9
Managemant
Coordinated dysfunction
★Vaginal examination to rule out
Cephalopelvic disproportion or fetal malposition. ★Evaluate fetus and maternal complexion.
ABNORMAL LABOR OR DYSTOCIA
1
Defintion：
Dystocia is defined as difficult labor.It may be associated with various abnormalities that prevent or deviate from the normal course of labor and delivery.It is the consequence of four distinct abnormalities that may exist singly or combination: the power, passage
In third stage of labor----prevention of postpartum
hemorrhage.
12
Uncoordinated dysfunction： ★ Sedation is generally effective in
converting uncoordinated contraction to normal labor patterns.
3
Abnormal uterine action
The rhythm, symmetry, polarity and retraction of uterine contraction become abnormal.
Include：uterine hypocontractility uterine hypercontractility
4
Abnormalities of the powers
Uterine dysfunction
hypocontractility Uterine Dysfunction
hypercontractility
coordianted
Uncoordinated
coordianted
uncoordinated
10
In the first stage of labor
Relax, Take good care Improve the contraction Rupture the membrane Oxytocin stimulation of labor:from low dose. Narcotic agent such as morphine sulfate is given in doses large enough to arrest uterine contractions and provide from 6-12 hours of rest;
13
Hypertonic dysfunction(coordinated)
Manifestation and diagnosis
The contraction have normal rhythm,symmetry and polarity,but the intensity is too strong.
5
Etiology of uterine action ：
Cephalopelvic disproportion or fetal malposition Psychological factors Abnormal uterus Endocrinal dysfutation
passenger and the psyche.
2
Cause of dystocia
Power contraction or intra-abdominal pressure Passage bone or soft birth canal Passenger malformation Psyche tension-anxiety
7
Hypotonic uterine action(uncoordianted)
★ Loss the normal rhythm,symmetry and polarity. ★ The intensity in the periods of relaxation between contractions become larger. ★ The pregnant women will fell persisting pain.
8
Effect on maternal and fetus
maternal fetus
Fatigue Acidosis Infection Postpartum hemorrhage Cesarean section rate increasing
Birth injury distress Prolapse of umbilical cord Stillbirth
Hypotonic uterine action(coordianted)
★ Have normal rhythm,symmetry and polarity. ★The intensity is low. including: primary and secondary hypotonic uterine action.
11
In second stage of labor
★There is no cephalopelvic disproportion-----improve the expulsive force. ★Fetal distress---- finish the labor in shortest time. ★Cephalopelvic disproportion -----cesarean section.