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Failure to Progress

Aka: Failure to Progress, Labor Dystocia, Cephalopelvic Disproportion, CPD
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  1. See Also
    1. First Stage of Labor
    2. Labor Dystocia Management
    3. Labor Dystocia Prevention
  2. Epidemiology
    1. Labor Dystocia is responsible for 50% of Cesereans
      1. Primary Ceserean rate: 20% in U.S.
  3. Criteria for active phase delay or arrest
    1. Background
      1. Based on Friedman Curve
      2. Assumes Active Phase of Labor
        1. Cervix dilated to 4 cm and
        2. Frequent contractions
    2. Protracted labor (slow rate of dilation and descent)
      1. Nulliparous women
        1. Fetal Descent: <1 cm/hour
        2. Cervical Dilation: <1 cm/hour
      2. Multiparous women
        1. Cervical Dilation: <1.5 cm/hour
        2. Fetal Descent: <2 cm/hour
    3. Arrest of Labor (complete cessation of progress)
      1. Active labor without change in descent for 1 hour
      2. Active labor without change in dilation for 2 hours
        1. Pause for 2 hours in dilation is common <7 cm
          1. Zhang (2002) Am J Obstet Gynecol 187:824-8
        2. Consider extending c-section indication to 4 hours
          1. Would decrease cesarean rate from 26 to 8%
          2. Rouse (2001) Obstet Gynecol 98:550-4
  4. Risk factors for Failure to Progress
    1. Obesity in nulliparous women
      1. Increased risk of ceserean delivery
      2. Decreased cervical dilation risk
      3. Increased labor duration
      4. Nuthalapaty (2004) Obstet Gynecol 103:452-6
  5. Etiologies for Failure to Progress
    1. Consider Macrosomia
      1. Gestational Diabetes
      2. Excess weight gain
      3. Older patient
      4. Multiparous
    2. Consider Cephalopelvic Disproportion (CPD)
      1. Pelvic Inlet AP <10 cm
      2. Midpelvis Interspinous <9 cm
      3. Outlet intertuberosity <8 cm
    3. Consider Fetal Malpresentation
      1. Occiput Posterior (consider manual rotation)
  6. Evaluation
    1. Confirm that patient is in Active Phase of Labor
      1. Cervix at least 4 cm dilated and
      2. Regular contractions
    2. Confirm cervical dilatation
      1. No anterior lip if "complete"
      2. Check Cervix q1-2 hours if membranes intact
      3. Assess for fetal malposition (e.g. Occiput Posterior)
    3. Confirm Fetal Presentation
      1. Digital cervical exam
      2. Consider Ultrasound if unsure of Fetal Presentation
    4. Empty Bladder (consider catheterization)
    5. Evaluate maternal hydration status
    6. Evaluate for adequate pushing or Powers
      1. Consider IUPC to document adequate contractions
      2. Adequate contractions: 200-300 montevideo Units
        1. Cumulative contraction amplitudes for 10 minutes
    7. Consider graphing labor curve (partograph)
  7. Management
    1. See Active Management of Labor
  8. Prevention
    1. See Prevention of Labor Dystocia
  9. References
    1. Shields (2000) ALSO, F:1-14

Dystocia (C0013418)

Definition (MSH) Slow or difficult OBSTETRIC LABOR or CHILDBIRTH.
