DYSTOCIA

Dystocia means that birth is abnormal and difficult. Conditions that make birth difficult, prolong birth time or prevent normal delivery are called dystocia. Dystocia is encountered in approximately 10-20% of all births.
It is divided into three according to the cause of dystocia:
1. Dystocia caused by pelvic stenosis
2. Dystocias due to fetal position, posture and developmental anomalies: Breech or transverse stop of the fetus, asynclitic head of the head, deflection of the head, occiput posterior, blow presentation, face presentation, excessive weight of the baby or excessive abdomen of the baby's head due to some anomalies (hydrocephalus, anencephaly), locked twins.
3. Dystoys due to uterine dysfunction: Contraction of the uterus is the driving force for the progression of labor. Abnormalities here can cause slowing or pause in the progression of labor. It can be seen as hypotonic dysfunction or hypertonic dysfunction. In the presence of uterine dysfunction, that is, if the contractions of the uterus can not occur in an adequate and proper order, sufficient opening in the cervix cannot occur.
Shoulder dystocia:
It is the event that the shoulders cannot be trapped between the pelvic bones of the mother at the last stage of birth, that is, during the birth of the baby's head.
Risk factors for dystocia:
- Advanced maternal age
- Macrosomia
- Pelvic stenosis
- Occiput posterior
- First birth (nulliparity): Multiparity is a risk factor for shoulder dystocia.
- Short length (less than 150 cm)
- Overdue pregnancy
- Obesity, overweight during pregnancy
- History of dystocia
- Epidural analgesia application
- Excessive sedation

Maternal complications related to dystocia:
- Uterus rupture
- Postpartum bleeding
- Birth canal, vagina and cervix lacerations
- Rectovaginal and vesicovaginal fistulas
- Hematomas in the birth canal and pelvis
- Chorioamnionitis
- Postpartum infection
- Uterine atony
- pelvic floor damage
- Peroneal nerve damage
Fetal complications related to dystocia:
- Intracranial bleeding, intraventricular bleeding, subdural bleeding
- Cephala hematoma
- Hood succsadeneum
- Bone fractures such as clavicle, humerus and femur
- Skull fractures
- Brachial plexus nerve injuries
- Facial nerve injury
- Fetal death
Prolonged labor time (Pause of delivery):
The process of birth, from the onset of the mother's pains to the full birth of the baby, is divided into several stages. Here, if the symptoms exceed the normal limits, the term prolongation or pause of labor is used and it is a sign that there is dystocia.
Prolonged labor criteria:
- The latent phase lasting more than 20 hours in the first births and 14 hours in the subsequent births is called the prolonged latent phase.
- During the active phase of labor, first births should be at least 1.2 cm per hour, and subsequent births should be at least 1.5 cm per hour. Below these values ​​indicates that birth is progressing slowly or pausing. Cephalopelvic incompatibility may result from incompatibility between the mother's pelvic bones and the baby's head.
- In the first births, the baby's head level should decrease at least 1 cm per hour, and subsequent births should decrease at least 2 cm per hour.
- After the full opening, the period until the birth of the fetus (2nd stage of birth) takes an average of 50 minutes in nulliparas and an average of 20 minutes in multiparas. It is abnormal that this phase lasts more than 2 hours in nulliparas and more than 1 hour in multipara. If spinal anesthesia is applied, this time is taken as 3 hours in nulliparas and 2 hours in multiparts.
Approximately 30% of all cesarean sections occur due to dystocia. The most common cesarean indication is dystocia.


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