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An hongmin
Department Of Obstetrics & Gynecology
Definition
Dystocia literally means difficult
labor and it is characterized by
abnormally slow progress of labor
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Categories of dystocia
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Hypotonic dysfunction is uterine
Hypotonic dysfunction activity characterized by contraction
of the uterus with insufficient force(
< 24mmHg), irregular or
infrequent rhythm, or both.
Hypertonic dysfunction Hypotonic dysfunction responds
well to oxytocin.
Uncoordinated dysfunction
◆ Bony abnormalities
◆ Soft tissue obstruction of the birth canal
◆ Abnormal placental location
Pelvic types
Pelvimetry( 骨盆测量 )
X-ray pelvimetry
Pelvic contraction
Birth canal
bony canal
soft canal
abnormal bony canal: pelvic
contraction
any contraction of the pelvic diameters
that diminishes the capacity of the pelvis
can creat dystocia during labor
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Pelvic contraction classification
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Abnormalities of birth canal
1.Bony pelvic
1)Contracted pelvic inlet
simple flat pelvis (单纯性扁平性骨盆)
rachitic flat pelvis( 佝偻病性扁平性骨盆 )
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Contracted pelvic inlet
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3)Contracted pelvic outlet
(funnel shaped pelvis 漏斗型骨盆 )
diminition of the interischial tuberous diameter to 8cm or less.
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4) Generally contracted pelvis
2cm or more shorter than normal
5) Pelvic deformities
osteomalacic (骨软化的) pelvis
obliquely contracted pelvis ( 斜狭骨盆 )
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Clinical signs of contracted pelvis
2) Contracted pelvic inlet
3) Contracted midpelvis
4) Contracted pelvic outlet
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Diagnosis :
History
Physical examination
Pelvimetry
external pelvimetry
internal pelvimetry
diagonal conjugate 12.5~13cm
bi-ischial diameter 10cm
incisura ischiadica 5~6cm
angle of subpubic arch 90
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Effects on mather and fetus
MOTHER:Inlet
Malpresentation and malposition
prolonged labor
insufficient uterine contraction
midpelvis and outlet
persistant occipitotransverse or occipitoposterior
position
fistula formation
intrapartum infection
threatening rupture or rupture
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Fetus
Prom
Prolapse
Distress 2. Abnormal of soft birth canal
Death
Injury
Infection
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2. Abnormal of soft birth canal
Lower segment of uterus
cervix
vaginal
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Abnormal of soft birth canal
Congenital anomalies
Scarring of the birth canal
Pelvic masses
Low-lying placenta
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Fetal malposition
Occipitoanterior position 90%
malposition 10%
abnormal cephalic posion 6-7%
breech presentation 3-4%
others
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Abnormalities of the passenger
A. malposition and malpresentation
a. vertex malposition
persistent occiput posterior
persistent occiput transverse 5%
sincipital presentation 1.08%
anterior asynclitism( 前不均 位 )
posterior asynclitism ( 后不均 位) 0.5%~0.81%
b. brow presentation 0.03%~0.1%
c. face presentation 0.08%~0.27%
d. breech presentation 3%~4%
e. abnormal fetal lie transverse or oblique lie
0.25%
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Persistant occipitoposterior
(transverse) position
Causes
abnormal pelvis:transverse narrowing
of the midpelvis
flexion not well
hypotonic uterine dysfunction
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Face presentation
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Breech presentation
Incidence
breech presentation is common
remote from term.
3-4% of singleton deliveries
Position
LSA, LST LSP. RSA, RST, RAP
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Causes
Uterine relaxation
limited uterine cavity
fetal head obstructed
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the lower extremities are flexed at the hips
and extended at the knees, and thus the
feet lie in close proximity to the head.
Breech presentation It appears most commonly
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Extraction of breech
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Compound presentation
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B. Fetal macrosomia
large for gestational
age(LGA) ≥400 0g
shou lder dystosia
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C. Fetal malformation
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Operative delivery
1)forceps
operations
2)Vacuum
extractor
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2)Vacuum
extractor
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3)Cesarean section
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Main point of dystocia
managemnet
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思考题 :
1.The definition and classification
of dystosia
2.How to deal with uterine inertia
during the first stage of labor ?
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THANKS FOR YOUR ATTENTION
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