Table of contents
Labor dystocia
What's new
Added 2024 ACOG, 2021 AAFP, and 2016 SOGC guidelines for the management of labor dystocia.
Background
Overview
Definition
Labor dystocia is the slow progression or arrest of labor due to ineffective uterine contractions, cephalopelvic disproportion, or fetal malposition.
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Pathophysiology
Inadequate uterine contractility due to insufficient oxytocin release or decreased sensitivity of uterine myometrial cells to oxytocin leads to the slow progression of cervical dilation and lack of fetal descent, resulting in prolonged labor. Fetal malposition, such as persistent occiput posterior position, can also contribute to labor dystocia by obstructing the birth canal and hindering fetal descent.
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Epidemiology
The incidence of labor dystocia in nulliparous women is estimated at 23-37%.
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Risk factors
Risk factors for labor dystocia include nulliparity, fetal macrosomia, induction of labor, prior fertility treatment, advanced maternal age, maternal diabetes and obesity. Other factors such as fetal abdominal circumference, premature rupture of membranes, prolonged latent phase, fetal station, and fetal position at the early stage of the active phase have also been identified as independent factors influencing the risk of labor dystocia.
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Disease course
The clinical course of labor dystocia includes prolonged labor, slow or lack of cervical dilation, maternal fatigue, and abnormal fetal HR patterns.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of labor dystocia are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2024), the American Academy of Family Physicians (AAFP 2021), and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2016).
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Screening and diagnosis
Diagnostic procedures
Medical management
Oxytocin: as per ACOG 2024 guidelines, administer either low-dose or high-dose oxytocin for the active management of labor to reduce operative deliveries.
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Management of pain (general principles)
Management of pain (neuraxial anesthesia)
Management of pain (opioids and inhaled anesthetics)
Nonpharmacologic interventions
Manual rotation: as per AAFP 2021 guidelines, consider performing manual rotation of occiput posterior presentation to reduce the rates of Cesarean delivery and severe perineal lacerations.
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Labor support
Pushing
Therapeutic procedures
Timing of delivery
As per SOGC 2016 guidelines:
Consider expediting delivery when the second stage exceeds the recommended time limits. Consider extending the time limits in the presence of continued descent of the head, satisfactory maternal and fetal status, and imminent vaginal birth.
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Do not perform operative delivery within 2 hours after commencing pushing, provided maternal status and fetal surveillance are normal.
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