OBSTETRICS

LECTURE: 2.02 Abnormal Labor

LECTURER: Dr. Ryan B.Capitulo
DATE: September 30, 2016
TRANSCRIBER: Group 16 (Peña [09176721124] to Pimentel)
EDITOR: Nidua, Sarah Michelle (09163497394)

OUTLINE  The second stage of labor is full cervical dilatation until full
I. Review of Normal Labor expulsion or delivery of the baby.
A.Stages of Labor  Finally, the third stage of labor is the elapsed time from the
B. Phases of the First Stage of Labor expulsion of the baby until the delivery or expulsion of the
C. Functional Divisions of Labor placenta.
II. Dystocia
A. Definitions B. Phases of the First Stage of Labor
B. Complications
C. Causes
D. Passenger
E. Power
F. Passage
G. Diagnosis
III. Partograms
IV. Precipitous Labor

OBJECTIVES:
At the end of the lecture, the student should be able to:
1. Discuss normal labor
2. Distinguish normal from abnormal labor
3. Enumerate the complications of abnormal labor
4. Differentiate the causes of abnormal labor
5. Diagnose abnormal labor

References:
Lecturer’s ppt Figure 1.2 Phases of the First Stage of Labor (Adapted from
2017B Trans the lecturer’s pptx.) Composite of the average dilatation curve
WHO Managing Prolonged and Obstructed Labor for nulliparous labor. The first stage is divided into a relatively flat
latent phase and a rapidly progressive active phase. In the active
I. REVIEW OF NORMAL LABOR phase, there are three identifiable component parts that include
Normal Labor has different stages, different phases, and an acceleration phase, a phase of maximum slope, and a
different divisions deceleration phase. (Williams 24th ed)

A. Stages of Labor
Figure 1.1 Stages of Labor (Adapted from lecturer’s pptx.).
REMEMBER:
 The first stage of true labor is an interval from the onset of
regular painful uterine contractions until full cervical dilatation
of 10cms. (Note: false labor characterized by Braxton-Hicks
contractions do not constitute the first stage).
 The first stage of labor is divided into two phases: (a) latent
phase and (b) active phase
 The onset of latent labor is the point at which the mother
perceives regular contractions. The latent phase for most
women ends once dilatation of 3cm to 5cm is achieved.
[Thus] Cervical dilatation of 3 to 5 cm or more, in the
presence of uterine contractions, can be taken to reliably
represent the threshold for active labor. (William’s 24th ed)
o The cut-off mentioned by Dr. Capitulo for the latent
phase during the lecture however, is 4cms.
 The active phase has three subdivisions: (a) acceleration
phase, (b) phase of maximum slope, and (c) deceleration
phase.
a) Acceleration phase: cervical dilatation from 4cms to
6cms.
b) Phase of Maximum Slope: cervical dilatation from
6cms to 8cms.
c) Deceleration Phase: cervical dilatation from 8cms to
10cms.
d) The cervix dilates during the acceleration phase but
FASTEST dilatation is expected during the phase of
maximum slope.
 Sometimes, in less than 30 mins the cervix can dilate from
6cms to 8cms but the dilatation slows down from 8cms to
10cms – taking around 1-2 hours.

