eMedicine Specialties > Obstetrics and Gynecology > Labor and Delivery

Abnormal Labor: Differential Diagnoses & Workup

Author: Saju Joy, MD, MS, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Coauthor(s): Patricia L Scott, MD, Fellow in Maternal-Fetal Medicine, Wake Forest University, Bowman Gray School of Medicine; Deborah Lyon, MD, Director, Division of Gynecology, Associate Professor, Department of Obstetrics and Gynecology, University of Florida Health Science Center at Jacksonville
Contributor Information and Disclosures

Updated: Aug 3, 2009

Differential Diagnoses

Abruptio Placentae
Amnionitis

Other Problems to Be Considered

False labor

Workup

Laboratory Studies

No specific laboratory studies are used to assess abnormal labor.

Other Tests

  • The simplest test used to evaluate abnormal labor is to plot the patient's labor progress (cervical dilation vs duration in hours) on a labor curve.
  • A second test used to address adequate labor is the review of the uterine contraction pattern by determining adequacy of contractions with use of an intrauterine pressure catheter.
  • Most importantly, the fetal heart tracing must be reassuring throughout the labor course.

Procedures

Clinical pelvimetry, at a minimum, must address the angles of the spinous processes (convergent, divergent, straight), the bi-ischial diameter (>8 cm), the distance to the sacral promontory from the symphysis pubis (>12 cm), and the relation of the bony pelvis to the fetal head.

Clinical pelvimetry requires experience and deliberate attention to the question of pelvic adequacy. It cannot account for fetal size or strength/frequency of contractions, but, in experienced hands, it may reliably identify a pelvis as adequate, borderline, or contracted.

More on Abnormal Labor

Overview: Abnormal Labor
Differential Diagnoses & Workup: Abnormal Labor
Treatment & Medication: Abnormal Labor
Follow-up: Abnormal Labor
Multimedia: Abnormal Labor
References
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References

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  2. Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. Oct 2002;187(4):824-8. [Medline].

  3. Rouse DJ, Owen J, Hauth JC. Criteria for failed labor induction: prospective evaluation of a standardized protocol. Obstet Gynecol. Nov 2000;96(5 Pt 1):671-7. [Medline].

  4. Cheng YW, Hopkins LM, Caughey AB. How long is too long: Does a prolonged second stage of labor in nulliparous women affect maternal and neonatal outcomes?. Am J Obstet Gynecol. Sep 2004;191(3):933-8. [Medline].

  5. Rinehart BK, Terrone DA, Hudson C, et al. Lack of utility of standard labor curves in the prediction of progression during labor induction. Am J Obstet Gynecol. Jun 2000;182(6):1520-6. [Medline].

  6. Cunningham FG, Leveno KL, Bloom SL, et al. Abnormal labor. In: Williams Obstetrics. 22nd ed. Appleton & Lange; 2007:415-434.

  7. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. Oct 19 2005;CD000331. [Medline].

  8. Gabbe SJ, O'Brien WF, Cefalo RC. Labor and delivery. In: Obstetrics: Normal and Problem Pregnancies. 5th ed. 2007:322-326.

  9. Sanchez-Ramos L, Quillen MJ, Kaunitz AM. Randomized trial of oxytocin alone and with propranolol in the management of dysfunctional labor. Obstet Gynecol. Oct 1996;88(4 Pt 1):517-20. [Medline].

  10. Mitrani A, Oettinger M, Abinader EG, et al. Use of propranolol in dysfunctional labour. Br J Obstet Gynaecol. Aug 1975;82(8):651-5. [Medline].

  11. [Best Evidence] Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev. Oct 17 2007;CD006167. [Medline].

  12. Mollberg M, Hagberg H, Bager B, et al. Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction. Obstet Gynecol. Nov 2005;106(5 Pt 1):913-8. [Medline].

  13. Mehta SH, Bujold E, Blackwell SC, et al. Is abnormal labor associated with shoulder dystocia in nulliparous women?. Am J Obstet Gynecol. Jun 2004;190(6):1604-7; discussion 1607-9. [Medline].

  14. Shields SG, Ratcliffe SD, Fontaine P, et al. Dystocia in nulliparous women. Am Fam Physician. Jun 1 2007;75(11):1671-8. [Medline].

