Dystocia and Labor Complications

Dystocia

• Dystocia is difficult labor resulting from issues with the powers, passenger, or passage.
• Dysfunctional labor patterns include hypertonic and hypotonic uterine dysfunction.
• Hypertonic uterine dysfunction involves uncoordinated, frequent, painful contractions without effective cervical dilation.
• Rest, hydration, and pain relief are therapeutic management methods for hypertonic uterine dysfunction.
• Hypotonic uterine dysfunction involves weak, infrequent contractions, typically in the active phase of labor.
• Labor augmentation with oxytocin or amniotomy may be needed for hypotonic uterine dysfunction.
• Precipitous labor is a rapid labor and birth, lasting less than 3 hours from onset to delivery.
• Continuous monitoring and support are crucial during precipitous labor to prevent complications for both mother and fetus.

Passenger Problems

• Fetal size (macrosomia), malpresentation, and multifetal pregnancy are problems with the passenger.
• Macrosomia can lead to shoulder dystocia, where fetal shoulders impact after head delivery.
• Shoulder dystocia may require McRobert's maneuver and suprapubic pressure to resolve.
• Fetal malpresentations like breech or transverse lie can impede vaginal delivery.
• External cephalic version (ECV) may be used to convert a breech presentation to cephalic before labor.
• Multifetal pregnancies increase risks of malpresentation, preterm labor, and uterine atony.

Passage Problems

• Variations in the maternal bony pelvis or soft tissue abnormalities are problems with the passage.
• Pelvic dystocia is a contracted or abnormally shaped pelvis obstructing fetal passage.
• Soft tissue dystocia can result from cervical edema, tumors, or scarring.

Induction and Augmentation of Labor

• Labor induction is stimulating uterine contractions before spontaneous onset.
• Post-term pregnancy, preeclampsia, and intrauterine growth restriction (IUGR) are indications for labor induction.
• Cervical ripening methods like prostaglandins or a Foley catheter may prepare the cervix for induction.
• Oxytocin is commonly used to induce or augment labor.
• Maternal and fetal responses require close monitoring during oxytocin administration to prevent complications like tachysystole.
• Amniotomy (artificial rupture of membranes) induces or augments labor.
• Monitor fetal heart rate patterns closely after amniotomy to detect potential umbilical cord compression.

Operative Vaginal Birth

• Forceps-assisted birth uses forceps to guide the fetal head during delivery.
• Vacuum-assisted birth uses a vacuum cup on the fetal head to aid delivery.
• Prolonged second stage of labor, fetal distress, or maternal exhaustion are indications for operative vaginal delivery.

Cesarean Birth

• Cesarean birth is the surgical delivery via an incision in the abdomen and uterus.
• Fetal distress, malpresentation, placental abnormalities, and previous cesarean birth are indications for cesarean birth.
• Trial of labor after cesarean (TOLAC) may be an option for women with a prior cesarean.

Uterine Rupture

• Uterine rupture is a rare but serious complication involving uterine wall tearing.
• Previous uterine surgery, especially classical cesarean incision, is a risk factor for uterine rupture.

Umbilical Cord Prolapse

• Prolapse occurs when the umbilical cord lies below the presenting part of the fetus.
• Prompt recognition and intervention are essential to relieve cord pressure and prevent fetal hypoxia.

Amniotic Fluid Embolism (AFE)

• AFE is a rare, life-threatening complication where amniotic fluid enters maternal circulation.
• Sudden respiratory distress, cardiovascular collapse, and disseminated intravascular coagulation (DIC) can result from AFE.

Postpartum Hemorrhage

• Postpartum hemorrhage is excessive bleeding after childbirth.
• Uterine atony, lacerations, retained placental fragments, and coagulation disorders are common causes.
• Uterine atony is the failure of the uterus to contract adequately after delivery, a leading cause of postpartum hemorrhage.
• Medications like oxytocin, misoprostol, and methylergonovine may treat uterine atony.
• Manual massage of the uterus helps stimulate contractions and control bleeding.
• Lacerations of the genital tract can cause significant bleeding after delivery.
• Prompt repair of lacerations is necessary to control hemorrhage.
• Retained placental fragments can interfere with uterine involution, causing late postpartum hemorrhage.
• Manual exploration of the uterus or dilation and curettage (D&C) may remove retained fragments.
• Coagulation disorders such as disseminated intravascular coagulation (DIC) can complicate postpartum hemorrhage.
• Treatment focuses on addressing the underlying cause, providing blood products and clotting factors to stabilize the patient.

Thromboembolic Disorders

• Deep vein thrombosis (DVT) and pulmonary embolism (PE) are potential complications in the postpartum period.
• Early ambulation, sequential compression devices, and prophylactic anticoagulation in high-risk patients are prevention strategies.

Postpartum Infections

• Postpartum infections, such as endometritis, wound infections, and mastitis, can occur after childbirth.
• Endometritis is an infection of the uterine lining, often associated with prolonged labor or cesarean birth.
• Wound infections can occur at the site of episiotomy, laceration repair, or cesarean incision.
• Mastitis is an infection of the breast tissue, usually caused by bacteria entering through a cracked nipple.

Postpartum Mood Disorders

• Postpartum mood disorders, including postpartum blues, postpartum depression, and postpartum psychosis, can affect women after childbirth.
• Postpartum blues are mild, transient mood changes that typically resolve within a few weeks after delivery.
• Postpartum depression is a more severe and persistent mood disorder requiring treatment.
• Postpartum psychosis is a rare but serious psychiatric emergency characterized by hallucinations, delusions, and disorganized thinking.