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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)
 The rate of cervical dilatation during the acceleration and
deceleration phases are similar but it is the fastest during
the phase of maximum slope.
REMEMBER: It is important to know these phases because the
descent of the head starts at the midpoint of the phase of
maximum slope while maximum descent only occurs at the start
of the deceleration phase at 8cms.
C. Functional Divisions of Labor
Figure 1.3 Functional Divisions of Labor (Adapted from the
lecturer’s pptx.) Labor course divided functionally on the basis
of dilatation and descent curves into (1) a preparatory division,
including latent and acceleration phases; (2) a dilatational
division, occupying the phase of maximum slope; and (3) a
pelvic division, encompassing both deceleration phase and
second stage concurrent with the phase of maximum slope
descent. (William’s, 24th ed)
1) Preparatory Division: during the preparatory division, the
cervix, the uterus, and the fetus are preparing for delivery.
o The cervix dilates a little with considerable change in the
connective tissue components. Sedation and analgesia
are capable of arresting this labor division. (William’s 24th
ed)
2) Dilatational Division: since the dilatation is fastest during
the phase of maximum slope, it is also functionally called the
“dilatational division”.
3) Pelvic Division: Corresponding to 8cms, the point of
maximum descent of the head is functionally called the pelvic
division. The head enters the pelvis at this point.
 The classic labor mechanisms that involve the cardinal fetal
movements of the cephalic presentation take place principally
during this pelvic division. (William’s 24th ed)
II. DYSTOCIA
a. Definitions
 Difficult Labor
 Abnormally slow progress of labor.
b. Complications
 Management of dystocia is aimed primarily at preventing its
complications.
1) Infection
o When labor is abnormally prolonged, there will be an
elongated time frame for the microorganisms to ascend
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through the vagina and infect the baby or the uterus
o The amniotic sac is a good barrier to prevent ascending
infection from the vaginal canal into the baby and the
uterus but during labor the bag of membranes is
ruptured, either physiologically or artificially so as to
hasten the delivery, there will be increased susceptibility.
o Repeat internal examinations done during prolonged labor
may also introduce further microbes by iatrogenically
pushing the microbes from the vagina into the uterus.
2) Uterine Atony
Figure 2.1 Uterine Atony (Adapted from medical
exhibits.com). The uterus is also a muscle thus it may get
fatigued after continuous contraction when labor is prolonged.
After delivery, due to its fatigue, the uterus will cease to contract
leading to postpartum hemorrhage and soon an eventful death.
Most maternal deaths during delivery are due to postpartum
hemorrhage.
3) Uterine Rupture
o If the baby won’t fit into the pelvis, the uterus will contract
against an obstruction. If dystocia is not diagnosed at this
point, the uterus will continue to contract leading to uterine
rupture. This is a hemorrhagic obstetrical complication.
4) Pathologic retraction ring (Bandl)
o When the uterus contracts against an obstruction, the
lower uterine segment expands and the junction between
the LUS, and the corpus and fundus (these are the
contracting portions) is then called the pathologic retraction
ring.
Figure 2.2 Pathologic Ring of Bandl (Adapted from the
internet). This is associated with marked stretching and thinning
of the lower uterine segment. The ring may be seen clearly as a
uterine indentation and signifies impending rupture of the lower
uterine segment. (Williams 24th ed)
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5) Fistula a. PASSENGER
o If there is obstructed labor, the head of the baby will remain
on the pelvic floor impinging on the structures around it. It
occludes the blood supply to the area eventually causing
ischemia and necrosis.

o When there is ischemia and necrosis in the posterior

vaginal wall, once it heals, a rectovaginal fistula forms:
 Patient’s Chief Complaint: “Doc. umuutot po ako sa
puerta”. (Flatus is coming out of my vagina. Eventually,
feces may come out from the vagina)

o When there is ischemia and necrosis in the anterior vaginal

wall, once it heals, a vesicovaginal fistula forms:
 Patient’s Chief Complaint: Continuous or uncontrollable
passage of urine like fluid from the vagina. Since most
patients believe that urine comes out of the vagina, they
won’t say: “Doc umiihi po ako sa puerta”.
 High incidence in Subsaharan Africa.

6) Pelvic Floor Injury

o When the head stays for a prolonged period of time in the
pelvis, it may injure the pelvic diaphragm or floor causing
tears in the muscle or ligaments which can lead to either
urinary or fecal incontinence.

