Skip to main content

Advertisement

SpringerLink
Log in

The Pathophysiology of Labor Dystocia: Theme with Variations

  • Review
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

All data and material are available upon request to the corresponding author.

Abbreviations

ACNM:

American College of Nurse Midwives

ACOG:

American College of Obstetricians and Gynecologists

SMFM:

Society for Maternal–Fetal Medicine

CPD:

Cephalopelvic disproportion

ATP:

Adenosine triphosophate

pCRH:

Placental corticotropin releasing hormone

References

  1. Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014;210(3):179–93.

    Article  PubMed  Google Scholar 

  2. Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol. 2012;29(1):7–18.

    Article  PubMed  Google Scholar 

  3. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Major survey findings of listening to mothers III: new mothers speak out: report of national surveys of women’s childbearing experiences. J Perinat Educ. 2014;23(1):17–24.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tichelman E, Westerneng M, Witteveen AB, van Baar AL, van der Horst HE, de Jonge A, et al. Correlates of prenatal and postnatal mother-to-infant bonding quality: a systematic review. PLoS ONE. 2019;14(9):e0222998.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Prior E, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 2012;95(5):1113–35.

    Article  CAS  PubMed  Google Scholar 

  6. Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis. PLoS Med. 2018;15(1):e1002494.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jakobsson HE, Abrahamsson TR, Jenmalm MC, Harris K, Quince C, Jernberg C, et al. Decreased gut microbiota diversity, delayed Bacteroidetes colonisation and reduced Th1 responses in infants delivered by caesarean section. Gut. 2014;63(4):559–66.

    Article  CAS  PubMed  Google Scholar 

  8. Sandall J, Tribe RM, Avery L, Mola G, Visser GH, Homer CS, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392(10155):1349–57.

    Article  PubMed  Google Scholar 

  9. World Health Organization. WHO Statement on Caesarean Section Rates. World Health Organization; 2015. Report No.: WHO/RHR/15.02. Available at: https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf. Accessed 11/10/2021

  10. Gams B, Neerland C, Kennedy S. Reducing primary cesareans: an innovative multipronged approach to supporting physiologic labor and vaginal birth. J Perinat Neonatal Nurs. 2019;33(1):52–60.

    Article  PubMed  Google Scholar 

  11. Office of Disease Prevention and Health Promotion. Healthy people 2020: Maternal infant and child health. 2017. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health. Accessed 11/10/2021.

  12. Hamilton BE, Martin JA, Osterman MJ, Office of Disease Prevention and Health Promotion. Births: Provisional Data for 2020. Vital Statistics Rapid Release; no 12. Hyattsville, MD: National Center for Health Statistics. 2021.

  13. Barber EL, Lundsberg L, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Contributing indications to the rising cesarean delivery rate. Obstet Gynecol. 2011;118(1):29.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203(4):326 e1-e10.

    Article  PubMed  Google Scholar 

  15. Friedman E. The graphic analysis of labor. Am J Obstet Gynecol. 1954;68(6):1568–75.

    Article  CAS  PubMed  Google Scholar 

  16. Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol. 2010;116(6):1281–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lundborg L, Aberg K, Sandstrom A, Discacciati A, Tilden EL, Stephansson O, et al. First stage progression in women with spontaneous onset of labor: a large population-based cohort study. PLoS ONE. 2020;15(9):e0239724.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Rouse D. Active-phase labor arrest: oxytocin augmentation for at least 4 hours. Obstet Gynecol. 1999;93(3):323–8.

    CAS  PubMed  Google Scholar 

  19. Rouse D. Active phase labor arrest: revisiting the 2-hour minimum. Obstet Gynecol. 2001;98(4):550–4.

    CAS  PubMed  Google Scholar 

  20. Bugg GJ, Siddiqui F, Thornton JG. Oxytocin versus no treatment or delayed treatment for slow progress in the first stage of spontaneous labour. Cochrane Database Syst Rev. 2013;6:CD007123.

    Google Scholar 

  21. Neal JL, Lamp JM, Buck JS, Lowe NK, Gillespie SL, Ryan SL. Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor. J Midwifery Womens Health. 2014;59(1):28–34.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Neal JL, Lowe NK, Schorn MN, Holley SL, Ryan SL, Buxton M, et al. Labor dystocia: a common approach to diagnosis. J Midwifery Womens Health. 2015;60(5):499–509.

