CASE PROTOCOL DYSTOCIA

A 25 y/o primigravid is admitted at 6 am for hypogastric

and lumbosacral pains of 4 hours’ duration, associated
with scanty bloody mucoid discharge.

Antenatal history was unremarkable. Past, Personal and

social, Family, Gynecologic, and Immunization history
were likewise unremarkable.

On examination vital signs were normal.

Pertinent findings centered on the following:

Abdomen: globular, with linea nigra; fundic height is 32
cms. Leopold Maneuver (LM) 1 reveals a doughy slightly
irregular mass; LM2 : wide convex smooth surface on the
right, irregular nodularities on the left, FHT’s -140, RLQ;
LM3 : hard round mass, slightly ballotable; LM4; fingers
almost touching each other.

Internal exam showed the cervix is 4 cms. dilated, 80%

effaced, cephalic, station -4, intact membranes. Estimate
of fetal weight is 3 kgs.

Clinical pelvimetry : sacral promontory not accessible,

prominent ischial spines and convergent sidewalls. A
closed fist can barely be accommodated in between the
ischial tuberosities; sub-pubic angle is less than 90º.
Uterine contractions come every 3 minutes, lasting 50
seconds.

After 3 hours the cervix is 5 cms, station -2. After an hour

membranes rupture spontaneously, and cervix dilates to
8-9 cms, fully effaced, station 0. After 1 hour the cervix is
8-9 cms, station +1. The anterior fontanel was at the 3:00
position. In 2 hours the findings remain unchanged, but
there is note of caput succedaneum. Fetal heart tones
140/min.

Abdominal delivery is done.

Questions:

1. What is the position of the fetal head?

2. At what level was the head in the pelvis before

delivery?

3. What is the estimate of the pelvic capacity based

on clinical pelvimetry findings ?

4. Identify the abnormal labor pattern/s.

5. Give possible causes of abnormal progress in

this patient and correlate with the labor course.

6. Using the graph below, plot the partogram of

the patient’s course of labor and label
appropriately.