7) Lower Extremity Nerve Injury

o Can occur if the patient is in the dorsal lithotomy position
for a long time during the second stage of labor. The
peroneal nerve (the nerve passing through the hips going
into the lower extremity) will be compressed and injured.
Sometimes the patient is unable to walk for 6 months.
 As prevention, the legs are straightened and removed
from the stirrups intermittently.
8) Fetal Injury
o Because the uterus is continually contracting against the
head of the baby, hypertonic contractions may lead to:
 Intracranial hemorrhage
 Brachial Plexus Injury
 Fractures and Trauma
 Death
c. Causes of Dystocia
Any abnormality in any of the 3P’s below will lead to abnormal
labor.
REMEMBER:
a. Passenger (the fetus)
 Refers to fetal abnormalities of PRESENTATION,
POSITION, DEVELOPMENT, and LIE.
b. Power (uterine factors)
 Refers to fetal abnormalities resulting from EXPULSIVE
FORCES during labor and delivery that includes BOTH
UTERINE CONTRACTIONS AND MATERNAL EFFORT.
Figure 2.3 Fetal Head Diameters/ Cephalometric
measurements (Adapted from the lecturer’s pptx.). The birth
canal is a very tortous space and the baby has to insinuate itself
in between thus to get through cardinal movements must be
done by the baby. Movement is brought about by both the fetal
head size and the maternal pelvis.
 Review of the Cardinal Movements of Labor (E D’FIRE ERE)
(Mnemonics: “After Engagement, Don’t Forget I Enjoy
Expensive Equipment”)
1. Engagement
 The bone referred to when discussing engagement is the
parietal bone. It is defined as the passage of the
BIPARIETAL DIAMETER (9.5cm) through the pelvic
inlet.
 This cannot be determined by internal examination
because the pelvic inlet is unreachable and since the head
may already be there, the finger cannot be inserted to
where the BPD is.
 How to clinically determine engagement:
o Station ZERO: when the most dependent portion of
the fetal head is at the level of the ischial spine, the
baby is engaged.

c. Passage (pelvis)
 Refers to fetal abnormalities resulting from passage
through the BONES and SOFT TISSUES OF THE
PELVIS.

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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)

6. Expulsion / Delivery

Figure 2.4 Fetal Stations: Engagement (Adapted from the

internet). How do we know that the BPD has traversed the
inlet already porket nasa spine na yung tip of the head?
There are 5 stations above station 0 where the pelvic spine.
The 5th cm is in the level of the pelvic inlet. We are sure that
the BPD has already traversed the inlet when the tip of the
head is at the level of the spine because from the tip of the
head to the biparietal bone is just 3cms. Thus, the pelvic inlet
-5cm from station 0 has already been traversed since the
BPD is already in station -3. 2cms have been traversed at
this point. FIGURE 2.5 Longitudinal lie. Cephalic presentation. (Adapted
from Williams, 24th ed). Differences in attitude of the fetal body in
 The distance between the inlet to the spine is 5cm. (a) vertex, (b) sinciput, (c) brow, and (d) face presentations. Note
 The distance between the spine to the introitus is 5cm. changes in fetal attitude in relation to fetal vertex as the fetal
head becomes less flexed. MEMORIZE THE NUMBERS!!!
2. Descend
o As the head descends it encounters resistance on the
pelvic floor.
o When it is not yet flexed, the diameter of the head that
tries to enter the pelvis is the FO Diameter: 11.5cm; this
will not fit. Editor’s notes:
o When the head of the baby flexes to adapt to the pelvis, it
is the SOB Diameter: 9.5cm that presents. Fetal lie - relation of the fetal long (cephalocaudal)
axis to that of the mother. It is either longitudinal
3. Internal Rotation (vertical) or transverse (horizontal).
o The head will now encounter the bi-spinous diameter (the Fetal Presentation – Presenting part is the
distance between the two ischial spines). portion of the body that is either foremost within the
o The presenting diameter is the BPD: 9.5cm birth canal. It can be felt through the cervix on
o The head has to internally rotate because it will use the vaginal examination. Denotes the body that will first
SYMPHYSIS PUBIS as a FULCRUM for EXTENSION so contact the cervix.
that it can come out of the introitus. Fetal Attitude / Posture – Degree of flexion of a
o You still cannot see the baby until this point. fetus assumes during labor or the relation of fetal
parts to each other.
4. Extension Fetal position - the relationship of the presenting
o The point in which the baby is seen. part to a specific quadrant of a woman’s pelvis.
o Head on the introitus (eg. LOA, ROA)
o After internal rotation, the sharply flexed head reaches the Example: The picture on figure 2.5
vulva and undergoes extension. If the sharply flexed Fetal lie: longitudinal (long axis of the baby is
head, on reaching the pelvic floor, did not extend but was along with the long axis of the mother)
driven farther downward, it would impinge on the posterior Presentation: cephalic (since it is the head that will
portion of the perineum and would eventually be forced come out first upon birth)
through the perineal tissues (Williams, 24th ed) Attitude or posture: different pictures shows
different attitude of the baby
5. External Rotation / Restitution Fetal position: can’t be determined because the
o The body of the baby does not move, ONLY THE HEAD! baby not placed inside pelvis.
o Extension and external rotation happens VERY FAST
o This movement corresponds to rotation of the fetal body
and serves to bring its bisacromial diameter (outermost
portion of the shoulders) into relation with the
anteroposterior diameter of the pelvic outlet. (Williams,
24th ed).

