 Abnormalities of the 3 P's of labor

o Pelvis: size and shape of the maternal pelvis (e.g., small bony pelvis)
o Passenger: size and position of the infant (e.g., fetal macrosomia or abnormal
orientation)
o Power: strength and frequency of contractions (e.g., dysfunctional contractions),
hypertonic uterus and inadequate contractions. if the contractions are too strong or too
frequent, too weak or not frequent enough, if contractions are not coordinated, cervical
corporal dystochia
 Dystocia literally means difficult labour and it is characterized by abnormally slow progress of
labour
 Abnormalities of the expulsive forces–either uterine forces insufficiently strong or
inappropriately coordinated to efface and dilate the cervix (uterine dysfunction); inadequate
voluntary muscle effort during the second stage of labour
 Clinical picture : Inadequate cervical dilation or fetal descent : Protracted labour (slow progress),
arrested labour (no progress), Inadequate expulsive effort (ineffective „pushing”)
 Malfunction of abdominal forces : Age, Debility, Pain,Herniation of uterus, Ruptured diaphragm,
Perforated trachea
 Causes of uterine dysfunction : Chorioamnionitis, Maternal position during labour (different
results; no evidence for or against walking during labour), Birthing position in second-stage
labour (no evidence for or against different positions during the second stage), Immersion in
water.
 Treatment of uterine dysfunction:
Oxytocininfusion2.Glucoseinfusion3.Mobilization4.CervixdilatationProstaglandinsDrotaverin+
OpiatesParacervicalblockEpiduralanalgesia5.PerinealrelaxationPudendalblockEpiduralanalg
esiaSpinalanalgesia

hypotonic uterus : more common•no basal hypertonus•uterine contractions have a normal gradient
pattern•the slight rise in pressure during a contraction is insufficient to dilate the cervix.

The cause of hypotonic labor is uterine inertia, also known as hypotonic or hypocontractile uterine
dysfunction. Though the etiology of the inertia is unknown, these conditions are commonly
associated with hypocontractile uterine dysfunction:

 Uterine overdistension and overuse as seen in multifetal gestation, fetal macrosomia,

polyhydramnios and grand-multiparity
 Rupture of the uterus (ectopic) or torsion
 Mechanical disruption of myometrial function from myoma or distension of the bladder or
bowel
 Malpositioning and malpresentation of the fetus, where there is absent reflex in uterine
contraction, due to inadequate contact of the presenting part onto the lower uterine segment
 Abnormal uterine axis as seen in a pendulous abdomen. There is an exaggerated anteversion of
the uterus.
 Uterine deformities or myometrial disorganization as seen with developmental uterine
hypoplasia and extensive myomectomy
 Prematurity below 30weeks gestation where oxytocin receptors are not fairly established
 Other general/systemic causes may include maternal anemia, maternal exhaustion, and
improper use of analgesia in labor
 Hypertonic uterine dysfunction•either basal tone is elevated or the pressure gradient is
distorted•complete asynchronism of the impulses originating in each cornu