Concepts Disease or Syndrome (T047)
MSH D004420
ICD9 661.9
ICD10 O66.9
SnomedCT 45757002, 199746004, 111448009, 289255001, 237323007, 199816006
English Labor, abnormal, Labor, dysfunctional, Dystocias, ABNORMAL LABOR, Unspecified abnormality of labor, Abnormal labor, NOS, LABOR ABNORMAL, LABOR DIFFICULTY, Dystocia, NOS, Dystocia NOS, Abnormal labour, NOS, dysfunctional labor (physical finding), dysfunctional labor, Dystocia (disorder), Labour problem (disorder), dysfunctional labor was observed, Abnormal labor, Labor abnormal, Abnormal labour, Unspecified abnormality of labour, Dystocia NOS (finding), Dystocia [Disease/Finding], difficult labor, abnormal labor, labour problems, dystocias, Labour abnormal, Difficult labor, Dysfunctional labor, Dysfunctional labour, Difficult labour, Labor problem, Labour problem, Labor problem (finding), Dystocia, dystocia, abnormal; labor, Dystocia (disorder) [Ambiguous]
Italian Travaglio anormale, Anomalia del travaglio non specificata, Distocia
Dutch niet-gespecificeerde abnormale bevallling, abnormale bevalling, niet-gespecificeerde abnormale bevalling, abnormaal; weeën, abnormale ontsluitingsfase, Dystocie
French Anomalie non précisée du travail, Anomalie du travail non précisée, Travail anormal, Dystocie
German Wehen anomal, unspezifische Wehenanomalie, anomale Wehen, Dystokie
Portuguese Trabalho de parto, Anomalia NE do trabalho de parto, Trabalho de parto anormal, Distocia
Spanish Parto anormal, Anormalidad no especificada del parto, parto anormal, Labor problem, Labour problem, Dystocia NOS, distocia (hallazgo), problema en el trabajo de parto (hallazgo), problema en el parto (hallazgo), problema en el trabajo de parto, distocia, problema en el parto, parto disfuncional, parto distócico, trabajo de parto disfuncional, parto difícil, distocia (concepto no activo), distocia (trastorno), distocia, SAI (hallazgo), distocia, SAI, parto anormal (hallazgo), Parto distócico, Distocia
Japanese 詳細不明の異常分娩, 分娩異常, 異常分娩, ｼｮｳｻｲﾌﾒｲﾉｲｼﾞｮｳﾌﾞﾝﾍﾞﾝ, ﾌﾞﾝﾍﾞﾝｲｼﾞｮｳ, ｲｼﾞｮｳﾌﾞﾝﾍﾞﾝ
Swedish Svår förlossning
Czech dystokie, Abnormální porod, Blíže neurčená abnormalita porodu
Finnish Dystokia
Russian DISTOTSIIA, RODOVOI DEIATEL'NOSTI DISKOORDINATSIIA, TRUDNYE RODY, RODY PATOLOGICHESKIE, ДИСТОЦИЯ, РОДОВОЙ ДЕЯТЕЛЬНОСТИ ДИСКООРДИНАЦИЯ, РОДЫ ПАТОЛОГИЧЕСКИЕ, ТРУДНЫЕ РОДЫ
Croatian DISTOCIJA, TEŠKI POROĐAJ
Polish Dystocja, Brak postępu porodu, Niestosunek porodowy
Hungarian Vajúdás nem meghatározott zavara, Abnormális vajúdás, Kóros vajúdás, Vajúdás kóros
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Cephalopelvic Disproportion (C0085988)

Definition (NCI) An abnormal condition during labor when the diameter of the fetal head is larger than the maternal pelvic canal; thus it is dangerous or impossible for the fetus to progress to a vaginal method of delivery.
Definition (MSH) A condition in which the HEAD of the FETUS is larger than the mother's PELVIS through which the fetal head must pass during a vaginal delivery.