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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)

TYPES OF ATTITUDE IN CEPHALIC PRESENTATION

a) VERTEX PRESENTATION:
o Presenting diameter: SOB diameter (9.5cms)
o Can easily fit into the pelvis. No abnormal labor
o No dystocia.

Figure 2.9 Brow posterior presentation.

d) FACE PRESENTATION
FIGURE 2.6 Vertex fetal attitude. Complete flexion allows the
o With this presentation, the head is hyperextended so that
smallest diameter (SOB) of the head to enter the cervix.
the occiput is in contact with the fetal back, and the chin
(mentum) is presenting. (William’s 24th ed)
b) SINCIPUT/MILITARY PRESENTATION:
o Presenting diameter: SUBMENTOBREGMATIC (9.5cm)
o Cases wherein the head do not flex.
– not a usual diameter because this presentation is very
o Presenting diameter: Fronto-occipital (FO) diameter
rare.
(12.5cms)
o REMEMBER: Can deliver vaginally IF internal rotation
o Can cause abnormal labor because the head will not fit.
occurs and the mentum is ANTERIORLY located -
because when it delivers it is able to use the symphysis
pubis as a fulcrum
o Very rare
o A mentum posterior presentation is undeliverable because
of the resistance from the sacrum and the delivery table
except with a very preterm fetus.
 Do a Caesarian Section if mentum is posterior

FIGURE 2.7 Sinciput Presentation. Did not flex causing FO

presentation of the head.

c) BROW PRESENTATION:
o The fetal head occupies a position midway between full
flexion (occiput) and extension (face). Except when the
fetal head is small or the pelvis is unusually large,
engagement of the fetal head and subsequent delivery
cannot take place as long as the brow presentation
persists. (William’s 24th ed)
o Pelvis is too small, head is too big.
o Instead of flexing, it extends a bit, then you can palpate FIGURE 2.10 Face presentation. The occiput is the longer end
the brow ridge. of the head lever. The chin is directly posterior. Vaginal delivery
o Presenting diameter: Mento-occipital (MO) (13.5cms) is impossible unless the chin rotates anteriorly.
o POOREST PROGNOSIS FOR VAGINAL DELIVERY
because MO is the largest diameter.
o Very rare and transient, can convert.
o If it does not convert, do a Caesarian Section.

FIGURE 2.11 Actual face presentation. (Adapted from

lecturer’s pptx) A case wherein the baby was delivered vaginally
FIGURE 2.8 Brow Presentation. With the head hyperextended,
because the mentum was anteriorly located. When the baby was
it will present mentooccipital diameter of the head.

