Dystocia (antonym eutocia)

- Is an abnormal or difficult childbirth or labour, dysfunctional labour. Approximately one fifth

of human labours have dystocia.
- It may arise due to in coordinate uterine activity, abnormal foetal lie or presentation,
absolute or relative cephalopelvic disproportion or (rarely) a massive foetal tumor such as a
sacrococcygeal teratoma.
Types
- Foetal dystocia
- Cervical dystocia
- Placental dystocia
Signs and Symptoms
- One often described feature is the turtle sign, which involves the appearance and retraction
of the fetal head (analogous to a turtle withdrawing into its shell), and the erythematous,
red puffy face indicative of facial flushing. This occurs when the baby's shoulder is
obstructed by the maternal pelvis.
Diagnosis
- Caesarean section if necessary.
- Unusual small vulvar openings may require a partial episiotomy to deliver foetus vaginally.
- An accurate history, including reproductive events, ovulation timing and breeding dates
- PE, including a digital pelvic examination.
- Hand-held foetal Doppler
- Abdominal ultrasound
- X-rays
- Blood test to measure calcium and glucose levels may be helpful in indentifying metabolic
disorders contributing to dystocia.
Management
- Ask for help. This involves requesting the help of an obstetrician, anesthesia and pediatrics
for subsequent resuscitation of the infant.
- Leg hyperflexion (McRoberts' maneuver)
- Anterior shoulder disimpaction (suprapubic pressure)
- Rubin maneuver
- Manual delivery of posterior arm
- Episiotomy
- Roll over on all fours

Complication
- Foetal death
- Respiratory depression
- Hypoxic Ischaemic Encephalopathy (HIE)
- Brachial nerve damage

Maternal Causes
- Uterine inertia
o Primary uterine inertia multifactorial, with genetic, mechanical, hormonal and
physical components. Failure to initiate an effective labour pattern.
o Secondary uterine inertia failure tom complete expulsion of all foetuses as a result
of exhaustion of the uterine muscle.
- Abnormalities associated with foetal and uterine fluids
o Hydrops an excessive accumulation of allantonic fluid causing foetal unit to be
markedly oversized.
o Underproduction of foetal fluids resulting in dystocia that is due to lack of
lubricating fluids.
- Disorders of the birth canal distributing to dystocia include pelvic abnormalities such as
narrowing from a healed fracture or congenital disorders, and vaginovulvar abnormalities
such as strictures.
- Herniation or torsion of a uterine horn.
- Prolonged interval between pregnancies, primigravid birth, and multiple birth.
- Maternal distress (excessive pain or systemic illness), green or copious vaginal bleeding.
- Irreversible history of dystocia (pelvic canal abnormalities, mismatch foetal/maternal size)
or radiographic evidence of foetal apposition.
- Failure of the dam to initiate labor at term. Bitches can be considered over term at more
than 70-72 days from the first breeding, more than 58-60 days of diestrus, or more than 66
days from the LH surg or initial rise in progesterone above 2ng/ml during estrus.
- Failure or the dam to enter Stage 1 labour beyond 24-36 hours after a detectable drop in
rectal temperature more than 99F - 100F, or to proceed from Stage 1 to Stage 2 labour
within 24 hours.
- Failure of the dam to complete delivery of all foetuses in a timely fashion. Delivery should
occur within 30-60 minutes of active labour (visible abdominal efforts).
- No more than 4-6 hours between deliveries without active labour.



Foetal Causes
- Foetal oversize due to prolonged gestation.
- Foetal anomalies such as anasarca and hydrocephalus.
- Malpositioning such as flip position.
- Foetal distress (unborn foetus with slow heart rate, stillborns)

GLOSSARY
1. Sacrococcygeal teratoma (SCT)
- A kind of tumour located at the base of the coccyx (tailbone). It isthought to be derivative of
the primitive streak.
2. Hypoxic Ischaemic Encephalopathy (Intrauterine hypoxia, and birth asphyxia)
- Occur when the fetus is deprived of an adequate supply of oxygen. IH is used to describe
inadequate oxygen availability during the gestation period, birth asphyxia (also referred to
as perinatal asphyxia or Asphyxia neonatorum ) can result from inadequate supply of oxygen
immediately prior to, during or just after delivery.
3. Estrus
- Comprises the recurring physiologic changes that are induced by reproductive hormones in
most mammalian placental females.
4. Anasarca
- Also known as "extreme generalized edema" is a medical condition characterized by
widespread swelling of the skin due to effusion of fluid into the extracellular space.








Reported by:
Val Edienhel E. Rabang
Mid 2 (Ladderized)