Dystocia

An abnormal, long, or
difficult labor or delivery

Dysfunctional Labor is related to

Abnormalities of the Critical Factors:
PASSAGEWAY

PSYCHE

Critical
Factors

PASSENGER

POWERS

UTERINE DYSTOCIA
DYSFUNCTIONAL UTERINE CONTRACTIONS

HYPOTONIC UTERINE CONTRACTIONS

UTERINE INERTIA
Etiology and Pathophysiology:
Overstretching of the uterus --large
baby, multiple babies, polyhydramnios,
multiple parity
Bowel or bladder distention preventing
descent
Excessive use of analgesia

ASSESSMENT
Signs and Symptoms of HYPOTONIC
UTERINE INERTIA:
Weak contractions become mild
Infrequent (every 10 15 minutes +)
and brief,
Can be easily indented with fingertip
pressure at peak of contraction.
Prolonged ACTIVE Phase
Exhaustion of the mother
Psychological trauma - frustrated

Friedmans Graph
Hypotonic Uterine Contractions

Normal
Curve

Prolonged active phase

Therapeutic Interventions
Ambulation
Nipple Stimulation --release of endogenous
Pitocin
Enema--warmth of enema may stimulate
contractions
Amniotomy--artificial rupture of the
membranes
Augmentation of labor with Pitocin

Amniotomy
Amniotomy is the artificial rupture of the
amniotic sac with a tool called the
amniohook (a long crochet type hook, with
a pricked end) or an amnicot (a glove with
a small pricked end on one finger).

One of these will be placed inside the

vagina, where the caregiver will rupture
the amniotic sac or membrane.

AMNIOTOMY
Advantages of doing this before Pitocin
Contractions are more similar to those of
spontaneous labor
Usually no risk of rupture of the uterus
Does not require as close surveillance

Disadvantages of an Amniotomy
Delivery must occur
Increase danger of prolapse of umbilical cord
Compression and molding of the fetal head (caput)

Amniotomy
Nursing Care:

# 1-Check the fetal heart tones

Assess color, odor, amount
Provide with perineal care
Monitor contractions
Check temperature every 2 hours

Answer

Cervical Ripening

Cervical Ripening
prostaglandin E2 Medications
Prepidil gel
Cervodil

Prostaglandin E1 Medication
Cytotec

Nursing Care
Monitor maternal vital signs, cervical dilatation and
effacement
Monitor fetal status for presence of reassuring fetal
heart rate
Remove medication if hyperstimulation occurs

Hyperstimulation
Remove the medication
Turn patient to side-lying position
Provide oxygen via face mask
Give Terbutaline

PITOCIN
Augmentation of Labor

Assess first to make sure CPD is not

present, then start procedure:

Give 10 units / 1000 cc. fluid and hang as a

secondary infusion, never as primary

Nursing Care:

Assess contractions--are they increasing

but not tetanic
Assess dilation and effacement
Monitor vital signs and FHTs
Make sure no signs of hyperstimulation
before increasing dose

HYPERTONIC UTERINE
CONTRACTIONS
Most often occur in first-time mothers,
Primigravidas
Contractions are ineffectual, erratic,
uncoordinated, and of poor quality that
involve only a portion of the uterus
Increase in frequency of contractions, but
intensity is decreased, do not bring about
dilation and effacement of the cervix.

Signs and Symptoms

PAINFUL contractions RT uterine muscle
anoxia, causing constant cramping pain
Dilation and effacement of the cervix does
not occur.
Prolonged latent phase. Stay at 2 - 3 cm.
dont dilate as should
Fetal distress occurs early uterine resting
tone is high, decreasing placental perfusion.
Anxious and discouraged

Friedmans Graph
Hypertonic Uterine Contractions

Prolonged latent
phase