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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)
delivered, instead of extending, it flexed because the opposite
occurred on the inside. The Face of the baby is usually
edematous because of intrapartum impingement.
Figure 2.12 Compound presentation (A) The left hand is lying
in front of the vertex. With further labor, the hand and arm may
retract from the birth canal, and the head may then descend
normally. Not a problem, just sweep up the hands and labor can
proceed.
Figure 2.13 Compound presentation (B) Photograph of a small
34-week fetus with a compound presentation that delivered
uneventfully with the hand presenting first. Hands are also
edematous due to head compression.
Figure 2.14 Transverse lie. Right acromiodorsoposterior
(RADP). The shoulder of the fetus is to the mother’s right, and
the back is posterior. Cannot be delivered vaginally because the
baby cannot fold by itself unless it’s dead! If the baby is alive,
deliver this via C/S.
b. POWER
 Refers to the expulsive forces during delivery
o Uterine contractions
o Maternal effort
 Needed during the 2nd stage of labor to expel the
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baby, or else the baby won’t be delivered.
 The voluntary muscle effort from the mother.
 Measured using Montevideo units
Figure 2.15 Diagrams of the birth canal. A. At the end of
pregnancy. B. During the second-stage of labor, showing
formation of the birth canal. C.R. = contraction ring; Int = internal;
Ext = external. At the onset of labor cervix is still elongated. With
the onset of contraction, the primary purpose is to efface the
cervix (thinning and eventually obliterating it, parang nawawala
na ung cervix), it can only achieve full cervical dilatation if it is
fully effaced, the one responsible for this is UTERINE
CONTRACTIONS. Uterine contractions are reinforced on the
second stage of labor by the voluntary muscular action of the
abdominal wall, or PUSHING.
Figure 2.16 Montevideo units are calculated by subtracting the
baseline uterine pressure from the peak contracture pressure for
each contraction in a 10-minute window and adding the
pressures generated by each contraction. In the example shown,
there were five contractions, producing pressure changes of 52,
50, 47, 44, and 49mmHg, respectively. The sum of these five
contractions is 242 Montevideo units. The graph above
corresponds to the fetal heart rate while the graph below
corresponds to the uterine contractions.
 How to interpret Montevideo Units:
1. Recorded for 10 minutes
2. Measured by subtracting base contraction from the peak
of contraction.
3. Get the sum of the differences of each contraction in a 10
minute trace.
4. A sum of greater than or equal to 200 contractions for 10
minutes signifies ADEQUATE CONTRACTION. If less
than 200, it is already abnormal, as such, it is called
hypotonic or inadequate uterine contractions.
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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)

o Diagonal conjugate must not be less than or equal to

 Patients must be in the active phase because strong uterine 11.5cm (contracted)
contractions are not to be expected during the latent phase.  Engagement- only cardinal movement that involves inlet

 Types:
1. Hypotonic Uterine Dysfunction: Montevideo units less
than 200 for 2 hours.
2. Hypertonic or Incoordinate Uterine Dysfunction: Very
strong, yet uncoordinated uterine contractions. (Minsan
strong, minsan mild, minsan every minute, minsan every
ten minutes).
 Causes of contractions or power problems:
1) Epidural analgesia
 May cause insignificant but prolonged first and
second stages of labor.
 Labor pain is pain of dysmenorrhea multiplied 1000x.
 Pain of labor does not go away in epidural
anaesthesia, it is just LESS PAIN, it is NOT PAIN
FREE.
2) Chorioamnionitis
 Infection of the membrane, of the endometrium and
of the uterus.
B. Midpelvis
 Bispinous diameter
o <10cm midpelvis is contracted
o Should not be less than 10cm so that BP diameter
can pass through (9.5cm)
 Posterior sagittal diameter
o REMEMBER: Determines roominess of the pelvis
o Midpoint of bispinous diameter and distance from that
point to the sacrum
o Where all cardinal movements as far as internal
rotation (except engagement) take place
o Determined by assessing the sacrosciatic notch
(formed by the spine, notch and the sacrum)
 Place 2 fingers in the space, must be at least
4.5cm
 Narrow: contracted midpelvis- prolonged labor or
will not fit

3) Maternal position during labor

 Some say that ambulation during labor will hasten/
shorten labor, but this has yet to be proven, hence,
remain as anecdotal evidences.
 WHO allows assuming any position during labor, as
long as the mother is COMFORTABLE.