  15. [Best Evidence] Oppenheimer LW, Labrecque M, Wells G, Bland ES, Fraser WD, Eason E. Prostaglandin E vaginal gel to treat dystocia in spontaneous labour: a multicentre randomised placebo-controlled trial. BJOG. May 2005;112(5):612-8. [Medline].

  16. [Best Evidence] Allen VM, Baskett TF, O'Connell CM, McKeen D, Allen AC. Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol. Jun 2009;113(6):1248-58. [Medline].

  17. Treacy A, Robson M, O'Herlihy C. Dystocia increases with advancing maternal age. Am J Obstet Gynecol. Sep 2006;195(3):760-3. [Medline].

  18. Zhu BP, Grigorescu V, Le T, et al. Labor dystocia and its association with interpregnancy interval. Am J Obstet Gynecol. Jul 2006;195(1):121-8. [Medline].

  19. American College of Obstetricians and Gynecologists. ACOG technical bulletin. Dystocia and the augmentation of labor. Number 218--December 1995 (replaces no. 137, December 1989, and no. 157, July 1991). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. Apr 1996;53(1):73-80. [Medline].

  20. American College of Obstetrics and Gynecology Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin Number 49, December 2003: Dystocia and augmentation of labor. Obstet Gynecol. Dec 2003;102(6):1445-54. [Medline].

  21. Cheng YW, Hopkins LM, Laros RK Jr, et al. Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes. Am J Obstet Gynecol. Jun 2007;196(6):585.e1-6. [Medline].

  22. Creasy RK, Resnik R, Iams J. Clinical aspects of normal and abnormal labor. In: Maternal-Fetal Medicine. 5th ed. 2003:543-549.

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  24. Gardberg M, Stenwall O, Laakkonen E. Recurrent persistent occipito-posterior position in subsequent deliveries. BJOG. Feb 2004;111(2):170-1. [Medline].

  25. Gifford DS, Morton SC, Fiske M, et al. Lack of progress in labor as a reason for cesarean. Obstet Gynecol. Apr 2000;95(4):589-95. [Medline].

  26. Hoffman MK, Vahratian A, Sciscione AC, et al. Comparison of labor progression between induced and noninduced multiparous women. Obstet Gynecol. May 2006;107(5):1029-34. [Medline].

  27. Saito M, Kozuma S, Kikuchi A, et al. Sonographic assessment of the cervix before, during and after a uterine contraction is effective in predicting the course of labor. Ultrasound Obstet Gynecol. Dec 2003;22(6):604-8. [Medline].

  28. Socol ML, Peaceman AM. Active management of labor. Obstet Gynecol Clin North Am. Jun 1999;26(2):287-94. [Medline].

  29. Vahratian A, Hoffman MK, Troendle JF, et al. The impact of parity on course of labor in a contemporary population. Birth. Mar 2006;33(1):12-7. [Medline].

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Further Reading

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Keywords

dystocia, prolonged labor, arrest of dilation, arrest of descent, cephalopelvic disproportion, protraction disorder, primary dysfunctional labor, failure to progress, lack of progressive cervical dilatation, lack of descent, cephalopelvic disproportion, CPD, pelvimetry, Montevideo units, MVUs, cesarean section, c-section, cesarean birth, cesarean delivery, mechanical dystocia, functional dystocia

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Contributor Information and Disclosures

Author

Saju Joy, MD, MS, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Saju Joy, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Patricia L Scott, MD, Fellow in Maternal-Fetal Medicine, Wake Forest University, Bowman Gray School of Medicine
Patricia L Scott, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Deborah Lyon, MD, Director, Division of Gynecology, Associate Professor, Department of Obstetrics and Gynecology, University of Florida Health Science Center at Jacksonville
Deborah Lyon, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of American Medical Colleges, Association of Professors of Gynecology and Obstetrics, and Florida Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Robert K Zurawin, MD, Associate Professor, Director of Baylor College of Medicine Program for Minimally Invasive Gynecology, Director of Fellowship Program, Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine
Robert K Zurawin, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Harris County Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Texas Medical Association
Disclosure: Johnson and Johnson Honoraria Speaking and teaching; Conceptus Honoraria Speaking and teaching; Biosphere Medical Honoraria Speaking and teaching; Eli Lilly Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Richard S Legro, MD, Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center
Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals Obstetrics/Gynecology Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Department of Obstetrics/Gynecology, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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