Dystocie

Dystocie, or dystocia, is an obstetric condition in which labor progresses abnormally slowly or fails to progress, leading to a prolonged or obstructed birth. It is typically diagnosed when uterine contractions are adequate but cervical dilation or fetal descent is insufficient, or when instrumental delivery is required due to persistent difficulty.

Causes and classification can be grouped into maternal, fetal, and mechanical factors. Dystocie is often categorized as primary, where dilation or descent does not progress despite contractions, or secondary, where initial progress occurs but later slows or stops. Common causes include cephalopelvic disproportion (a mismatch between fetal size or position and the maternal pelvis), malpresentation or malposition (for example, occiput posterior), fetal macrosomia, multiple pregnancy, uterine dysfunction, and soft tissue obstruction within the birth canal.

Diagnosis involves regular assessment of labor progress, fetal status, and maternal well-being. This is typically monitored with cervical dilation measurements, fetal heart rate monitoring, and a partogram to track progress over time. Additional imaging or examinations may be used to evaluate fetal size, position, or pelvic dimensions when indicated.

Management aims to ensure the safety of both mother and baby. Approaches include adequate analgesia, maternal repositioning, and augmentation of contractions with oxytocin when appropriate. If labor fails to progress despite these measures, or if fetal distress is present, instrumental delivery (forceps or vacuum) may be attempted if feasible, or cesarean section may be performed. In cases of persistent obstruction or unfavorable fetal presentation, cesarean delivery is commonly indicated.

Prognosis and epidemiology vary with the underlying cause and timely management. Dystocie increases the likelihood of operative delivery and associated maternal or neonatal complications, but risk is reduced with careful prenatal assessment and appropriate intrapartum care.