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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


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


  1. Triad of Naegele's pelvis, Pott's disease and dystocia. Micozzii, M.S., Paz, J.T. N. Engl. J. Med. (1977) [Pubmed]
  2. Shoulder dystocia: are historic risk factors reliable predictors? Ouzounian, J.G., Gherman, R.B. Am. J. Obstet. Gynecol. (2005) [Pubmed]
  3. Current clinical problems in placental steroid or aryl sulphatase C deficiency and the related 'cervical dystocia' and X-linked ichthyosis. Harkness, R.A. J. Inherit. Metab. Dis. (1982) [Pubmed]
  4. Invited review: pathology, etiology, prevention, and treatment of fatty liver in dairy cows. Bobe, G., Young, J.W., Beitz, D.C. J. Dairy Sci. (2004) [Pubmed]
  5. Short stature--an independent risk factor for Cesarean delivery. Sheiner, E., Levy, A., Katz, M., Mazor, M. Eur. J. Obstet. Gynecol. Reprod. Biol. (2005) [Pubmed]
  6. Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis. Halpern, S.H., Leighton, B.L., Ohlsson, A., Barrett, J.F., Rice, A. JAMA (1998) [Pubmed]
  7. Antiprogesterone, RU 486, facilitates parturition in cattle. Li, Y.F., Perezgrovas, R., Gazal, O.S., Schwabe, C., Anderson, L.L. Endocrinology (1991) [Pubmed]
  8. A randomized study of combined spinal-epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Gambling, D.R., Sharma, S.K., Ramin, S.M., Lucas, M.J., Leveno, K.J., Wiley, J., Sidawi, J.E. Anesthesiology (1998) [Pubmed]
  9. Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction. Mollberg, M., Hagberg, H., Bager, B., Lilja, H., Ladfors, L. Obstetrics and gynecology. (2005) [Pubmed]
  10. Newborn shoulder width: a prospective study of 2222 consecutive measurements. Verspyck, E., Goffinet, F., Hellot, M.F., Milliez, J., Marpeau, L. British journal of obstetrics and gynaecology. (1999) [Pubmed]
  11. Progesterone concentrations in maternal and fetal serum are lower during functional dystocia than in normal labor. Löfgren, M., Bäckström, T. Obstetrics and gynecology. (1992) [Pubmed]
  12. No mutations found in candidate genes for dystocia. Algovik, M., Lagercrantz, J., Westgren, M., Nordenskjöld, A. Hum. Reprod. (1999) [Pubmed]
  13. A randomized trial of misoprostol and oxytocin for induction of labor: safety and efficacy. Kramer, R.L., Gilson, G.J., Morrison, D.S., Martin, D., Gonzales, J.L., Qualls, C.R. Obstetrics and gynecology. (1997) [Pubmed]
  14. Prediction of fetal macrosomia using humeral soft tissue thickness. Sood, A.K., Yancey, M., Richards, D. Obstetrics and gynecology. (1995) [Pubmed]
  15. Effect of hormonal treatment on fertility in dairy cows with dystocia or retained fetal membranes at parturition. Risco, C.A., Archbald, L.F., Elliott, J., Tran, T., Chavatte, P. J. Dairy Sci. (1994) [Pubmed]
  16. Late-gestation treatment of pregnant cows with trenbolone acetate does not increase subsequent growth of heifer calves. Harting, M.A., de Avila, D.M., Johnson, K.A., Reeves, J.J. J. Anim. Sci. (1997) [Pubmed]
  17. Effect of administration of a controlled-release monensin capsule on incidence of calving-related disorders, fertility, and milk yield in dairy cows. Melendez, P., Goff, J.P., Risco, C.A., Archbald, L.F., Littell, R.C., Donovan, G.A. Am. J. Vet. Res. (2006) [Pubmed]
  18. Gestational diabetes mellitus--implications of different treatment protocols. Peled, Y., Perri, T., Chen, R., Pardo, J., Bar, J., Hod, M. Journal of pediatric endocrinology & metabolism : JPEM. (2004) [Pubmed]
  19. Recurrence of gestational diabetes mellitus: identification of risk factors. Spong, C.Y., Guillermo, L., Kuboshige, J., Cabalum, T. American journal of perinatology. (1998) [Pubmed]
  20. Sex steroid receptors and human parturition. Rezapour, M., Bäckström, T., Lindblom, B., Ulmsten, U. Obstetrics and gynecology. (1997) [Pubmed]
  21. Randomized trial of isosorbide mononitrate versus misoprostol for cervical ripening at term. Chanrachakul, B., Herabutya, Y., Punyavachira, P. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. (2002) [Pubmed]
  22. Hematology and clinical chemistry in dystocic and healthy post-reproductive female chameleons. Cuadrado, M., Díaz-Paniagua, C., Quevedo, M.A., Aguilar, J.M., Prescott, I.M. J. Wildl. Dis. (2002) [Pubmed]
  23. The use of clenbuterol in large animal obstetrics: manual correction of bovine dystocias. Ménard, L. Can. Vet. J. (1994) [Pubmed]
  24. Maternal and infant complications in high and normal weight infants by method of delivery. Gregory, K.D., Henry, O.A., Ramicone, E., Chan, L.S., Platt, L.D. Obstetrics and gynecology. (1998) [Pubmed]
  25. Myometrial steroid concentration and oxytocin receptor density in parturient women at term. Rezapour, M., Bäckström, T., Ulmsten, U. Steroids (1996) [Pubmed]
  26. Oxytocin release during parturition in the pelvic-neurectomized rat. Higuchi, T., Uchide, K., Honda, K., Negoro, H. J. Endocrinol. (1986) [Pubmed]
  27. Effects of oxytocin on placental retention following dystocia. Hickey, G.J., White, M.E., Wickenden, R.P., Armstrong, D.A. Vet. Rec. (1984) [Pubmed]
  28. Variables associated with peripartum traits in dairy cows. VII. Hormones, calf traits and subsequent milk yield. Erb, R.E., Chew, B.P., Malven, P.V., D'Amico, M.F., Zamet, C.N., Colenbrander, V.F. J. Anim. Sci. (1980) [Pubmed]
  29. High progesterone is related to effective human labor. Study of serum progesterone and 5alpha-pregnane-3,20-dione in normal and abnormal deliveries. Löfgren, M., Bäckström, T. Acta obstetricia et gynecologica Scandinavica. (1997) [Pubmed]
  30. Relative macrosomia identified by the individualised birthweight ratio (IBR). A better method of identifying the at risk fetus. Sanderson, D.A., Wilcox, M.A., Johnson, I.R. Acta obstetricia et gynecologica Scandinavica. (1994) [Pubmed]
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