring of uterus
Tetanic contraction
of uterus
RENJI HOSPITAL 14
Abnormalities of the powers
----- hypercontractility
2.Effect on maternal and fetus
?Precipitate delivery
?soft birth canal trauma
?Rupture of uterus
?Fetal distress
?Fetal death
?stillbirth
RENJI HOSPITAL 15
Abnormalities of the powers
----- hypercontractility
3.management
?Prophylaxis
?Tocolytic therapies
?Forcep
?operation