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Prevention of Labor DystociaAka: Labor Dystocia Prevention

See Also
1. Labor Dystocia
2. Labor Dystocia Management
General Measures
1. Avoid early hospitalization in Latent Phase of Labor
  1. See Latent Phase of Labor for management
2. Consider Structured Intermittent Auscultation (SIA)
  1. Preferred over Continuous Electronic Fetal Monitoring
  2. Consider using CEFM only in high risk pregnancies
3. Informed consent regarding Labor Anesthesia
  1. Epidural Anesthesia increases risk of ceserean
  2. Avoid epidural and intrathecal anesthesia until >4 cm
4. Encourage ambulation
5. Avoid induction if cervix unripe if possible
  1. See Bishops Score
  2. See Cervical Ripening
6. Antepartum labor classes (e.g. Lamaze)
  1. Patient Education on what to expect in labor
7. Physician and nurse team impacts Labor Dystocia
  1. Be patient in slow progressing nullip
    1. DeMott (1992) Am J Obstet Gynecol 166:1799
  2. Increased total contact time decreases ceserean rate
    1. Radin (1993) Birth 20:14
8. Encourage Doula use
9. Amniotomy when in Active Phase of Labor
10. Employ alternatives to labor Analgesics
  1. See Non-Pharmacologic Pain Control in Labor
11. Consider high dose Oxytocin augmentation in nullips
  1. Decrease labor duration by 2 hours without added risk
  2. Merrill (1999) Obstet Gynecol 94:455
References
1. Shields (2000) ALSO, F:1-14
2. Warenski (1997) Clin Obstet Gynecol 40(3):525

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.