4) Birthing position

c. PASSAGE

Figure 2.18 (red circle) Posterior sagittal diameter- midpoint

of bispinous diameter and distance from that point to the
sacrum; determines roominess of the pelvis for
accommodation of the cardinal movements (TANDAAN
NIYO YAN!!!)

C. Outlet
 Bituberous diameter
o Distance between the two tuberosities
o Place fist in between the space
 Very rare to have contracted outlet
Figure 2.17 Different measurements of the pelvis assessed
through clinical pelvimetry. A measurement that is too small is
considered contracted and may cause complications of delivery.

Clinical Pelvimetry
A. Inlet
 Diagonal Conjugate- from inferior border of symphysis
pubis to the sacral promontory
 Obstetric conjugate
o Where baby’s head will pass through
o Cannot be directly measured by IE
o OC= Diagonal Conjugate – 1.5
o OC <10cm inlet is contracted, baby may not be able Figure 2.19 Bituberous diameter- distance between two
to pass through tuberosities; measured with fist, assesses outlet

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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)

d. Diagnosis o MUST have descended first

o 8cm, station 0  after an hour 9cm, station +1 
after an hour 10cm full cervical dilatation, station
+1
 Failure of descent
o No descent in deceleration phase or second stage
o At 8cm, station 0  after an hour 10cm fully
dilated, station 0
o As long as there is no descent from 8cm onwards
(see figure 3.7)
 For arrest disorders, management is caesarian section

Figure 2.20 Abnormal Labor Patterns, Diagnostic Criteria,
and Methods of Treatment. See appendix for a larger
picture. MEMORIZE!!!
III. PARTOGRAPH
Partograph: “A record of all of the clinical observations made on
a woman in labor, the central feature of which is the graphic
recording of the dilatation of the cervix, as assessed by vaginal
examination, and descent of the head”. (WHO, 2008)

A. Prolongation Disorder
 Latent phase disorders: 0-4 cm
 Nulliparous: does not go beyond 4 cm after 20 hrs.
 Multiparous: does not go beyond 4 cm after 14 hrs.
 Considered dystocia but caesarian is not indicated yet
 Management: bed rest or oxytocin
 If there is no cephalopelvic disproportion (CPD- adequate
pelvis and baby is normal in size), oxytocin may be given to
hasten labor if there is an urgency to deliver
 BUT usually, bed rest only.
Figure 3.1 Normal Partograph
B. Protraction Disorder
 Protracted active-phase dilatation
o Active-phase: 4cm onwards
o Nulliparous- rate of cervical dilatation slower than
1.2cm/hour
 SAMPLE QUESTION (on a graph) 10am- 4cm;
12nn- 6cm; 2pm- 7cm
 3cm/4hrs= 0.75cm/hr –ABNORMAL
o Multiparous- rate of cervical dilatation slower than
1.5cm/hr
 Protracted descent
o Deceleration phase disorders: 8cm onwards
o Nulliparous- rate of descent slower than 1cm/hour, 1
station per hour
o Multiparous- rate of descent slower than 2cm/hour
Figure 3.2 Abnormal Labor Patterns.
 Management: Expectant management/ oxytocin OR
Caesarian section
 Prolonged deceleration phase: From 8 cm, there is slow
cervical dilation to 10 cm.
C. Arrest Disorder
 Secondary arrest of dilatation: After 4 cm, cervix dilated but
 Prolonged deceleration phase after 2 hours, it remained at 6 cm.
o Deceleration: 8-10cm  Protracted active phase: From 4 cm to 10 cm is 6 cm and it
o Nulliparous: >3 hours to reach 10 cm took the patient 6 hours. 6 cm divided by 6 hours is 1
o Multiparous: >1 hour to reach 10 cm cm/hour. That’s protracted dilatation. It should be 1.2
 Secondary arrest of dilatation cm/hour for nulliparous and 1.5cm/hour for multiparous.
o Only diagnosed during the active phase: 4 cm  Prolonged latent phase: It took the patient too long to reach
onwards (TANDAAN NIYO YAN!!!) 4 cm. The cut off is 20 hours for nulliparous and 14 hours for
o Nulliparous and Multiparous- no change in cervical multiparous.
dilatation for 2hrs
 Arrest of descent
o Deceleration phase: 8cm
o At 8cm, head descends but STOPS
o Nulliparous and Multiparous: stops at a station for more
than an hour

