Symptom Finder - Dystocia
DYSTOCIA
Both physiology and anatomy must be applied to develop the differential diagnosis of dystocia. An abnormally long labor may result from inadequate abdominal muscle or uterine muscle contractions, obstruction of the birth canal, abnormalities of the fetus or placenta, and unusual positions of the fetus in the abdomen and pelvis.
1. Inadequate abdominal muscle contractions: This may be due to diastasis recti, ventral hernias, and obesity.
2. Inadequate uterine muscle contractions: This may result from malformations of the uterus, such as bicornuate uterus; multiple fibroids and other neoplasms of the uterus; drugs that inhibit uterine contractions, such as morphine and other sedatives; and
primary uterine inertia.
3. Obstruction of the birth canal: Look for ovarian cysts, uterine fibroids, cervical stenosis, deformities of the pelvis, impacted feces, and an enlarged bladder in this category.
4. Abnormalities of the fetus: This category includes large babies, polyhydramnios due to diabetes mellitus, hydrocephalus, abdominal neoplasms or ascites in the fetus, and twins or additional multiple births.
5. Abnormal position of the fetus: Breech presentation, transverse lie, face or brow presentation, and occipitoposterior presentations are included in this category.
Approach to the Diagnosis
Thorough examinations, sonograms, x-rays of the abdomen for fetal size and position, and amniocentesis are all useful procedures to assist in the diagnosis.
Both physiology and anatomy must be applied to develop the differential diagnosis of dystocia. An abnormally long labor may result from inadequate abdominal muscle or uterine muscle contractions, obstruction of the birth canal, abnormalities of the fetus or placenta, and unusual positions of the fetus in the abdomen and pelvis.
1. Inadequate abdominal muscle contractions: This may be due to diastasis recti, ventral hernias, and obesity.
2. Inadequate uterine muscle contractions: This may result from malformations of the uterus, such as bicornuate uterus; multiple fibroids and other neoplasms of the uterus; drugs that inhibit uterine contractions, such as morphine and other sedatives; and
primary uterine inertia.
3. Obstruction of the birth canal: Look for ovarian cysts, uterine fibroids, cervical stenosis, deformities of the pelvis, impacted feces, and an enlarged bladder in this category.
4. Abnormalities of the fetus: This category includes large babies, polyhydramnios due to diabetes mellitus, hydrocephalus, abdominal neoplasms or ascites in the fetus, and twins or additional multiple births.
5. Abnormal position of the fetus: Breech presentation, transverse lie, face or brow presentation, and occipitoposterior presentations are included in this category.
Approach to the Diagnosis
Thorough examinations, sonograms, x-rays of the abdomen for fetal size and position, and amniocentesis are all useful procedures to assist in the diagnosis.
