Dystocia in nulliparous women

Dept of Family Medicine and Community Health, Family Health Center of Worchester, University of Massachusetts, Massachusetts 01610, USA.
American family physician (Impact Factor: 2.18). 07/2007; 75(11):1671-8.
Source: PubMed


Dystocia is common in nulliparous women and is responsible for more than 50 percent of primary cesarean deliveries. Because cesarean delivery rates continue to rise, physicians providing maternity care should be skilled in the diagnosis, management, and prevention of dystocia. If labor is not progressing, inadequate uterine contractions, fetal malposition, or cephalopelvic disproportion may be the cause. Before resorting to operative delivery for arrested labor, physicians should ensure that the patient has had adequate uterine contractions for four hours, using oxytocin infusion for augmentation as needed. For nulliparous women, high-dose oxytocin-infusion protocols for labor augmentation decrease the time to delivery compared with low-dose protocols without causing adverse outcomes. The second stage of labor can be permitted to continue for longer than traditional time limits if fetal monitoring is reassuring and there is progress in descent. Prevention of dystocia includes encouraging the use of trained labor support companions, deferring hospital admission until the active phase of labor when possible, avoiding elective labor induction before 41 weeks' gestation, and using epidural analgesia judiciously.

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    • "Prolonged labour or dystocia is a common birth complication and constitutes the major indication of instrumental deliveries and delivery by emergency Caesarean section (CS) [1,2]. Diagnosing prolonged labour is inherently difficult and it is a controversial issue that has been discussed ever since Friedman introduced the graphic analysis of labour, a study based on 100 women [3]. "
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    ABSTRACT: Background: Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour. Method: Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women's feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not. Results: Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours.Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P <0.00). The factors that contributed most strongly to a negative birth experience in women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement 'My birth experience made me decide not to have any more children' (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement 'It was exiting to give birth' (OR 0.13, 95% CI 0.34-0.5). Conclusions: There is need for increased clinical skill in identification and classification of prolonged labour, in order to improve care for all women and their experiences of birthing processes regardless whether they experience a prolonged labour or not.
    BMC Pregnancy and Childbirth 07/2014; 14(1):233. DOI:10.1186/1471-2393-14-233 · 2.19 Impact Factor
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    • "Bailit et al. [8] found that the frequency of emergency caesarian section was twice that of women admitted to delivery wards in early labour compared to women who sought care in the active phase of labour. Moreover, the risk for an abnormal birth outcome in relation to early admission is particularly high if the woman is also expecting her first child [9,11,12]. The reason for this deviation from the normal birthing process is still not clear. "
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    ABSTRACT: Previous research has reported that women who are admitted to delivery wards in early labour process before an active stage of labour has started run an increased risk of instrumental deliveries. Therefore, it is essential to focus on factors such as self-efficacy that can enhance a woman's own ability to cope with the first stage of labour. However, there was no Swedish instrument measuring childbirth self-efficacy available. Thus, the aim of the study was to translate the Childbirth Self-efficacy Inventory and to psychometrically test the Swedish version on first- time mothers within the Swedish culture. The method included a forward-backward translation with face and content validity. The psychometric properties were evaluated using a Principal Component Analysis and by using Cronbach's alpha coefficient and inter-item correlations. Descriptive statistics and non-parametric tests were used to describe and compare the scales. All data were collected from January 2011 to June 2012, from 406 pregnant women during the gestational week 35-42. The Swedish version of the Childbirth Self-Efficacy Inventory indicated good reliability and the Principal Component Analysis showed a three-component structure. The Wilcoxon Signed-Ranks Test indicated that the women could differentiate between the concepts outcome expectancy and self-efficacy expectatancy and between the two labour stages, active stage and the second stage of labour. The Swedish version of Childbirth Self-efficacy Inventory is a reliable and valid instrument. The inventory can act as a tool to identify those women who need extra support and to evaluate the efforts of improving women's self-efficacy during pregnancy.
    BMC Pregnancy and Childbirth 01/2014; 14(1):1. DOI:10.1186/1471-2393-14-1 · 2.19 Impact Factor
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    • "Women with a diagnosed dystocia had more often non-clear amniotic fluid, more post-partum hemorrhage, significantly increased odds of chorioamnionitis and their children were more often given low one-minute neonatal Apgar scores as compared to women delivered without a diagnosed dystocia (Kjaergaard et al., 2009; Pitkin, 2003). Although many reasons were identified such as inappropriate position or size of the fetus, congenital anomalies, cephalopelvic disproportion, abnormal uterine contractions and others (Chard & Grudzinskas, 1994), diagnosis of dystocia and optimal management recommendations are still under consideration (Shields et al., 2007). One of the reasons for slow diagnosis of dystocia in labor progress is a lack of qualitative measurement methods for evaluating the uterus activity during labor (Euliano et al., 2009). "
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    ABSTRACT: Understanding the physiology of the uterus during term and preterm parturition is essential to solving clinical problems related to gestation and labor. The uterus is a smooth muscle organ. It undergoes specific changes during gestation and is known for its unique contractility during the labor.
    Applications of EMG in Clinical and Sports Medicine, 01/2012; , ISBN: 978-953-307-798-7
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