Most common cause of dystocia is dysfunctional/uncoordinated uterine contractions, may result in prolonged labor.
Prolonged labor - lasting more than 24 hours
Normal uterine contractions pattern: moderate or strong and regular
Early labor phase: 2-4 contractions in 10 minutes
Later phases: 4-5 contractions in 10 minutes
Tachysystolic Labor Patterns: >5 contractions in 10 minutes, averaged over a 30-mins window.
Maternal Risks:
- increased discomfort due to uterine muscle anoxia (absence of oxygen)
- fatigue as patterns continue
- stress on coping abilities
- dehydration if labor is prolonged
- increased infection risks if labor is prologed
- nonreassuring fetal status because contractions and increased uterine tone interfere w/ the uteroplacental exchange of gases and nutrients.
- prolonged presurre on the fetal head, which may result in cephalohematoma, caput succedaneum, or excessive molding.
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| Caput Succedaneum |
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| Cephalohematoma |
Clinical Therapy:
- bed rest and sedation to promote relaxation and reduced pain
- Often, pharmacologic intervention to promote sedation will stop tachysystolic contractions.
- Pitocin and amniotomy (artificial rupture of membrane) may be considered if the pattern continues and developed into a prolonged latent phase. However, cephalopelvic disproportion (CPD) and fetal malpresentation need to be ruled out first. If CPD is present, labor is not stimulated because vaginal birth is not possible. Instead c/s will be performed.
- CPD is said to be present if the maternal pelvic diameters are less than average, or if the fetus is particularly large or is in malpresentation or malposition.
- Evaluate relationship between intensity of pain being experienced and the degree to which cervix is dilating and effacing.
- Note if anxiety is negatively affecting the labor progress
- Monitor for signs of nonreassuring fetal status.
- provide comfort and support to the laboring woman and her partner
- woman will be very uncomfortable due to increased force of contractions. Her anxiety and her partners anxiety will be very high. Work to reduce discomfort and promote more effective labor pattern
- Change of positions: left lateral side lying, high fowlers, on her knees with arms up, rocking in a rocking chair, sitting, walking.
- Soothing measures: quiet environment, back rub, therapeutic touch, music, visualization
- Comfort measures: mouth care, change of linens, effleurage, relaxation exercises
- Tub baths, warm shower can help promote comfort and uterine relaxation
- Provide information about the cause of tachysystolic labor pattern
- assure woman she's not overreacting
- patient education. She needs information about the dysfunctional labor pattern and the possible implications for her and her baby. This will relieve anxiety.
- Explain tx options
- offer opportunities to ask questions
- Woman has increased comfort and decreased anxiety
- Woman and partner able to cope w/ the labor
- Woman experiences a more effective labor pattern
Hypotonic Labor Patterns: fewer than 2-3 contractions in a 10-min period; develops in the active phase of labor; may occur when the uterus is overstretched from a twin gestation, or in the presence of a large fetus, hydramnios, or grand multiparity. Bladder or bowel distention and CPD may also be assoc. w/ this pattern.
Maternal Risks:
- exhaustion
- stress on coping abilities
- postpartum hemmorhage from insufficient uterine contractions ff birth
- intrauterine infection if labor is prolonged
- nonreassuring fetal status due to prolonged labor pattern
- fetal sepsis from pathogen that ascend from the birth canal in the presence of ruptured membranes.
Clinical Therapy: The goal is to improve the quality of the uterine contractions and to ensure a safe outcome for mom and baby.
Stimulation of uterine contractions can be performed in several ways: Pitocin, amniotomy, and release of oxytocin due to nipples stimulation.
CPD, fetal malpresentation, and fetal immaturity need to be ruled out before Pitocin may be given to improve the quality of contractions.
IV fluids for hydration maintenance and prevention of maternal exhaustion.
Amniotomy may be used to stimulate labor process.
Electric breast pump can be applied or manual stimulation of nipples to help strengthen uterine contractions. Excellent starting point for women who wanted unmedicated birth.
- If labor pattern does not become effective or if other complications develop, c/s or other interventions may be necessary.
- Assess ccontactions (frequency, intensity, duration), maternal VS and FHR.
- Assess s/s of infection and dehydration
- Observe coping mechanism
- Acute pain, ineffective coping, fatigue
- promote maternal-fetal physical well being by frequent monitoring of contractions, maternal vs and fhr.
- Assess for presence of meconium if amniotic membranes were ruptured. Meconium indicates that the fetus is experiencing some form of stress w/c makes close observation of fetal status more critical.
- I/O record for maternal hydration or dehydration
- Encourage woman to void q2h, check bladder for distention.
- Monitor for s/s of infections (elevated temperature, chills, foul smelling amniotic fluid, fetal tachycardia)
- Keep vaginal examinations to a minimum to decrease risk for infections
- Emotional support
- Provide information about dysfunctional labor process and implications to mother and baby.
- Discuss disadvantages of and alternative tx
- Woman maintains comfort during labor,
- Woman understand the type of labor pattern that is occurring and the tx plan.
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