    Article  PubMed  Google Scholar 

  23. Quenby S, Pierce SJ, Brigham S, Wray S. Dysfunctional labor and myometrial lactic acidosis. Obstet Gynecol. 2004;103(4):718–23.

    Article  PubMed  Google Scholar 

  24. Parturition SR. N Engl J Med. 2007;356(3):271–83.

    Article  Google Scholar 

  25. Vannuccini S, Bocchi C, Severi FM, Challis JR, Petraglia F. Endocrinology of human parturition. Ann Endocrinol (Paris). 2016;77(2):105–13.

    Article  PubMed  Google Scholar 

  26. Arrowsmith S, Kendrick A, Hanley JA, Noble K, Wray S. Myometrial physiology—time to translate? Exp Physiol. 2014;99(3):495–502.

    Article  PubMed  Google Scholar 

  27. Tilden EL, Phillippi JC, Carlson N, Dissanayake M, Lee CS, Caughey AB, et al. The association between longer durations of the latent phase of labor and subsequent perinatal processes and outcomes among midwifery patients. Birth. 2020;47(4):418–29. 

  28. Aguilar HN, Mitchell BF. Physiological pathways and molecular mechanisms regulating uterine contractility. Hum Reprod Update. 2010;16(6):725–44.

    Article  CAS  PubMed  Google Scholar 

  29. Noble K, Matthew A, Burdyga T, Wray S. A review of recent insights into the role of the sarcoplasmic reticulum and Ca entry in uterine smooth muscle. Eur J Obstet Gynecol Reprod Biol. 2009;144(Suppl 1):S11–9.

    Article  CAS  PubMed  Google Scholar 

  30. Wray S, Arrowsmith S. Uterine excitability and ion channels and their changes with gestation and hormonal environment. Annu Rev Physiol. 2021;83:331–57.

    Article  CAS  PubMed  Google Scholar 

  31. Tachi M, Kouzaki M, Kanehisa H, Fukunaga T. The influence of circulatory difference on muscle oxygenation and fatigue during intermittent static dorsiflexion. Eur J Appl Physiol. 2004;91(5–6):682–8.

    Article  PubMed  Google Scholar 

  32. Wan JJ, Qin Z, Wang PY, Sun Y, Liu X. Muscle fatigue: general understanding and treatment. Exp Mol Med. 2017;49(10):e384.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Ortenblad N, Westerblad H, Nielsen J. Muscle glycogen stores and fatigue. J Physiol. 2013;591(18):4405–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Allen DG, Lamb GD, Westerblad H. Impaired calcium release during fatigue. J Appl Physiol (1985). 2008;104(1):296–305.

    Article  CAS  PubMed  Google Scholar 

  35. MacIntosh BR, Holash RJ, Renaud JM. Skeletal muscle fatigue—regulation of excitation-contraction coupling to avoid metabolic catastrophe. J Cell Sci. 2012;125(Pt 9):2105–14.

    CAS  PubMed  Google Scholar 

  36. Westerblad H, Bruton JD, Katz A. Skeletal muscle: energy metabolism, fiber types, fatigue and adaptability. Exp Cell Res. 2010;316(18):3093–9.

    Article  CAS  PubMed  Google Scholar 

  37. Wiberg-Itzel E, Pembe AB, Jarnbert-Pettersson H, Norman M, Wihlback AC, Hoesli I, et al. Lactate in amniotic fluid: predictor of labor outcome in oxytocin-augmented primiparas’ deliveries. PLoS ONE. 2016;11(10):e0161546.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wiberg-Itzel E, Pettersson H, Andolf E, Hansson A, Winbladh B, Akerud H. Lactate concentration in amniotic fluid: a good predictor of labor outcome. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):34–8.

    Article  CAS  PubMed  Google Scholar 

  39. Wiberg-Itzel E, Pettersson H, Cnattingius S, Nordstrom L. Association between lactate concentration in amniotic fluid and dysfunctional labor. Acta Obstet Gynecol Scand. 2008;87(9):924–8.

