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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 reported estimated at 23-37%.
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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

Definitions: as per ACOG 2024 guidelines, view cervical dilation of 6 cm as the start of the active phase of labor.
B
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Diagnostic procedures

Intrauterine pressure catheter monitoring: as per ACOG 2024 guidelines, use intrauterine pressure catheters in case of Ruptured membranes to determine adequacy of uterine contractions in patients with protracted active labor or when contractions cannot be accurately externally monitored.
B

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.
A

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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.
C

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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.
C
Do not perform operative delivery within 2 hours after commencing pushing, provided maternal status and fetal surveillance are normal.
D

Surgical interventions

Amniotomy: as per ACOG 2024 guidelines, perform amniotomy in patients undergoing augmentation or induction of labor to reduce the duration of labor.
A

More topics in this section

  • Cesarean delivery