PROBLEMS of THE PASSAGEWAY
 MID PELVIS CONTRACTION-
1. ABNORMAL SIZE OR SHAPE OF THE PELVIS
 Narrowing of the passageway/birth canal
 Happen in the inlet, outlet and midpelvis
 Types of pelvis
 Gynecoid
 Anthropoid- oval inlet, ape
 Android – male pelvis, hear shaped
 Platypelloid- compressed front-
back, oval
 The narrowing causes: CPD and failure
to progress in labor.
Factors influencing the size and shape of the
pelvis:
 Developmental factor: hereditary or
congenital
 Racial factor
 Nutritional factor: Malnutrition results in
small pelvis
 Sexual factor: as excessive androgen may
produce android pelvis
 Metabolic factor: as rickets and
osteomalacia
 Trauma, diseases or tumors of the bony
pelvis, legs or spines
2. CEPHALOPELVIC DISPROPORTION/ CPD
 Is suggested by lack of engagement at the
beginning of labor, prolonged first stage and
finally poor fetal descent.
 A disproportion between the size of the fetal
head and the pelvic diameters. This result in
failure to progress labor.
 INLET CONTRACTION- Narrowing of the
anteroposterior diameter to less than 11 cm or of
the transverse diameter to 12 cm or less
Causes
 Rickets in early life
 Small pelvis
Effects
 Floating vertex presentation with no descent
during labor
 Abnormal presentation\
 Prolapsed cord extremity
 Considerable molding of the fetal head
 Caput succedaneum formation
 Prolonged rupture of the membranes
 If allowed to continue, abnormal thinning of
the lower uterine segment may occur with
development of Bandl’s retraction ring or
even uterine rupture.
 CS is the treatment of choice in true inlet
contraction
Management
 If minor inlet contraction- spontaneous delivery
 If with moderate and severe degrees
 induction of labor
 CS
 Trial Labor
 OUTLET CONTRACTION- Narrowing of the
transverse diameter at the outlet to less than 11
cm. This is the distance between the ischial
tuberosities, a measurement that is easy to
make during a prenatal visit.
 The interspinous diameter is estimated by
palpating the ischial spines.
 Most frequent than inlet dyticia because the
midpelvis is maller than the inlet and positional
abnormality is more common at this level
 An estimated distance of >9 cm
Effects:
 Arrest of descent
 Poor application of the head to the cervix
 Abnormal rate of cervical dilatation
3. SHOULDER DYSTOCIA
 Occurs at the 2nd stage of labor when the infant
head is born but the shoulders are too btoad to
enter and be delivered thru the pelvic outlet.
 Hazardous to the mother- can result in vaginal
cervical tear
 Hazardous to the fetus == cord compression
 Occur with women with diabetetis, multipara,
post dated pregnancies
Risk Factors
a) Brachial plexus injury
b) Brain injury- due to lack of o2 r/t cord
compression of umbilical cord
c) Chest compression leading to the
uncoordinated breathing
Management
 Mc Robert’s Manuever- mother is sharlply
flexing her thighs on her abdomen
 Suprapubic pressure
PROBLEMS OF THE PSYCHE FACTORS
1. Inadequate Voluntary Expulsive Forces
2. Fear/ anxiety
 Psyche is the woman’s psychological
outlook or refers to the state or feeling that a
woman brings into labor.
 A feeling of apprehension or Fright.
 Women without adequate support can have
a labor experience so frightening and
stressful which can develop a post traumatic
stress syndrome.
Nursing care management
 Encourage women to ask questions at
prenatal visitsand to attend preparation for
childbirth classes help prepare them to
labor.
 Encourage to share their experience after
labor serves a briefing time and helps them
integrate the experience into their totallife.