1. Dystocia Risk Factors

what is dystocia?

difficult or abnormal labor with poor cervical dilation, fetal descent, or both

how can epidural or excessive analgesia interfere with labor?

it can reduce the urge or ability to push effectively and prolong the second stage

how can maternal exhaustion affect labor?

it can make pushing less effective

• support rest between contractions and effective bearing-down efforts

• let mom push spontaneously

how can an occiput posterior position affect birth?

it can make fetal rotation and descent more difficult and prolong the second stage

how can a prolonged first stage affect the rest of labor?

it can increase maternal exhaustion and make pushing less effective

what does nulliparity mean?

no previous births at 20 weeks or later

• associated with increased risk of dystocia

why can short maternal stature increase concern for dystocia?

it may be associated with smaller pelvic dimensions

what fetal birth weight is associated with increased dystocia risk?

over 8.8 lb, approximately 4,000 g

what is shoulder dystocia?

the fetal head delivers, but one or both shoulders become trapped

• an obstetric emergency

how can abnormal fetal presentation or position cause dystocia?

it can prevent the fetus from fitting through or moving effectively through the pelvis

how can fetal hydrocephalus interfere with vaginal birth?

enlargement of the fetal head can make passage through the pelvis difficult

what is gastroschisis?

an abdominal wall defect that allows the intestines to protrude outside the fetal abdomen

• risk for dystocia

what additional factors are associated with difficult labor?

• multiples

• hydramnios

• maternal age over 35 years

• high caffeine intake

• overweight

• gestational age over 41 weeks

what is chorioamnionitis?

infection and inflammation of the fetal membranes and amniotic fluid

• associated with dystocia

how do ineffective uterine contractions contribute to dystocia?

they do not produce adequate cervical dilation or fetal descent

why is a high fetal station at complete dilation concerning?

the fetus has not descended as expected despite the cervix being fully open

• requires assessment, can have c-section

• dystocia risk factor

what should the nurse do immediately when shoulder dystocia is recognized?

• call for assistance

• help the team perform maneuvers to release the shoulder

what is the McRoberts maneuver?

sharply flexing the patient’s thighs toward her abdomen to help release the trapped fetal shoulder

where is suprapubic pressure applied during shoulder dystocia?

just above the pubic bone to help dislodge the fetal shoulder

what type of pressure must never be used to resolve shoulder dystocia? *

fundal pressure

• it can worsen shoulder impaction

• increase maternal and fetal injury, including uterine rupture