Concepts Finding (T033)
MSH D052178, D007744
ICD9 653.4
SnomedCT 25749005, 367482008, 60994005, 199397009, 156162005, 267329003
English Cephalopelvic disproportion, NOS, Disproportion between fetal head and pelvis, NOS, Disproportion of mixed maternal and fetal origin with normally formed fetus, Fetopelvic disproportion, NOS, Disproportion between foetal head and pelvis, NOS, Disproportion of mixed maternal and foetal origin with normally formed foetus, Foetopelvic disproportion, NOS, Disproportion between fetus and pelvis, Cephalopelvic disproportion [ambiguous], fetopelvic disproportion, fetopelvic disproportion (diagnosis), CPD - Cephalopelv disproportn, Cephalo-pelvic disproportion, FETOPELVIC DISPROPORTION, Disproportion between foetal head and pelvis, Foetopelvic disproportion, Disproportion between foetus and pelvis, Cephalopelvic Disproportion [Disease/Finding], cephalo pelvic disproportion, cephalo-pelvic disproportion, cephalopelvic disproportion, Cephalopelvic Disproportion, Cephalo-Pelvic Disproportion, Fetopelvic disproportion, Cephalopelvic disproportion, CPD - Cephalopelvic disproportion, Cephalopelvic disproportion (disorder), Disproportion between fetal head and pelvis, Disproportion between fetus and pelvis (disorder), Disproportion of mixed maternal AND fetal origin with normally formed fetus, cephalopelvic; disproportion, disproportion; cephalopelvic, Cephalo-pelvic disp., Cephalopelvic disproportion (disorder) [Ambiguous], Cephalopelvic disproportion [ambiguous] (disorder), Cephalopelvic disproportion NOS, Disproportion of mixed maternal and fetal origin, with normally formed fetus, Disproportion, Cephalopelvic
Italian Sproporzione cefalo-pelvica, Sproporzione feto-pelvica, Sproporzione fetopelvica, Sproporzione cefalopelvica
Dutch foetus-bekken wanverhouding, foetus-bekken-wanverhouding, cefalopelvisch; wanverhouding, wanverhouding; cefalopelvisch, hoofd-bekken wanverhouding, Cefalopelvische disproportie
German Becken-Kind-Missverhaeltnis, Missverhaeltnis zwischen fetalem Kopf und Becken der Mutter, Kopf-Becken-Mißverhältnis (Geburtshilfe)
Portuguese Desproporção fetopélvica, Desproporção céfalo-pélvica, Desproporção Cefalopélvica
Spanish Desproporción fetopélvica, Cephalo-pelvic disproportion, Cephalopelvic disproportion, Cephalo-pelvic disp., desproporción cefalopélvica (ambiguo) (trastorno), desproporción cefalopélvica (concepto no activo), desproporción cefalopélvica (trastorno), desproporción cefalopélvica, desproporción de origen fetal y materno mixto con feto normoformado, desproporción de origen materno Y fetal mixto con feto normalmente formado, desproporción entre la pelvis y la cabeza fetal (trastorno), desproporción entre la pelvis y la cabeza fetal, desproporción fetopélvica, distocia ósea, Desproporción pelvicocefálica, Desproporción Cefalopélvica, Desproporcion Cefalopelvica, Desproporcion Cefalopelviana, Desproporción Cefalopelviana
Japanese 胎児骨盤不均衡, 児頭骨盤不均衡, ｼﾞﾄｳｺﾂﾊﾞﾝﾌｷﾝｺｳ, ﾀｲｼﾞｺﾂﾊﾞﾝﾌｷﾝｺｳ
Swedish Bäckenförträngning
Czech cefalopelvická disproporce, Kefalopelvický nepoměr, Fetopelvický nepoměr, Fetopelvická disproporce
Finnish Sikiön ja lantion välinen epäsuhta
French Disproportion foeto-pelvienne, Disproportion foetopelvienne, Disproportion céphalo-pelvienne, Disproportion céphalopelvienne
Russian DISPROPORTSIIA SOOTNOSHENIIA GOLOVKI PLODA I MATERINSKOGO TAZA, ДИСПРОПОРЦИЯ СООТНОШЕНИЯ ГОЛОВКИ ПЛОДА И МАТЕРИНСКОГО ТАЗА
Polish Niewspółmierność porodowa
Hungarian Cephalo-pelvikus téraránytalanság, Foetopelvikus discrepantia, Foetopelvikus aránytalanság
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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