    Article  CAS  PubMed  Google Scholar 

  40. Murphy M, Butler M, Coughlan B, Brennan D, O’Herlihy C, Robson M. Elevated amniotic fluid lactate predicts labor disorders and cesarean delivery in nulliparous women at term. Am J Obstet Gynecol. 2015;213(5):673 e1-8.

    Article  PubMed  Google Scholar 

  41. Wiberg-Itzel E, Pembe AB, Wray S, Wihlback AC, Darj E, Hoesli I, et al. Level of lactate in amniotic fluid and its relation to the use of oxytocin and adverse neonatal outcome. Acta Obstet Gynecol Scand. 2014;93(1):80–5.

    Article  PubMed  Google Scholar 

  42. Guerra DD, Bok R, Breen K, Vyas V, Jiang H, MacLean KN, et al. Estrogen regulates local cysteine metabolism in mouse myometrium. Reprod Sci. 2021;28(1):79–90.

    Article  CAS  PubMed  Google Scholar 

  43. Vyas V, Guerra DD, Bok R, Powell T, Jansson T, Hurt KJ. Adiponectin links maternal metabolism to uterine contractility. FASEB J. 2019;33(12):14588–601.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Vink J, Myers K. Cervical alterations in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2018;52:88–102.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Yellon SM. Contributions to the dynamics of cervix remodeling prior to term and preterm birth. Biol Reprod. 2017;96(1):13–23.

    Article  PubMed  Google Scholar 

  46. Menon R, Bonney EA, Condon J, Mesiano S, Taylor RN. Novel concepts on pregnancy clocks and alarms: redundancy and synergy in human parturition. Hum Reprod Update. 2016;22(5):535–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Timmons B, Akins M, Mahendroo M. Cervical remodeling during pregnancy and parturition. Trends Endocrinol Metab. 2010;21(6):353–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Vrhovec J. Evaluating the progress of the labour with sample entropy calculated from the uterine EMG activity. Elektrotehniski vestnik: Ljubljana, Slovenia. 2009;76(4):165–70.

    Google Scholar 

  49. Santoso AP, Vink JY, Gallos G, Feltovich H, Hall TJ. Quantitative ultrasound detects smooth muscle activity at the cervical internal os in vitro. Ultrasound Med Biol. 2020;46(1):149–55.

    Article  PubMed  Google Scholar 

  50. Hay R, Patterson J. Effects of cervical excisional procedures for cervical intraepithelial neoplasia on pregnancy and birth: a literature review. N Z Coll Midwives J. 2018;54:22–9.

    Article  Google Scholar 

  51. Simkin P, Hanson L, Ancheta R. The labor progress handbook: early interventions to prevent and treat dystocia: John Wiley & Sons, Hoboken, NJ; 2017;978 1119170464

  52. Houlard S, Perrotin F, Fourquet F, Marret H, Lansac J, Body G. Risk factors for cervical stenosis after laser cone biopsy. Eur J Obstet Gynecol Reprod Biol. 2002;104(2):144–7.

    Article  PubMed  Google Scholar 

  53. Hofmeyr GJ, Singata-Madliki M. The second stage of labor. Best Pract Res Clin Obstet Gynaecol. 2020;67:53–64.

    Article  CAS  PubMed  Google Scholar 

  54. Hanson L. Second-stage labor care: challenges in spontaneous bearing down. J Perinat Neonatal Nurs. 2009;23(1):31–9; quiz 40–1.

  55. Denison FC, Price J, Graham C, Wild S, Liston WA. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG. 2008;115(6):720–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Kominiarek MA, Zhang J, Vanveldhuisen P, Troendle J, Beaver J, Hibbard JU. Contemporary labor patterns: the impact of maternal body mass index. Am J Obstet Gynecol. 2011;205(3):244 e1-8.

    Article  PubMed  Google Scholar 

  57. Wray S. Insights from physiology into myometrial function and dysfunction. Exp Physiol. 2015;100(12):1468–76.

    Article  PubMed  Google Scholar 

  58. Carlson NS, Hernandez TL, Hurt KJ. Parturition dysfunction in obesity: Time to target the pathobiology. Reprod Biol Endocrinol. 2015;13:135–49.

