Disease relevance of Dystocia

• Triad of Naegele's pelvis, Pott's disease and dystocia [1].
• The clinical triad of oxytocin use, labor induction, and birth weight greater than 4,500 g yielded a cumulative odds ratio of 23.2 (95% CI 17.3-31.0) for shoulder dystocia, but its sensitivity and positive predictive value were only 12.4% and 3.4%, respectively [2].
• Current clinical problems in placental steroid or aryl sulphatase C deficiency and the related 'cervical dystocia' and X-linked ichthyosis [3].
• Insufficient or unbalanced dietary intake, obesity, and elevated estrogen concentrations are involved in the etiology of fatty liver, which is associated with greater incidence of dystocia, diseases, infections, and inflammations [4].
• Controlling for possible confounders such as previous CS, IUGR, PROM, failed induction, labor dystocia, mal-presentations and CPD, using the Mantel-Haenszel technique, did not change the significant association between short stature and CS [5].

High impact information on Dystocia

• While epidural patients were more likely to have instrumented delivery (OR, 2.19; 95% CI, 1.32-7.78), they were no more likely to have instrumented delivery for dystocia (OR, 0.68; 95% CI, 0.31-1.49) [6].
• There was no incidence of difficult birth (dystocia) with RU 486 treatment compared with that in the controls [7].
• RESULTS: An intent-to-treat analysis of 1,223 women indicated that CSE does not increase the rate of cesarean delivery for dystocia in nulliparous and parous women (CSE, 3.5% vs. intravenous meperidine, 4; P=not significant) or in nulliparous women alone (CSE, 7% vs. intravenous meperidine, 8%; P=not significant) [8].
• CONCLUSION: Shoulder dystocia in the setting of vacuum extraction is a prominent risk factor for OBPP in the newborn [9].
• SETTING: Department of Obstetrics and Gynaecology of Saint-Antoine University Hospital, Paris, France. POPULATION: A total of 2222 newborn shoulder width measurements were performed and 22 cases of true shoulder dystocia occurred during the study period [10].

Chemical compound and disease context of Dystocia

• Progesterone concentrations in maternal and fetal serum are lower during functional dystocia than in normal labor [11].
• We have studied three candidate genes for dystocia, i.e. the genes for testosterone 5-alpha reductase type 1, prostaglandin F2alpha receptor and endothelin 1 and performed mutational screening in 23 women with dystocia, of which 12 have affected relatives [12].
• The total percentage of cesarean deliveries was not significantly different, although the percentage of cesarean deliveries for dystocia was lower in the misoprostol group (8 versus 21%, P = .02) [13].
• Women with the most severe oxytocin-resistant dystocia, delivered by cesarean, had significantly lower serum concentrations of E2 in fetal cord serum compared with the vaginally delivered women (P less than .001) [11].
• The humeral soft tissue thickness was significantly higher in macrosomic infants (P < .001), in those with an abnormally high ponderal index (P = .02), and in infants whose deliveries were complicated by shoulder dystocia (P = .05) [14].

Biological context of Dystocia

• Holstein cows (n = 445) that had experienced dystocia, retained fetal membrane, or both at parturition were used to determine the effects of GnRH, PGF2 alpha, or both on various reproductive measurements [15].
• Cows' rate of gain, serum levels of trenbolone acetate, gestation length, degree of dystocia, percentage bred back, days until conception, and 24-h milk production were evaluated [16].
• CONCLUSIONS AND CLINICAL RELEVANCE: Despite increasing the likelihood of developing dystocia and metritis, administration of monensin improved the lactational performance of multiparous cows and may be a promising additive for use at the time of cessation of lactation [17].
• RESULTS: The last two periods (1993-1999) were characterized by lower mean glucose level, lower mean gestational age at delivery, and a decline in macrosomia, shoulder dystocia and perinatal mortality rates, but also by high rates of labor induction and Cesarean delivery [18].
• No significant differences were observed in maternal age, prepregnancy body mass index, HbgA1C values, second-trimester blood glucose levels, method of delivery, incidence of shoulder dystocia and Apgar scores between the two groups of women [19].

Anatomical context of Dystocia

• RESULTS: In the lower segment of the uterus, the progesterone receptor concentrations of myometrium were significantly lower in oxytocin-resistant dystocia compared with those of normal labor and before labor (P < .04, P < .005, respectively) [20].
• Cows affected with dystocia, retained fetal membranes, or both and treated early postparum with GnRH alone or followed 14 d later with PGF2 alpha did not have improved reproductive performance [15].
• The cesarean rate was not significantly different between the groups, but the major indications were different: dystocia (45%) in the IMN group vs. persistent non-reassuring fetal heart rate pattern (56%) in the misoprostol group [21].
• Females with dystocia differed from reference values in an increase in monocytes and in the high concentrations of aspartate aminotransferase probably associated with tissue trauma [22].
• This study was undertaken to test the effect of clenbuterol, a smooth muscle relaxant, as an aid for the manual correction of bovine dystocias in a rural Quebec practice [23].

Gene context of Dystocia

• Macrosomic infants have higher rates of Erb palsy, but similar rates of other serious complications of shoulder dystocia when compared with normal weight infants [24].
• The low oxytocin receptor density in oxytocin-resistant dystocia needs further investigation [25].
• A shortage of oxytocin secretion may not, however, be the main cause of the dystocia in pelvic-neurectomized rats [26].
• Effects of oxytocin on placental retention following dystocia [27].
• Among all other cows, including those with dystocia alone, adjusted yields were increased by heavier calves (P < .07, Y60), high plasma PRL (P < .025, Y60) and below average plasma E1 (P < .025, Y200) [28].

Analytical, diagnostic and therapeutic context of Dystocia

• The maternal and umbilical progesterone concentrations in dystocia and elective cesarean section were between 77-43% of those in normal labor [29].
• Skinfold thickness and ponderal index measurements, operative delivery, shoulder dystocia, fetal trauma, impaired glucose tolerance [30].

References