Académique Documents
Professionnel Documents
Culture Documents
Joserizal Serudji
Bag/SMF OBGIN FK Unand/RS.
M.Djamil Padang
Dystocia
Descent of the fetal biparietal diameter to the level of the maternal pelvic ischial spines (0
station) is defined as engagem ent
There was a significant association between higher station at the onset of labor and subsequent
dystocia.
Both protraction and arrested labor disorders in women with fetal head stations above +1 cm
and noted that the higher the station at the onset of labor in nulliparas, the more prolonged the
labor (Friedman and Sachtleben, 1976).
Handa and Laros (1993) found that fetal station at the time of arrested labor was also a risk
factor for dystocia.
Roshanfekr and associates (1999) analyzed fetal station in 803 nulliparas women with term
pregnancies in whom active labor had been diagnosed. About 30 percent of these women
presented to the hospital with the fetal head at or below 0 station, and their cesarean delivery
rate was 5 percent compared with that of 14 percent for those with higher fetal stations.
The prognosis for dystocia, however, was not related to incrementally higher fetal head stations
above the pelvic midplane (0 station).
Importantly, 86 percent of nulliparous women without fetal head engagement at diagnosis of
active labor delivered vaginally. Thus, lack of engagement at the onset of labor, although a
statistical risk factor for dystocia, should not be assumed to necessarily predict fetopelvic
disproportion. This caveat is especially true for parous women because the head typically
descends later in labor.
Mechanism of Dystocia
Clinically:
Slower than normal progress: protraction disorder
Complete cessation of progress: arrest disorder
Active phase arrest: no dilatation for 2 hours or more; both
criteria should be met:
The latent phase has been completed, with the cervix dilated 4 cm or
more
A uterine contraction pattern of 200 Montevideio units or more in 10-
minutes period has been present for 2 hour without cervical change
Protraction: less than 1 cm/hour cervical dilatation for a
minimum of 4 hour Abnormalities:
Power:uterine contractility and maternal expulsive effort
Passenger: fetus
Passage: pelvis
2nd stage Disorders