  59. Zelig CM, Nichols SF, Dolinsky BM, Hecht MW, Napolitano PG. Interaction between maternal obesity and Bishop score in predicting successful induction of labor in term, nulliparous patients. Am J Perinatol. 2013;30(1):75–80.

    PubMed  Google Scholar 

  60. Carlson NS, Lowe NK. Intrapartum management associated with obesity in nulliparous women. J Midwifery Womens Health. 2014;59(1):43–53.

    Article  PubMed  Google Scholar 

  61. Moynihan AT, Hehir MP, Glavey SV, Smith TJ, Morrison JJ. Inhibitory effect of leptin on human uterine contractility in vitro. Am J Obstet Gynecol. 2006;195(2):504–9.

    Article  CAS  PubMed  Google Scholar 

  62. Mumtaz S, AlSaif S, Wray S, Noble K. Inhibitory effect of visfatin and leptin on human and rat myometrial contractility. Life Sci. 2015;125:57–62.

    Article  CAS  PubMed  Google Scholar 

  63. Frias AE, Morgan TK, Evans AE, Rasanen J, Oh KY, Thornburg KL, et al. Maternal high-fat diet disturbs uteroplacental hemodynamics and increases the frequency of stillbirth in a nonhuman primate model of excess nutrition. Endocrinology. 2011;152(6):2456–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Mele J, Muralimanoharan S, Maloyan A, Myatt L. Impaired mitochondrial function in human placenta with increased maternal adiposity. Am J Physiol Endocrinol Metab. 2014;307(5):E419–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Shmygol A, Noble K, Wray S. Depletion of membrane cholesterol eliminates the Ca2+-activated component of outward potassium current and decreases membrane capacitance in rat uterine myocytes. J Physiol. 2007;581(Pt 2):445–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Zhang J, Kendrick A, Quenby S, Wray S. Contractility and calcium signaling of human myometrium are profoundly affected by cholesterol manipulation: implications for labor? Reprod Sci. 2007;14(5):456–66.

    Article  CAS  Google Scholar 

  67. Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women—systematic review and meta-analysis of cohort studies. Obes Rev. 2009;10(1):28–35.

    Article  CAS  PubMed  Google Scholar 

  68. Rossi AC, Mullin P, Prefumo F. Prevention, management, and outcomes of macrosomia: a systematic review of literature and meta-analysis. Obstet Gynecol Surv. 2013;68(10):702–9.

    Article  PubMed  Google Scholar 

  69. Simkin P. The fetal occiput posterior position: state of the science and a new perspective. Birth. 2010;37(1):61–71.

    Article  PubMed  Google Scholar 

  70. Lenhard MS, Johnson TR, Weckbach S, Nikolaou K, Friese K, Hasbargen U. Pelvimetry revisited: analyzing cephalopelvic disproportion. Eur J Radiol. 2010;74(3):e107–11.

    Article  PubMed  Google Scholar 

  71. Rizzo G, Aiello E, Bosi C, D’Antonio F, Arduini D. Fetal head circumference and subpubic angle are independent risk factors for unplanned cesarean and operative delivery. Acta Obstet Gynecol Scand. 2017;96(8):1006–11.

    Article  PubMed  Google Scholar 

  72. Committee on Practice B-O. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol. 2020;135(1):e18–35.

    Article  Google Scholar 

  73. Zafman KB, Bergh E, Fox NS. Accuracy of sonographic estimated fetal weight in suspected macrosomia: the likelihood of overestimating and underestimating the true birthweight. J Matern Fetal Neonatal Med. 2020;33(6):967–72.

    Article  PubMed  Google Scholar 

  74. Pilliod RA, Caughey AB. Fetal malpresentation and malposition: diagnosis and management. Obstet Gynecol Clin North Am. 2017;44(4):631–43.

    Article  PubMed  Google Scholar 

  75. Tully G. Understanding Labor Patterns: Spinning Babies; 2022. Available from: https://www.spinningbabies.com/pregnancy-birth/labor/understanding-labor-patterns/. Accessed 11/10/2021.

  76. Cheng YW, Shaffer BL, Caughey AB. Associated factors and outcomes of persistent occiput posterior position: a retrospective cohort study from 1976 to 2001. J Matern Fetal Neonatal Med. 2006;19(9):563–8.

