DYSTOCI A Assoc Prof Pawin Puapornpong DYSTOCIA OR

DYSTOCI A Assoc. Prof. Pawin Puapornpong

DYSTOCIA OR OBSTRUCTED LABOR Cause: • Passage • Passenger • Power

PASSAGE Pelvimetry Inlet Midplane Outlet

PELVIMETRY Diagonal conjugate diameter Interspinous diameter Pubic angle Intertuberous diameter

PASSENGER Fetal weight estimation Palpation Ultrasound CT scan/ MRI

POWER Uterine contraction Palpation External monitoring Internal monitoring

MONTEVIDEO UNIT Use for uterine contraction assessment Need intrauterine pressure monitoring Good uterine contraction: more than 200 Montevideo unit in 10 minutes

ASSESSMENT History&physical examination Partogram Friedman curve

MANAGEMENT Diagnosis Counseling&Treatment

ABNORMAL PRESENTATION Occiput posterior position/occiput transverse position Breech presentation Face presentation Brow presentation Transverse lie; shoulder/acromion presentation Compound presentation

PELVIC TYPES Gynecoid type Android type Anthropoid type Platypelloid type Mixed type

CALDWELL-MOLOY CLASSIFICATION Gynecoid Pelvis (50%) Android Pelvis (Male type) Pelvic brim is a transverse ellipse (nearly a circle) Most favorable for delivery Pelvic brim is triangular Convergent Side Walls (widest posteriorly) Prominent ischial spines Narrow subpubic arch More common in white women Anthropoid Pelvis Pelvic brim is an anteroposterior ellipse Gynecoid Pelvis turned 90 degrees Narrow ischial spines Much more common in black women Platypelloid Pelvis (3%) Pelvic brim is transverse Kidney shape Flattened gynecoid shape

BREECH ASSISTING

ARM DELIVERY ASSISTING Classical method Lovset’s method

การชวยคลอดศรษะ Mauriceau-smellie-veit method Forceps to aftercoming head (Piper forceps(

Deflexion attitude • Bregma presentation • Brow presentation • Face presentation

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