Prevention of Labor Dystocia


Prevention of Labor Dystocia, Labor Dystocia Prevention

  • 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
    3. Consider Peanut Ball placed between knees, in lateral decubitus position, following Epidural Anesthesia
  4. Encourage mobility (walking, sitting, standing, kneeling)
  5. Avoid induction if Cervix unripe if possible
    1. See Bishops Score
    2. Consider Cervical Ripening
      1. 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 166:1799-810 [PubMed]
    2. Increased total contact time decreases ceserean rate
      1. Radin (1993) Birth 20:14-21 [PubMed]
  8. Continuous Labor Support
    1. Encourage Doula use
    2. Continuous Labor Support shortens labor by 35 minutes and reduces C-Section and operative Vaginal Delivery risk
      1. Bohren (2017) Cochrane Database Syst Rev (7):CD003766 [PubMed]
  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 94:455-63 [PubMed]
  • References