    Article  PubMed  Google Scholar 

  77. Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP. Uterine contractility in women whose fetus is delivered in the occipitoposterior position. Am J Obstet Gynecol. 2003;188(3):734–9.

    Article  PubMed  Google Scholar 

  78. Gardberg M, Leonova Y, Laakkonen E. Malpresentations—impact on mode of delivery. Acta Obstet Gynecol Scand. 2011;90(5):540–2.

    Article  PubMed  Google Scholar 

  79. Makajeva J, Ashraf M. Delivery, Face and Brow Presentation: StatPearls Publishing; 2022.

  80. Bommarito KM, Gross GA, Willers DM, Fraser VJ, Olsen MA. The effect of clinical chorioamnionitis on cesarean delivery in the United States. Health Serv Res. 2016;51(5):1879–95.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Fan S-R, Liu P, Yan S-M, Peng J-Y, Liu X-P. Diagnosis and management of intraamniotic infection. Maternal-Fetal Medicine. 2020;2(4):223–30.

    Article  Google Scholar 

  82. Peng CC, Chang JH, Lin HY, Cheng PJ, Su BH. Intrauterine inflammation, infection, or both (Triple I): a new concept for chorioamnionitis. Pediatr Neonatol. 2018;59(3):231–7.

    Article  PubMed  Google Scholar 

  83. Conde-Agudelo A, Romero R, Jung EJ, Garcia Sanchez AJ. Management of clinical chorioamnionitis: an evidence-based approach. Am J Obstet Gynecol. 2020;223(6):848-69.

  84. Zackler A, Flood P, Dajao R, Maramara L, Goetzl L. Suspected chorioamnionitis and myometrial contractility: mechanisms for increased risk of cesarean delivery and postpartum hemorrhage. Reprod Sci. 2019;26(2):178–83.

    Article  PubMed  Google Scholar 

  85. Rauk PN, Friebe-Hoffmann U. Interleukin-1 beta down-regulates the oxytocin receptor in cultured uterine smooth muscle cells. Am J Reprod Immunol. 2000;43(2):85–91.

    Article  CAS  PubMed  Google Scholar 

  86. Leroy MJ, Dallot E, Czerkiewicz I, Schmitz T, Breuiller-Fouche M. Inflammation of choriodecidua induces tumor necrosis factor alpha-mediated apoptosis of human myometrial cells. Biol Reprod. 2007;76(5):769–76.

    Article  CAS  PubMed  Google Scholar 

  87. Gomez-Lopez N, Romero R, Xu Y, Garcia-Flores V, Leng Y, Panaitescu B, et al. Inflammasome assembly in the chorioamniotic membranes during spontaneous labor at term. Am J Reprod Immunol. 2017;77(5):e.12648.

  88. Lirussi F, O’Brien M, Wendremaire M, Goirand F, Sagot P, Dumas M, et al. SAR150640, a selective beta3-adrenoceptor agonist, prevents human myometrial remodelling and activation of matrix metalloproteinase in an in vitro model of chorioamnionitis. Br J Pharmacol. 2010;159(6):1354–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  89. Oner C, Schatz F, Kizilay G, Murk W, Buchwalder LF, Kayisli UA, et al. Progestin-inflammatory cytokine interactions affect matrix metalloproteinase-1 and -3 expression in term decidual cells: implications for treatment of chorioamnionitis-induced preterm delivery. J Clin Endocrinol Metab. 2008;93(1):252–9.

    Article  CAS  PubMed  Google Scholar 

  90. Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol. 1997;177(5):1024–9.

    Article  CAS  PubMed  Google Scholar 

  91. Imseis HM, Trout WC, Gabbe SG. The microbiologic effect of digital cervical examination. Am J Obstet Gynecol. 1999;180(3):578–80.

    Article  CAS  PubMed  Google Scholar 

  92. Adams SS, Eberhard-Gran M, Eskild A. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG. 2012;119(10):1238–46.

    Article  CAS  PubMed  Google Scholar 

  93. Lederman RP, Lederman E, Work BA Jr, McCann DS. The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol. 1978;132(5):495–500.

