PAMANTASAN NG LUNGSOD NG MAYNILA

College of Medicine
Department of Obstetrics and Gynecology

DYSTOCIA

Group 3, Section III-A

FERRER, Terence Christopher P.

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GAMBOA, Christine Grace P.

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GARVIDA, Pia Uzelle F.

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GATCHALIAN, Ysrael Orlando D.

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GOMEZ, Ma. Gia Ana A.

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JUNIO, Ace Drazen E.

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KASILAG, Raiza Michaella A.

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LABO, Guian Carlo C.

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LARCIA, Nikka Mae A.

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LAROA, Harold Robin F.

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LASCANO, Normilando

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22 October 2014

THE CASE
21 y/o, G1P0, cephalic in beginning labor was admitted due to labor pains. BPS= 8/8
Stable VS:
BP: 100/60

HR: 80 bpm

T: 36.5C

LMP: January 3, 2014

FH: 34 cm

FHT: 145 bpm

Time

Admission

2 Hours After
Admission

4 Hours After
Admission

6 Hours After
Admission

8 Hours After
Admission

10 Hours After
Admission
12 Hours After
Admission
13 Hours After
Admission

Internal Examination Findings

Cervix 3 cm dilated
60% effaced
Cephalic
Station -3
+BOW
Cervix 3-4 cm dilated
70% effaced
Station -3
Cephalic
Intact BOW
Uterine contractions every 5-6 minutes, moderate intensity
Cervix 4-5 cm dilated
70% effaced
Station -2
Cephalic
Intact BOW
Uterine contractions every 5 minutes, moderate intensity
o Oxytocin side drip started as 12 gtt/min then titrated to get uterine
contractions every 3-4 minutes, strong intensity
Cervix 5-6 cm dilated
80% effaced
Station -2
+ BOW
Cervix 6 cm dilated
80%
Station -1
+ BOW
Amniotomy done, revealing clear Amniotic Fluid
Cervix 6-7 cm dilated
80% effaced
Station 0
- BOW
Cervix 6-7 cm dilated
90% effaced
Station +1, with 1 cm caput

Remained the same

I. Compute the AOG and EDC

A. Age of Gestattion (AOG)

B. Estimated Date of Confinement: October 10, 2014

II. Plot the Friedmans curve

10
9
8
7
6
5
4
3
2
1
0

-3

-2
-1
0
1

Fetal Station

Cervical Dilatation (cm)

Friedman's Curve

Cervical Dilatation
Fetal Station

2
3
0

10

12

14

Time

III. Identify the Abnormal Labor Patterns and their Possible Causes
Time

Cervical dilatation

Progress in Latent Phase

0
3 cm
2
3-4 cm
Progress in Active Phase
4
4-5 cm
6
5-6 cm
8
6 cm
10
6-7 cm
12
6-7 cm
13
6-7 cm

Change in
dilation

Rate of dilatation

Descent
(Station)

1 cm

0.5 cm/ hr

-3
-3

1 cm
1 cm
No change
1 cm
No change
No change

0.5 cm/ hr
0.5 cm/ hr
0 cm/ hr
0.5 cm/ hr
0 cm/ hr
0 cm/ hr

-2
-2
-1
0
+1
+1

An active phase is abnormal (1) when it lasts longer than 12 hours or (2) when the rate
of cervical dilatation is less than 1.2 cm/hr or (3) when descend of the presenting part is less
than 1 cm/h for primigravidas. In the case, the patient is in active phase for more than 9 hours at
a rate of 0.3 cm/hr, thus satisfying a criteria for protracted active phase of labor. At 6 cm and

7 cm cervical dilatation in the 8 th and 12th hour of labor respectively, there were no progressions
to 10 cm (full dilation) for about 2 hours. Therefore, there was a secondary arrest of dilatation.
Therefore, the abnormal labor patterns demonstrated by the patent are protracted
active phase of labor and secondary arrest of dilatation. Factors contributing to both
protraction and arrest disorders are:
Excessive sedation/ epidural anesthesia
Fetal malposition/ feto-pelvic disproportion secondary to the passenger, the size of
the infant and/ or the presentation of the infant
Patient is extremely short or obese wherein the pelvis or the size of the passages
inhibits delivery
Weak uterine contractions which is problem in power (uterine contractions and
maternal bearing effort.
IV. Outcome of Labor
Patients who develop arrest disorders during labor usually have CPD and will require
caesarian delivery. If there is no CPD, vaginal delivery is allowable considering that according to
studies the length of the second stage (even those lasting > 6 hours or more) is not related to
neonatal outcome. However, an important caveat to remember is that after 3 hours in the
second stage, delivery by caesarian or other operative method increases such that in 5 hours
the chance of delivering spontaneously in the successive hour is only 10 to 15 percent.
Oxytocin infusion can be used to cause uterotonic stimulation and lead to further
dilatation and descent. Before oxytocin administration, it is important to make sure that the
pelvis is adequate for the fetus through assessment of the post arrest slope since it can be
related to the slope of dilatation or descent before the arrest developed. For vaginal delivery to
be anticipated, post arrest slope is equal or greater than the pre- arrest slope. However, if the
development of the post arrest slope is poor then caesarian delivery is indicated.
Mechanical restrictions should be considered when encountering arrest disorders. In
transverse lie position, vaginal delivery is not possible and labor prolongation may lead to
uterine rupture unlike with the occiput posterior position where spontaneous delivery is still
possible but may take longer than usual. In the case of large fetus, spontaneous delivery is still
an option but may take longer than usual and would require fetal molding. In compound
presentation, it is similar to occiput position that vaginal delivery is possible but will take more
time.
Lastly, arrested labor is associated with chorioamnionitis, endomyometritis and
postpartum hemorrhage and so those in charge should be aware of these complications and
their proper management.

REFERENCES
Cunningham, G. F., Leveno, K. J., Bloom, S. L., Spong, C. Y., Dashe, J. S., Hoffman, B. L., . . .
Sheffield, J. S. (2014). Williams Obstetrics (24th ed.). McGraw-Hill Education.
Edmonds, K. (2007). Dewhursts Textbook of Obstetrics & Gynecology 7th Edition.
Massachusetts, USA: Blackwell Publishing, Inc.
Henry, D.E. (2008, November). Perinatal Outcomes in the Setting of Active Phase Labor Arrest.
Obstet Gynecol (112), 1109-1115