Dystocia refers to difficult labor which is usually due to uterine dysfunction, fetal malpresentation/abnormality, or pelvic abnormality.
(Refer to CPs: Labor: Stage I—Latent Phase; Labor: Stage I—Active Phase.)
CLIENT ASSESSMENT DATA BASE
Activity/Rest
Report of fatigue, lack of energy
Lethargy, decreased performance
Circulatory
BP may be elevated.
May have received magnesium sulfate (MgSO4) for pregnancy-induced hypertension.
Elimination
Bowel or bladder distension may be evident.
Ego Integrity
May be extremely anxious, fearful
Pain/Discomfort
May have received narcotic or peridural anesthesia early in labor process.
May have noted false labor at home.
Infrequent or irregular contractions, mild to moderate in intensity (fewer than three contractions in a 10-min period).
May occur prior to the onset of labor (primary latent-phase dysfunction) or after labor is well established (secondary active-phase dysfunction).
Latent Phase of Labor May Be Prolonged: 20 hr or longer in nullipara (average is 81⁄2 hr), or 14 hr in multipara (average is 51⁄2 hr).
Myometrial resting tone may be 8 mm Hg or less, and contractions may measure less than 30 mm Hg or may occur more than 5 min apart; or resting tone may be greater than 15 mm Hg, with contractions rising to 50–85 mm Hg with increased frequency and decreasing intensity.
Safety
May have had external version after 34 weeks’ gestation in attempt to convert breech to cephalic presentation.
Fetal descent may be less than 1 cm/hr in nullipara or less than 2 cm/hr in multipara (protracted descent), or no progress over 1 or more hr for nullipara or for 30 min in multipara after complete cervical dilation (arrest of descent).
Vaginal examination may reveal fetus to be in malposition (i.e., breech; chin, face, or brow position).
Cervix may be rigid/“not ripe.”
Dilation may be less than 1.2 cm/hr in primipara or less than 1.5 cm/hr for multipara, in active phase (protracted active phase), or absence of cervical changes over a 2-hr period (secondary arrest of labor).
Failure to deliver within 2 hr, or 3 hr with regional anesthesia for primipara, or 1 hr/2hr with regional anesthesia for multipara (prolonged stage II).
Sexuality
May be primigravida or grand multipara.
Uterus may be overdistended owing to hydramnios, multiple gestation, a large fetus, or grand multiparity.
May have identifiable uterine tumors.
DIAGNOSTIC STUDIES
Prenatal Testing: May have confirmed polyhydramnios, large fetus, or multiple gestation.
Nonstress Test/Contraction Stress Test (NST/CST): Assesses fetal well-being.
X-ray Pelvimetry or Ultrasound: Evaluates pelvic architecture, fetal presentation, position, and formation.
Fetal Scalp Sampling: Occasionally done to detect or rule out acidosis.
NURSING PRIORITIES
1. Identify and treat abnormal uterine pattern.
2. Monitor maternal/fetal physical response to contractile pattern and length of labor.
3. Provide emotional support for the client/couple.
4. Prevent complications.
(Refer to CPs: Labor: Stage I—Latent Phase; Labor: Stage I—Active Phase.)
CLIENT ASSESSMENT DATA BASE
Activity/Rest
Report of fatigue, lack of energy
Lethargy, decreased performance
Circulatory
BP may be elevated.
May have received magnesium sulfate (MgSO4) for pregnancy-induced hypertension.
Elimination
Bowel or bladder distension may be evident.
Ego Integrity
May be extremely anxious, fearful
Pain/Discomfort
May have received narcotic or peridural anesthesia early in labor process.
May have noted false labor at home.
Infrequent or irregular contractions, mild to moderate in intensity (fewer than three contractions in a 10-min period).
May occur prior to the onset of labor (primary latent-phase dysfunction) or after labor is well established (secondary active-phase dysfunction).
Latent Phase of Labor May Be Prolonged: 20 hr or longer in nullipara (average is 81⁄2 hr), or 14 hr in multipara (average is 51⁄2 hr).
Myometrial resting tone may be 8 mm Hg or less, and contractions may measure less than 30 mm Hg or may occur more than 5 min apart; or resting tone may be greater than 15 mm Hg, with contractions rising to 50–85 mm Hg with increased frequency and decreasing intensity.
Safety
May have had external version after 34 weeks’ gestation in attempt to convert breech to cephalic presentation.
Fetal descent may be less than 1 cm/hr in nullipara or less than 2 cm/hr in multipara (protracted descent), or no progress over 1 or more hr for nullipara or for 30 min in multipara after complete cervical dilation (arrest of descent).
Vaginal examination may reveal fetus to be in malposition (i.e., breech; chin, face, or brow position).
Cervix may be rigid/“not ripe.”
Dilation may be less than 1.2 cm/hr in primipara or less than 1.5 cm/hr for multipara, in active phase (protracted active phase), or absence of cervical changes over a 2-hr period (secondary arrest of labor).
Failure to deliver within 2 hr, or 3 hr with regional anesthesia for primipara, or 1 hr/2hr with regional anesthesia for multipara (prolonged stage II).
Sexuality
May be primigravida or grand multipara.
Uterus may be overdistended owing to hydramnios, multiple gestation, a large fetus, or grand multiparity.
May have identifiable uterine tumors.
DIAGNOSTIC STUDIES
Prenatal Testing: May have confirmed polyhydramnios, large fetus, or multiple gestation.
Nonstress Test/Contraction Stress Test (NST/CST): Assesses fetal well-being.
X-ray Pelvimetry or Ultrasound: Evaluates pelvic architecture, fetal presentation, position, and formation.
Fetal Scalp Sampling: Occasionally done to detect or rule out acidosis.
NURSING PRIORITIES
1. Identify and treat abnormal uterine pattern.
2. Monitor maternal/fetal physical response to contractile pattern and length of labor.
3. Provide emotional support for the client/couple.
4. Prevent complications.
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