    Article  CAS  PubMed  Google Scholar 

  94. Dencker A, Nilsson C, Begley C, Jangsten E, Mollberg M, Patel H, et al. Causes and outcomes in studies of fear of childbirth: a systematic review. Women Birth. 2019;32(2):99–111.

    Article  PubMed  Google Scholar 

  95. Kissler K, Jones J, McFarland AK, Luchsinger J. A qualitative meta-synthesis of women's experiences of labor dystocia. Women Birth. 2020;33(4):e332–e8.

  96. Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med. 2012;10:47.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett G, et al. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379(6):513–23.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Bohra U, Donnelly J, O’Connell MP, Geary MP, MacQuillan K, Keane DP. Active management of labour revisited: the first 1000 primiparous labours in 2000. J Obstet Gynaecol. 2003;23(2):118–20.

    Article  CAS  PubMed  Google Scholar 

  99. O’Driscoll K, Stronge JM, Minogue M. Active management of labour. Br Med J. 1973;3(5872):135–7.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7:CD003766.

    PubMed  Google Scholar 

  101. Bastidas K, Romero XC, Uriel M, De la Hoz JA. Perinatal outcomes associated with the diagnosis of gestational diabetes: systematic review and meta-analysis. Diabetes Metab Syndr. 2021;15(5):102262.

    Article  CAS  PubMed  Google Scholar 

  102. Barbour LA, Hernandez TL. Maternal non-glycemic contributors to fetal growth in obesity and gestational diabetes: spotlight on lipids. Curr Diab Rep. 2018;18(6):37.

    Article  PubMed  Google Scholar 

  103. Barakat R, Franco E, Perales M, Lopez C, Mottola MF. Exercise during pregnancy is associated with a shorter duration of labor. A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 2018;224:33–40.

    Article  PubMed  Google Scholar 

  104. Souter V, Painter I, Sitcov K, Caughey AB. Maternal and newborn outcomes with elective induction of labor at term. Am J Obstet Gynecol. 2019;220(3):273 e1-11.

    Article  PubMed  Google Scholar 

  105. Sweeting A, Mijatovic J, Brinkworth GD, Markovic TP, Ross GP, Brand-Miller J, et al. The Carbohydrate Threshold in Pregnancy and Gestational Diabetes: How Low Can We Go? Nutrients. 2021;13(8):2599.

  106. Frigoletto FD Jr, Lieberman E, Lang JM, Cohen A, Barss V, Ringer S, et al. A clinical trial of active management of labor. N Engl J Med. 1995;333(12):745–50.

    Article  PubMed  Google Scholar 

  107. Lopez-Zeno JA, Peaceman AM, Adashek JA, Socol ML. A controlled trial of a program for the active management of labor. N Engl J Med. 1992;326(7):450–4.

    Article  CAS  PubMed  Google Scholar 

  108. Carlson NS, Corwin EJ, Hernandez TL, Holt E, Lowe NK, Hurt KJ. Association between provider type and cesarean birth in healthy nulliparous laboring women: a retrospective cohort study. Birth. 2018;45(2):159–68.

    Article  PubMed  PubMed Central  Google Scholar 

  109. Souter V, Nethery E, Kopas ML, Wurz H, Sitcov K, Caughey AB. Comparison of midwifery and obstetric care in low-risk hospital births. Obstet Gynecol. 2019;134(5):1056–65.

    Article  PubMed  Google Scholar 

  110. Carlson NS, Breman R, Neal JL, Phillippi JC. Preventing cesarean birth in women with obesity: influence of unit-level midwifery presence on use of cesarean among women in the consortium on safe labor data set. J Midwifery Womens Health. 2020;65(1):22–32.

    Article  PubMed  Google Scholar 

  111. Fore MS, Allshouse AA, Carlson NS, Hurt KJ. Outcomes of trial of labor after cesarean birth by provider type in low-risk women. Birth. 2020;47(1):123–34.

    Article  PubMed  Google Scholar 

  112. Smith DC, Phillippi JC, Lowe NK, Breman RB, Carlson NS, Neal JL, et al. Using the Robson 10-group classification system to compare cesarean birth utilization between US centers with and without midwives. J Midwifery Womens Health. 2020;65(1):10–21.

