b. Classification of Dystocia.
(1) Pelvic dystocia. This occurs when there is a significant shortening of the
(2) Soft tissue dystocia. This is caused by an obstruction of the birth
passage by an anatomic abnormality other than that of the bony pelvis. Those
abnormalities may be tumors, injuries that prevent dilatation, and congenital anomalies
(e.g., bicornate uterus).
(3) Fetal dystocia. This refers to conditions that involve the passenger
(fetus) that can delay and complicate the process of labor. The conditions may be
excessive size of the fetus, fetal anomaly (e.g., hydrocephalus, conjoined twins, or
gross ascites), or fetal malpresentation such as a breech presentation.
(4) Uterine dystocia. This is an abnormality of the contractile pattern of the
uterine muscles that prevents normal progress in labor. The contractions may be too
week, too short, too irregular, or too infrequent. Labor may also be extremely forceful,
rapid, or traumatic.
c. Nursing Intervention.
Continue monitoring uterine contractions and the FHTs.
Keep the patient informed of the progress.
Instruct the patient in proper breathing techniques to decrease
Allow the patient to ventilate feelings and frustrations.
(5) Monitor the patient's bladder status. The bladder should be kept empty
to provide as much space as possible for descent of the fetal head.
OVERSIZED BABIES AND THEIR DELIVERY
a. Description. An oversized baby is an infant that weighs more than 10
pounds (4500 grams). The infant may be classified as large for gestational age (LGA).
Most oversized babies are boys. Usually, causes of oversized babies are maternal
diabetes, postterm pregnancy, and inheritance from one or both parents who are large.
(1) Shoulder dystocia. Wide shoulders of the fetus are likely to be a
problem at the time of delivery. The fetus head may deliver, but the shoulders are too
large for the pelvic inlet.