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Dystocia

Abnormal or difficult childbirth or labor is termed as dystocia. Cervical dystocia is a condition where the cervix fails to dilate during labor. Shoulder dystocia is the condition where the shoulder gets stuck in pelvis while delivering the child. Dystocia is noticed just before or during the delivery. Depending on how the baby is presenting itself for delivery cephalic (head comes out first) or breech the doctor decides the type of delivery.


Causes of dystocia

Dystocia can occur due to one or more factors, both maternal and fetal:

  • The expulsive force of the uterus during all stages of delivery may not be strong enough.
  • Large fetus
  • Fetus size may not fit the size or portion of the pelvis.
  • Abnormally bony pelvis or fractured pelvis in mother.
  • Breech baby
  • Tumor in fetus
  • Uterine complications in mother
  • Obese mother
  • Herniated bladder in mother
  • Ruptured uterus/diaphragm in mother
  • Genetic defects in mother

Physical examination of the mother is done and labor progress is charted on a labor curve. Uterine contraction patterns are reviewed using an intrauterine pressure catheter. Oxytocin is used to improve contractions when they are inadequate. Forceps are used often when there is abnormal fetal positioning.

Gestational diabetes

Gestational diabetes insipidus occurs during pregnancy. This is a type of diabetes and about 2-10 percent of expectant mothers develop this condition. When pregnant, hormonal changes make your cells less responsive to insulin. But during pregnancy, the pancreas cannot keep up with the increased insulin demand, and hence blood glucose levels rise resulting in gestational diabetes.

Significantly, most women with gestational diabetes do not remain diabetic after the baby is born. Once you've had gestational diabetes, though, you are at higher risk during a future pregnancy and for developing diabetes later in life.


Symptoms of gestational diabetes

There are no symptoms and that is perhaps why all pregnant women have to undergo a glucose screening test between 24 and 28 weeks. If you are at a high risk for diabetes and are showing signs of it, then the doctor would recommend this screening test at the first prenatal visit and then repeat at 24 weeks, the initial test being negative. Follow up tests are done to find out if the result on glucose screening is positive.

High risk factors for gestational diabetes

The American Diabetes Association prescribes the following condition for early screening, in case of high risk namely:

Obesity and BMI over 30
If you have had gestational diabetes in previous pregnancy
If the urine has sugar and
If you have a strong family history of diabetes.

Other risk factors

If earlier delivery was a big baby
If you have had a stillbirth
If you have high blood pressure and
If you are over 35.

An association between excessive weight gain during pregnancy, particularly in the first trimester and risk of gestational diabetes has been established.

Gestational diabetes: Pregnancy and baby

Poorly controlled diabetes may have short and long term consequences for you and your baby. If blood sugar levels are too high, the baby's blood may have too much glucose. The excess blood sugar and insulin can cause the baby to put on extra weight particularly in the upper body. This can lead to a condition called macrosomia. This baby may be too large to enter the birth canal or the baby's head may enter but shoulder may get stuck. This is a tricky condition called dystocia and the doctor has to use special procedures to deliver the baby.

Sometimes delivery of such babies may result in fractured bone or nerve damage which could become permanent in 99% of babies. It is better that babies of mothers with gestational diabetes, check their blood sugar regularly and breast feed the baby immediately after birth to prevent or correct hypoglycemia.

Such babies with hypoglycemia at birth are given IV glucose solution. Testing the baby's sugar and providing an IV if necessary can prevent serious problems such as coma, brain damage and seizures. The baby also exhibits high risk for breathing problems and newborn jaundice. In addition, the baby is also at risk for polycythemia or increase in the number of red cells in the blood and hypocalcaemia or low calcium in the blood. Women with gestational diabetes are at an increased risk of developing Preeclampsia, particularly those who are obese before pregnancy and blood sugar levels are uncontrolled.


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Collection of Pages - Last revised Date: October 16, 2017