    Article  PubMed  Google Scholar 

  113. Dweik D, Girasek E, Meszaros G, Toreki A, Kereszturi A, Pal A. Non-medical determinants of cesarean section in a medically dominated maternity system. Acta Obstet Gynecol Scand. 2014;93(10):1025–33.

    Article  PubMed  Google Scholar 

  114. Kozhimannil KB, Vogelsang CA, Hardeman RR, Prasad S. Disrupting the pathways of social determinants of health: doula support during pregnancy and childbirth. J Am Board Fam Med. 2016;29(3):308–17.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Neal JL, Lowe NK. Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset. Med Hypotheses. 2012;78(2):319–26.

    Article  PubMed  Google Scholar 

  116. WHO. World Health Organization partograph in management of labour. Lancet. 1994;343(8910):1399–404.

    Google Scholar 

  117. Neal JL, Lowe NK, Nacht AS, Koschoreck K, Anderson J. Pilot study of physiologic partograph use among low-risk, nulliparous women with spontaneous labor onset. J Midwifery Womens Health. 2016;61(2):235–41.

    Article  PubMed  Google Scholar 

  118. Hauth JC, Hankins GD, Gilstrap LC 3rd, Strickland DM, Vance P. Uterine contraction pressures with oxytocin induction/augmentation. Obstet Gynecol. 1986;68(3):305–9.

    Article  CAS  PubMed  Google Scholar 

  119. Frey H, Tuuli M, Roehl K, Odibo A, Macones G, Cahill A. Montevideo units: A poor predictor of second stage outcomes. Am J Obstet Gynecol. 2013;208(1):S141.

  120. Kernberg A, Caughey AB. Augmentation of labor: a review of oxytocin augmentation and active management of labor. Obstet Gynecol Clin North Am. 2017;44(4):593–600.

    Article  PubMed  Google Scholar 

  121. Zhang J, Branch DW, Ramirez MM, Laughon SK, Reddy U, Hoffman M, et al. Oxytocin regimen for labor augmentation, labor progression, and perinatal outcomes. Obstet Gynecol. 2011;118(2 Pt 1):249–56.

    Article  PubMed  PubMed Central  Google Scholar 

  122. Wei S, Wo BL, Qi HP, Xu H, Luo ZC, Roy C, et al. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev. 2013;8:CD006794.

    Google Scholar 

  123. Blanc-Petitjean P, Le Ray C, Lepleux F, De La Calle A, Dreyfus M, Chantry AA. Factors affecting rotation of occiput posterior position during the first stage of labor. J Gynecol Obstet Hum Reprod. 2018;47(3):119–25.

    Article  CAS  PubMed  Google Scholar 

  124. Hanley JA, Weeks A, Wray S. Physiological increases in lactate inhibit intracellular calcium transients, acidify myocytes and decrease force in term pregnant rat myometrium. J Physiol. 2015;593(20):4603–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. Dawood F, Dowswell T, Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women. The Cochrane Library. 2013;208(3):226–e1.

  126. Riegel M, Quist-Nelson J, Saccone G, Locci M, Shrivastava VK, Salim R, et al. Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor. Eur J Obstet Gynecol Reprod Biol. 2018;228:284–94.

    Article  CAS  PubMed  Google Scholar 

  127. Singata M, Tranmer J, Gyte GM. Restricting oral fluid and food intake during labour. Cochrane Database Syst Rev. 2010;1:CD003930.

    Google Scholar 

  128. Ciardulli A, Saccone G, Anastasio H, Berghella V. Less-restrictive food intake during labor in low-risk singleton pregnancies: a systematic review and meta-analysis. Obstet Gynecol. 2017;129(3):473–80.

    Article  PubMed  Google Scholar 

  129. Wiberg-Itzel E, Wray S, Akerud H. A randomized controlled trial of a new treatment for labor dystocia. J Matern Fetal Neonatal Med. 2018;31(17):2237–44.

    Article  CAS  PubMed  Google Scholar 

  130. Seyedi M, Ghorashi Z, Sedighi DT. Randomized controlled trial of oral bicarbonate treatment for labor stagnation. J Obstet Gynaecol Res. 2021;47(1):114–8.

    Article  CAS  PubMed  Google Scholar 

  131. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57.