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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)
8 cm
Figure 3.3 Abnormal Labor Patterns. Broken lines represent
normal labor.
A. Secondary arrest of dilatation (see Figure 3.1)
B. Prolonged deceleration phase (see Figure 3.1)
C. Failure of descent: After 8 cm, there is no change in station
during the deceleration phase. This is not arrest because
there is NO descent that happened.
D. Arrest of descent: During the deceleration phase, there is
descent of the head but it stopped.
Note: The following are adapted from 2017B Trans:
Abnormal Partographs
1. Protracted Cervical Dilatation
Figure 3.4 Dilatation is less than 1.2 cm/hour. The patient is
admitted at the 2nd hour and dilatation is 3 cm. At the 4th hour, it
is still 3 cm. After about 11 hours, the cervical dilatation
increased by 3.5 cm only. There is progressive but slow
dilatation.
2. Arrest of Cervical Dilatation
Figure 3.5 It shows progressive dilatation but after the 12th hour,
there was NO dilatation for 2 hours.
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3. Arrest of Descent
Figure 3.6 There was INITIAL DESCENT but it STOPPED at the
8th hour for 2 hours. Green bracket: (+) descent in the
deceleration phase (8 cm-10cm). Red circle: Arrest of descent at
station -1.
4. Failure in Descent
Figure 3.7 NO DESCENT AT ALL for more than an hour in the
pelvic division. Green bracket: No descent from 8cm–10cm. This
is in contrast to arrest of descent wherein there is initial descent.
Take note: Deceleration phase starts at 8cm and failure of
descent is considered as long as there is NO descent from 8cm
onwards. (Compare to Letter C of Figure 3.3)
IV. PRECIPITOUS LABOR
A. Definitions
 Extremely rapid labor and delivery
 Delivery of fetus in less than 3 hours from the onset of labor
o Example: “Nag-labor siya ng 1 o’ clock; 4 o’ clock
lumabas na si baby. That’s precipitous labor and that’s
not good.”
 Cervical dilatation of 5 cm per hour
o Example: At 1 hour: 0-5cm and then after an hour: full
cervical dilatation
B. Complications
1) Uterine atony
o The reason why they’re having precipitous labor is
because the uterine contractions are very strong. When
the uterine contractions are very strong, the uterus can
rupture. But uterine atony is also a complication
because after delivery, the uterus will be tired from the
vigorous contractions for 3 hours of labor.
2) Genital tract lacerations
o During labor, the time it takes for the cervix to dilate or
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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)
reach full cervical dilatation is also needed by the
vaginal mucosa and the other structures in the pelvis so
that they will expand slowly as the head descends (slow
expansion of the vaginal canal). When labor is too fast,
there’s not enough time for the vaginal canal to expand.
It will explode (mawawasak). There will be genital tract
lacerations as a result of precipitous labor.
3) Placental abruption
o Premature separation of the placenta
o Abruptio placenta
o This can lead to fetal death because we want the
placenta to separate after the delivery. When the baby
is already breathing, has established circulation and is
no longer reliant on the circulation of the placenta, that’s
when we want the placenta to separate.
o If the baby is still inside and the placenta separates
prematurely because of the vigorous labor, it can lead
to fetal death, to intrauterine hemorrhage or to maternal
death.
4) Amniotic fluid embolism
o When the uterus is also vigorously contracting, the
amniotic fluid may find itself in the maternal circulation
o It is fatal or catastrophic or it can lead to cardiac arrest,
etc.
5) Intracranial trauma, palsy, birth injuries
o When the uterus is contracting so strongly, it can lead
to injuries in the baby (Maiipit nang maiipit yung baby.)
and in can lead to intracranial hemorrhage, trauma,
brachial plexus palsy and birth injuries.
SUMMARY
1. Discuss normal labor.
Review Figure 1.1: Stages of Labor
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Review Figure 1.3: Functional Divisions of Labor
2. Distinguish normal from abnormal labor.
Normal labor is labor that occurs within the established
parameters as indicated in the above figures. Abnormal labor
may be dystocia, an abnormally slow labor, or precipitous, an
extremely rapid labor and delivery.
3. Enumerate the complications of abnormal labor.
See Section II. Dystocia
 Infection
 Uterine Atony
 Uterine Rupture
 Pathologic Retraction Ring of Bandl
 Fistula
 Pelvic Floor Injury
 Lower Extremity Nerve Injury
 Fetal Injury
4. Differentiate the causes of abnormal labor.
3 Ps: Passenger, Power, Passage
 Passenger – fetal presentation, position, development, lie
 Power – expulsive forces during labor: uterine contractions
and maternal effort
 Passage – passing through bones and pelvic soft tissues
5. Diagnose abnormal labor.
Memorize Figure 3.0 and sections A. Prolongation Disorder; B.
Protraction Disorder; C. Arrest Disorders
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OBSTETRICS: 2.02 ABNORMAL LABOR (2018B)

