Disease diagnosis of head presentation dystocia

Many expectant mothers have gone through the hardships of ten months of pregnancy, but it is not a perfect ending. If a head presentation dystocia occurs at the last minute, it is very difficult, so generally before the pregnant woman is about to give birth, a comprehensive diagnosis and examination will be carried out to try to avoid the occurrence of head presentation dystocia. Now let me learn some knowledge about the diagnosis of head presentation dystocia.

Dystocia caused by abnormalities in the birth canal, labor force, and fetal head is called cephalic presentation dystocia. If not handled promptly or improperly, it will seriously affect the prognosis of the newborn and cause damage to the mother. Sometimes it is difficult to clearly distinguish between normal delivery and dystocia in cephalic presentation. Only by carefully observing the delivery process, finding abnormalities, and comprehensively analyzing the three elements of delivery, can the difficulty of delivery be diagnosed early and the appropriate delivery method be selected to ensure the health of mother and baby.

Overview of diagnostic points

1. Medical history characteristics: Is there a history of abnormal delivery (stillbirth, fetal death, etc.)

2. In general, height and obesity. If the maternal height is <140cm, the incidence of cephalopelvic disproportion increases. In addition, limping gait and hanging abdomen can also cause cephalopelvic disproportion.

3. Obstetric examination

(1) Four-step technique: palpate to see if the fetal head is connected, if it is too large, if the fetal limbs are concentrated in front of the abdomen, etc. This can be used to preliminarily diagnose whether the fetal position is abnormal and predict the occurrence of dystocia.

(2) Measure uterine height and abdominal circumference: to understand the size of the fetus and estimate the fetal weight.

(3) External pelvic measurement: Measure the inter-iliac spine diameter, inter-iliac crest diameter, sacropubic external diameter, and outlet plane to see if they are normal.

(4) Straddle test: If positive or questionable, there is a possibility of cephalopelvic disproportion.

(5) B-ultrasound monitoring: B-ultrasound imaging can show the relationship between the fetal head and pelvis, and can estimate the size of the fetus through measurements such as the biparietal diameter and head circumference of the fetal head. It can also detect the fetal position.

Entering labor

(1) Clinical manifestations: The fetal head is delayed in entering the pelvis, the membranes are prone to rupture prematurely, the mother is prone to fatigue, abdominal distension, weak uterine contractions, high rate of delayed labor, slow and prolonged latent and active phases (Figure 1), slow cervical dilation, stagnation of fetal head descent, and the mother may experience vulvar cervical edema and urinary retention. The fetus is also very likely to suffer from intrauterine asphyxia.

2) Vaginal examination

① Birth canal condition: exclude soft birth canal tumors, perform cervical scoring, and perform internal measurements of the pelvis to accurately understand whether the diameters of each plane of the pelvis are normal and whether they are commensurate with the fetal head.

②Condition of the fetal head: Through vaginal examination, we can understand the height of the fetal head, fetal position, whether a tumor has formed, whether the cranial sutures overlap, and fully estimate whether it can pass through the birth canal.