    Article  PubMed  PubMed Central  Google Scholar 

  132. Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gulmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016;123(5):745–53.

    Article  CAS  PubMed  Google Scholar 

  133. Cypher RL. Cesarean birth: a journey in historical trends. J Perinat Neonatal Nurs. 2016;30(3):259–64.

    Article  PubMed  Google Scholar 

  134. Carlson NS, Lowe NK. A concept analysis of watchful waiting among providers caring for women in labour. J Adv Nurs. 2014;70(3):511–22.

    Article  PubMed  Google Scholar 

  135. Lowe NK, Corwin EJ. Proposed biological linkages between obesity, stress, and inefficient uterine contractility during labor in humans. Med Hypotheses. 2011;76(5):755–60.

    Article  PubMed  Google Scholar 

  136. Cluff AH, Bystrom B, Klimaviciute A, Dahlqvist C, Cebers G, Malmstrom A, et al. Prolonged labour associated with lower expression of syndecan 3 and connexin 43 in human uterine tissue. Reprod Biol Endocrinol. 2006;4:24.

    Article  PubMed  PubMed Central  Google Scholar 

  137. Reinebrant HE, Pileggi-Castro C, Romero CL, Dos Santos RA, Kumar S, Souza JP, et al. Cyclo-oxygenase (COX) inhibitors for treating preterm labour. Cochrane Database Syst Rev. 2015;6:CD001992.

    Google Scholar 

  138. Arrowsmith S, Kendrick A, Wray S. Drugs acting on the pregnant uterus. Obstet Gynaecol Reprod Med. 2010;20(8):241–7.

    Article  PubMed  PubMed Central  Google Scholar 

  139. Turi A, Kiss AL, Mullner N. Estrogen downregulates the number of caveolae and the level of caveolin in uterine smooth muscle. Cell Biol Int. 2001;25(8):785–94.

    Article  CAS  PubMed  Google Scholar 

  140. Klein U, Gimpl G, Fahrenholz F. Alteration of the myometrial plasma membrane cholesterol content with beta-cyclodextrin modulates the binding affinity of the oxytocin receptor. Biochemistry. 1995;34(42):13784–93.

    Article  CAS  PubMed  Google Scholar 

  141. Grotegut CA, Gunatilake RP, Feng L, Heine RP, Murtha AP. The influence of maternal body mass index on myometrial oxytocin receptor expression in pregnancy. Reprod Sci. 2013;20(12):1471–7.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Crankshaw DJ, O’Brien YM, Crosby DA, Morrison JJ. Maternal body mass index and spontaneous contractility of human myometrium in pregnancy. J Perinatol. 2017;37(5):492–7.

    Article  CAS  PubMed  Google Scholar 

  143. Elmes MJ, Tan DS, Cheng Z, Wathes DC, McMullen S. The effects of a high-fat, high-cholesterol diet on markers of uterine contractility during parturition in the rat. Reproduction. 2011;141(2):283–90.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by an F31 Ruth L. Kirschstein Pre-Doctoral Individual National Research Service Award from the National Institute of Nursing Research of the National Institutes of Health under award number FN31NR018582-01 (to KK).

Author information

Authors and Affiliations

  1. College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA

    Katherine Kissler

  2. Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA

    K. Joseph Hurt

  3. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Mailstop 8613, Aurora, CO, 80045, USA

    K. Joseph Hurt

Authors
  1. Katherine Kissler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Joseph Hurt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KK conducted the review and drafted the text with guidance from KJH. KK and KJH wrote and revised the manuscript. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to K. Joseph Hurt.

Ethics declarations

Ethics Approval and Consent to Participate

Not applicable.

Consent for Publication

All authors consent to the publication of this work. No other consent is required.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Summary sentence: Labor dystocia leading to unplanned cesarean delivery is mediated by distinct mechanisms which we summarize here to facilitate translational research and new clinical approaches to increase the rate of successful vaginal birth.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kissler, K., Hurt, K.J. The Pathophysiology of Labor Dystocia: Theme with Variations. Reprod. Sci. 30, 729–742 (2023). https://doi.org/10.1007/s43032-022-01018-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43032-022-01018-6

Keywords

Search

Navigation