REVIEW QUESTIONS 7. In breech, delivery of the fetal head is accomplished by

1. Which is considered the most important Power? which maneuver?
a. Hydrostatic pressure of the cervix a. Johnson’s
b. Uterine contractions b. Brandt Andrew
c. Maternal Valsalva c. Mauricean
d. Pinard
2. Which of the following is the shortest pelvic inlet diameter?
a. Diagonal conjugate 8. Conduplicato corpore refers to the mechanism of delivery in
b. True conjugate which of the following conditions?
c. Obstetric conjugate a. Oblique lie
d. Transverse diameter b. Shoulder presentation
c. Asynclitism
3. Which of the following will most likely lead to undue
prolongation of labor? 9. What is the first maneuver to be performed in shoulder
a. Asynclitic fetal head dystocia?
b. Fetus with congenital heart block a. McRobert’s maneuver
c. Painful labor b. Suprapubic pressure
c. Rubin’s maneuver
4. Best enhances uterine contraction: d. Wood’s
a. O2 inhalation
b. Oxytocin 10. Which of the following labor abnormalities are present
c. Amniotomy during the dilatation division?
d. Nipple stimulation a. Arrest in descent
b. Failure of descent
5. In which of the following presentations would cord prolapse c. Prolonged deceleration
most likely be the complication? d. Arrest in cervical dilatation
a. Frank breech
b. Shoulder 11. What is the fatal complication of injudicious use of oxytocin?
c. Sinciput a. Precipitate delivery
d. Brow b. Caput succedanum
c. Uterine rupture
6. This condition is best managed by caesarean section. d. Uterine hypotonia
a. Occiput posterior
b. Occiput anterior Answers:
c. Mentum anterior 1. B , 2. C, 3. A, 4. B, 5. B, 6. D, 7. C, 8. B, 9. B, 10. D, 11. C
d. Mentum posterior

APPENDIX

MEMORIZE THIS TABLE: Abnormal Labor Patterns, Diagnostic Criteria, and Methods of Treatment

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