Cervical dystocia is when the birth process is delayed due to insufficient dilation of the cervix. Cervical dystocia is usually caused by functional disorders. Painful cramping occurs due to insufficient opening despite adequate labor.
What is cervical dystocia?
Cervical dystocia is a complication of the birth process. Normally, the cervix opens gradually with the onset of labor. In early labor, it should widen to a diameter of three to five centimeters. When the cervix is open about eight to nine centimeters, the stage of pushing labor begins. When the cervix is about ten centimeters in diameter, the baby’s head can be born. If the cervix does not open or opens too slowly, there is cervical dystocia.
Causes
Cervical dystocia is caused by either functional or pathologic-anatomic disorders. In most cases, cervical dystocia is caused by functional disorders. These are usually based on spasms of the cervix or the lower part of the uterus. These spasms, in turn, are usually triggered by uncoordinated or excessive labor. Normally, opening contractions occur about three times in ten minutes with a pressure of 10 to 50 mmHg. Untimed and uncoordinated contractions, unlike normal opening contractions, do not result in opening of the cervix. However, cervical spasm may also be psychological. First-time mothers aged 38 to 40 years and older are particularly affected by this psychologically induced spasm. In addition, the so-called endogenous prostaglandins respond worse in late first-time mothers than in younger mothers. Prostaglandins are local hormones that play a role in labor, among other things. This hormonal disturbance causes the cervix, including the cervical os, to remain rigid. This then leads to a functionally disturbed birth process. Pathological-anatomical causes of cervical dystocia are present when the muscles of the cervix are pathologically altered. The cause of these pathological changes is, for example, surgery, which can lead to scarring of the cervix. Such scarring occurs, for example, after conization. During a conization, a part of the cervix in the area of the cervix is removed. Emmetoplasty or cerclage, as well as inflammation, can also lead to scarring. In rare cases, the cervix may be stuck together by connective tissue. This condition is called conglutinatio orificii externi uteri.
Symptoms, complaints, and signs
Cervical dystocia is manifested by inadequate opening of the cervix during labor. Labor is not affected. On palpation, the cervix feels coarse or possibly even spasmodically hardened. Affected women feel each of the painful contractions, but the cervix does not open or opens inadequately. In most cases, the limit is reached at five to eight centimeters, above which the cervix no longer opens further. However, ten centimeters would be required for birth. A cervical dystocia can last for hours. The process is very exhausting and completely exhausts the woman giving birth.
Diagnosis and course of the disease
Diagnosis is made by inspection and palpation of the cervix. On inspection, the small diameter of the cervix is evident. On palpation, the cervix and cervix appear coarse and hard.
Complications
Cervical dystocia is a serious complication during the birth process. If the cervix does not open wide enough during labor, painful contractions and sometimes bleeding occur. In general, childbirth with cervical dystocia is very debilitating and exhausting for the expectant mother. The baby may experience hematomas and other injuries during delivery, but these are rarely serious. Major complications can occur if the cervix opens only a few centimeters. Then a natural birth is usually not possible and a cesarean section must be induced. Such an intervention is always associated with risks for the woman giving birth and the child. For example, the unborn child may twist awkwardly or be injured by the surgical tools.For the mother, a cesarean section is associated with the risk of infection, injury, and wound healing problems. The cosmetic blemish can cause emotional discomfort. Therapy of cervical dystocia using home remedies may cause complications, depending on the method and preparation. Thus, especially alternative medical procedures such as acupuncture or remedies from homeopathy bear certain risks. Conservative medicines may cause side effects.
When should you see a doctor?
In Europe, the birth of a child usually takes place under the care of a doctor and a midwife. It is less advisable for a woman to give birth to a child without the presence of medically trained personnel. Childbirth can take place in an inpatient setting, in a birth center, or in a home setting. In all locations, collaboration with obstetricians or midwives is possible. Well before the expected delivery date, the pregnant woman should seek appropriate care. If complications or adversities arise during the birthing process, this will allow the situation to be addressed as quickly as possible. In addition, the expectant mother should inform herself sufficiently about the birth process. An obstetrician should be called or a hospital visited no later than the onset of labor. If an unplanned and sudden birth occurs, an ambulance should be alerted. Immediate action should be taken to avoid developments that could endanger the health of the unborn child as well as the mother.
Treatment and therapy
The initial focus is on pain relief. Particularly in cases of spasm of the uterine muscles and cervix, affected women suffer severe pain. To protect the unborn child, the pain is primarily relieved in a conservative manner. For example, a relaxing bath in the bathtub can serve this purpose. In support of this, the midwife can provide detailed instructions and tips for better processing of the contractions and labor pain. The partner can be a valuable support in the delivery room. Alternative medical procedures such as acupuncture, homeopathy or aromatherapy can also bring improvement. If these conservative pain relief measures are unsuccessful, pain medications may be used. Anticonvulsant medications (spasmolytics) can be administered as suppositories or infusions. They provide decongestion of the cervix, which advances the opening of the same. Opiates can also be injected into the gluteal muscle. These have an analgesic and sedative effect. However, they have the disadvantage that the respiratory drive of the woman giving birth and possibly also the respiratory drive of the newborn are suppressed. Peridural anesthesia can be helpful, especially in cases of very severe pain and a long labor. In this case, a local anesthetic is delivered through a small tube in the area of the spinal cord. If the cervix is very rigid, local administration of prostaglandins can be supportive. The cervix may need to be stretched manually to allow the baby to be born.
Prevention
Functional cervical dystocia, in particular, is best prevented by thorough preparation for childbirth. A childbirth preparation course can be very helpful in this regard. It takes away the fear of childbirth and labor pains and also strengthens confidence in one’s own ability to give birth. During the course, the pregnant woman learns breathing exercises that make the birth easier and reduce pain. Incorrect breathing during labor can cause cramping in the cervix. With the help of the relaxation exercises learned in the course, the woman giving birth can draw new strength during the birth. Women who have already given birth naturally need not fear cervical dystocia. In fact, this occurs almost exclusively only in first-time mothers.
Follow-up
In the case of cervical dystocia, those affected usually have only a few and usually limited measures of aftercare available to them. Therefore, they should seek medical attention at the first symptoms of this condition to avoid complications or other symptoms as it progresses. Early diagnosis with subsequent treatment usually has a very positive effect on the further course of the disease. Most patients are dependent on surgical intervention, which can alleviate the symptoms.The time after is to refrain from physical exertion and stressful activities. Due to cervical dystocia, many of those affected are also dependent on the help and support of their own family. Support in everyday life is very important, and psychological help can also prevent the development of depression and other psychological complaints. However, the further course of cervical dystocia is strongly dependent on the time of diagnosis and also on the severity of the disease, so that a general prediction is not possible. Therefore, the focus is on early diagnosis and detection of the disease.
What you can do yourself
In the case of cervical dystocia, the measures and options for self-help are significantly limited. In some cases, they are not even available to the patient in the process. Therefore, in the first place, a quick and, above all, an early diagnosis of the disease is necessary, so that it can also be treated quickly, since it can not come to a self-healing in the process. In many cases of cervical dystocia, the support and help of one’s family is also very important. This can prevent or limit depression and also other mental illnesses. It is not uncommon for the partner to need support as well. Frequently, contact with other cervical dystocia patients has a positive effect on the further course of the disease and can make everyday life somewhat easier, as it leads to an exchange of information. Acupuncture or aromatherapy can also alleviate the symptoms, although these therapies cannot replace a full medical treatment. Regular check-ups by a doctor should also be performed to avoid further complications or discomfort.
