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Reproductive Sciences (Thousand Oaks,... Mar 2023Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk... (Review)
Review
Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Dystocia; Labor, Obstetric; Parturition; Delivery, Obstetric; Cesarean Section
PubMed: 35817950
DOI: 10.1007/s43032-022-01018-6 -
American Family Physician Jan 2021Dystocia (abnormally slow or protracted labor) accounts for 25% to 55% of primary cesarean deliveries. The latent phase of labor begins with onset of regular, painful... (Review)
Review
Dystocia (abnormally slow or protracted labor) accounts for 25% to 55% of primary cesarean deliveries. The latent phase of labor begins with onset of regular, painful contractions and continues until 6 cm of cervical dilation. Current recommendations are to avoid admission to labor and delivery during the latent phase, assuming maternal/fetal status is reassuring. The active phase begins at 6 cm. An arrested active phase is defined as more than four hours without cervical change despite rupture of membranes and adequate contractions and more than six hours of no cervical change without adequate contractions. Managing a protracted active phase includes oxytocin augmentation with or without amniotomy. The second stage of labor begins at complete cervical dilation and continues to delivery. This stage is considered protracted if it lasts three hours or more in nulliparous patients without an epidural or four hours or more in nulliparous patients with an epidural. Primary interventions for a protracted second stage include use of oxytocin and manual rotation if the fetus is in the occiput posterior position. When contractions or pushing is inadequate, vacuum or forceps delivery may be needed. Effective measures for preventing dystocia and subsequent cesarean delivery include avoiding admission during latent labor, providing cervical ripening agents for induction in patients with an unfavorable cervix, encouraging the use of continuous labor support (e.g., a doula), walking or upright positioning in the first stage, and not diagnosing failed induction during the latent phase until oxytocin has been given for 12 to 18 hours after membrane rupture. Elective induction at 39 weeks' gestation in low-risk nulliparous patients may reduce the risk of cesarean delivery.
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Labor Stage, First; Labor Stage, Second; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Time Factors
PubMed: 33448772
DOI: No ID Found -
Obstetrics and Gynecology Clinics of... Sep 2022Most of our knowledge pertaining to this obstetric emergency has emanated from case reports and retrospective studies that have subsequently resulted in empirical... (Review)
Review
Most of our knowledge pertaining to this obstetric emergency has emanated from case reports and retrospective studies that have subsequently resulted in empirical management protocols. This article has identified the existence of large gaps in our clinical knowledge base regarding the prevention and resolution of shoulder dystocia, as well as its long-term sequelae. We have attempted to challenge current recommendations regarding whether prophylactic cesarean delivery should be performed based on estimated fetal weight alone or a prior history of shoulder dystocia, shoulder dystocia management techniques, what defines "excessive" traction, and the role of simulation training for all clinicians.
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Pregnancy; Retrospective Studies; Shoulder; Shoulder Dystocia
PubMed: 36122981
DOI: 10.1016/j.ogc.2022.02.005 -
Obstetrics and Gynecology May 2017
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Risk Assessment; Shoulder
PubMed: 28426618
DOI: 10.1097/AOG.0000000000002043 -
The Veterinary Clinics of North... Sep 2023Veterinary care of breeding dogs begins before a breeding takes place, during prebreeding consultations, through matings, gestation, and delivery of newborns. (Review)
Review
Veterinary care of breeding dogs begins before a breeding takes place, during prebreeding consultations, through matings, gestation, and delivery of newborns.
Topics: Pregnancy; Female; Animals; Dogs; Dystocia; Reproduction; Dog Diseases
PubMed: 37414692
DOI: 10.1016/j.cvsm.2023.05.004 -
Current Opinion in Obstetrics &... Dec 1998Shoulder dystocia continues to represent a largely unpredictable and potentially disastrous obstetric emergency. Recent attention has been focused on the effectiveness... (Review)
Review
Shoulder dystocia continues to represent a largely unpredictable and potentially disastrous obstetric emergency. Recent attention has been focused on the effectiveness of obstetric maneuvers employed to alleviate shoulder dystocia. Reports have also questioned the traditional thinking that brachial plexus injury is caused by application of excessive lateral traction to the fetal head. Rather, in-utero forces may underlie a significant portion of these injuries.
Topics: Delivery, Obstetric; Dystocia; Female; Humans; Infant, Newborn; Pregnancy; Risk Factors; Shoulder
PubMed: 9866013
DOI: 10.1097/00001703-199812000-00005 -
Clinical Obstetrics and Gynecology Mar 1987
Review
Topics: Adolescent; Child, Preschool; Dystocia; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Shoulder
PubMed: 3555920
DOI: 10.1097/00003081-198703000-00011 -
Obstetrics and Gynecology Clinics of... Jun 2017Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and... (Review)
Review
Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and management to avoid significant morbidity or mortality. Shoulder dystocia is an uncommon, unpredictable, and unpreventable obstetric emergency and can be managed with appropriate intervention. Postpartum hemorrhage occurs more commonly and carries significant risk of maternal morbidity. Institutional protocols and algorithms for the prevention and management of shoulder dystocia and postpartum hemorrhage have become mainstays for clinicians. The goal of this review is to summarize the diagnosis, incidence, risk factors, and management of shoulder dystocia and postpartum hemorrhage.
Topics: Birth Injuries; Delivery, Obstetric; Dystocia; Emergencies; Female; Humans; Postpartum Hemorrhage; Pregnancy; Risk Factors; Shoulder
PubMed: 28499533
DOI: 10.1016/j.ogc.2017.02.003 -
The Veterinary Clinics of North... Mar 1994Dystocia is one of the leading causes of calf mortality between birth and weaning in beef cattle. An understanding of the effects of parturition and dystocia on... (Review)
Review
Dystocia is one of the leading causes of calf mortality between birth and weaning in beef cattle. An understanding of the effects of parturition and dystocia on perinatal calf viability is paramount for the development of breeding and calving programs that will minimize calf losses. This article discusses the factors affecting birth weight and replacement heifer development and redefines dystocia as any birth that reduces calf viability, causes maternal injury, or reduces maternal reproduction.
Topics: Animals; Cattle; Cattle Diseases; Dystocia; Female; Pregnancy; Risk Factors
PubMed: 8199922
DOI: 10.1016/s0749-0720(15)30589-2 -
NeoReviews Sep 2022
Topics: Birth Injuries; Delivery, Obstetric; Dystocia; Female; Humans; Infant, Newborn; Pregnancy; Shoulder Dystocia
PubMed: 36047758
DOI: 10.1542/neo.23-9-e645