Chapter 27: The Woman With an Intrapartum Complication

The content organizes dysfunctional labor patterns, commonly termed dystocia, into four functional categories: the powers, encompassing inadequate uterine contractions manifested as either hypotonic or hypertonic dysfunction; the passenger, including conditions such as fetal macrosomia, shoulder dystocia with specific maneuvers like the McRoberts technique and suprapubic pressure application, and malpresentations including breech and occiput posterior positions; the passage, involving pelvic architectural variations such as gynecoid or android configurations that may impede fetal descent; and the psyche, recognizing how maternal anxiety and psychological stress contribute to labor complications. The chapter distinguishes between prolonged labor, which elevates infection risk, and precipitate labor characterized by delivery within three hours, associated with placental abruption and fetal hypoxia. Premature rupture of membranes conditions, including both PROM at term and PPROM in preterm gestations, are examined for their role in chorioamnionitis development and management considerations based on gestational age milestones. Preterm labor assessment incorporates diagnostic modalities such as fetal fibronectin testing and transvaginal cervical ultrasound measurement to guide clinical decision-making. Pharmacological interventions receive detailed coverage, including tocolytic agents like magnesium sulfate for neuroprotection, calcium channel blockers such as nifedipine, nonsteroidal anti-inflammatory medications like indomethacin, and beta-2 agonists including terbutaline. Antenatal corticosteroid administration using betamethasone or dexamethasone accelerates fetal pulmonary maturation and reduces neonatal respiratory distress syndrome incidence. Postterm pregnancy complications arising from placental insufficiency and meconium aspiration risk are addressed alongside life-threatening emergencies including umbilical cord prolapse, uterine rupture particularly in prior cesarean patients, uterine inversion, and amniotic fluid embolism, all requiring immediate recognition and intervention.