Stagnation of dilation: causes, should a caesarean section be done?

Dilation of the cervix is ​​necessary to induce labor. But it happens that this process does not advance any more: one speaks then of stagnation of dilation. What is it due to? Is caesarean section compulsory? We do the point with Caroline Verhaeghe, obstetrician-gynecologist.

  Stagnation of dilation: causes, should a caesarean section be done?

What is stagnant dilation during childbirth?

After being long and closed throughout pregnancy, the cervix will fade and dilate, i.e. open, to let the baby through on the day of delivery. Full dilation, i.e. 10 centimeters, is necessary for the birth of the baby vaginally. Throughout the duration of labor, the midwife performs a vaginal examination every hour to assess the cervical dilation of the uterus. When this has not changed for two hours in the active phase or six hours in the latency phase, we speak of stagnation of the dilation. . ' This notion is variable according to the maternal and fetal context, and the progress of labor. For example, whether it is a scarred uterus or a healthy uterus, whether labor is spontaneous or has been induced. In the presence of a retardation of intra-uterine croissance (IUGR) major, we do not react in the same way, we do not allow ourselves the same time of stagnation of the dilation ', nuance le Dr Caroline Verhaeghe.

Is caesarean section recommended in case of stagnation of dilation?

The use of caesarean section is not systematic, it depends on the maternal-fetal context and the progress of labour. In the active phase, on a scarred uterus, in case of macrosomia or suffering of the baby, do not wait more than two hours. On the other hand, in the event of stagnation of dilation on a healthy uterus in the latency phase, the cesarean section can wait 4 to 6 hours.

Why is work not progressing?

Several causes can explain a stagnation of dilation:

  • Of the contractions ineffective either in intensity or frequency on the cervix
  • Poor presentation of the baby: he has a badly bent head or has an asynclite presentation; the baby does not press properly on the cervix, which prevents the cervix from dilating.
  • A fetal-pelvic disproportion: either the baby cannot descend into the pelvis because it is too big, or the mother's pelvis is too narrow and the baby does not have room to descend.

Does the epidural prevent labor from progressing?

Contrary to popular belief, the epidural does not slow labor unless it is put in place before the active phase of labor. This is the reason why most maternities only agree to place it from 2.5 to 3 centimeters of dilation.



What to do to get back to work?

In addition to non-drug techniques such as modify the posture of the future mother, do acupuncture, walk, there are no great methods to restart labor. 'When the membranes are intact, the midwife or the obstetrician can rupture them, which will release a whole bunch of proteins and enzymes which will start labor again. In general, the head of the fetus going to press the cervix much better. If this is not enough, oxytocin can be administered to promote dilation of the cervix. , inform the obstetrician gynecologist.

Thanks to Caroline Verhaeghe, obstetrician gynecologistSource journaldesfemmes.fr