Sep-29

Dystocia

Difficult labor
- results from interactions (problems) with the 3 P's

3 P's

1. Power of expulsion (uterine contractions and voluntary compulsive actions)
2. Passage (through birth canal)
3. Passenger (baby)

Abnormalities of Expulsion

1. forces not powerful enough
2. forces not synchronized
3. woman can't push

Abnormalities of Passage

1. bony abnormalities
2. tissue abnormalities

Abnormalities of Passenger

1. fetus not loaded properly into birth canal
2. fetus has an abnormally large skull

Labor

Begins when uterine contractions of sufficient frequency, duration, and intensity are attained to bring about readily demonstrable effacement and dilation of the cervix
*uterus needs to be contracting in synchrony
Latent and Active Phase

Active Phase of Labor

in first birth, women, unaided will usually deliver after 10 hours
it is 5.5 hours for women who have previously given birth

Normal Fetal Presentation

back of the head (occiput anterior)

Breech Presentation

~ 3% of deliveries
baby is coming down other end first (not head)

Frank Breech

baby is coming down butt first but both knees are flexed

Incomplete Breech

1 or both knees are flexed with one or both knees below the breech, feet are coming down

Complete breech

1 or both knees are flexed rather than both extended

Problems with Breech Deliveries

1. biggest part of a normal baby is the head (comes out first in normal delivery - like an icebreaker)
2. the difference with breeches is that the biggest part of the baby is the last thing to come out
3. usually the cervix isn't dilated enough for the he

Mortality for Breech Deliveries

10X higher than vertical deliveries

What are alternatives to doing a breech delivery?

1. external cephalic version: you try to flip the baby (one hand on the butt, one hand on the head). give woman oxytocin to try to keep baby in place and induce labor
2. vaginal breech delivery
3. c-section

Face Presentation

Face comes down first. Widest possible diameter of the head. physically impossible to be delivered vaginally

Brow Presentation

Variant of face presentation
Forehead presentation. usually the baby will revert to normal but could also turn into a face presentation