The Failure progress of labor is the second indication for cesarean delivery after repeat section. It is generally agreed that dystocia leading ro cesarean delivery is overdiagnosed in the world. Variability in the criteria for diagnosis is major determinant of the increase in cesarean deliveries for dystocia. This study was identified dystocia with comparison with the criteria obstetrics standards and determined the cause's effects of incorrect diagnosis. A descriptive analytic case-control study was performed on 1212 women who experienced cesarean delivery in Yahyanegad hospital of Babol a city in North of Iran during 2004. We compared criteria of diagnosis of dystocia among 248 women whome were operated with dystocia with criteria that were proposed by American college of obstetricians and gynecologis. Also, we compared 118 women with correct diagnosis with 130 women with incorrect diagnosis to identify causes of incorrect diagnosis. Statistical test 2, t-Test and multiple logistic regressions were used to analysis of data. Dystocia was diagnosed during latent phase, active phase and second stage respectively: %64.9, %29.8 and %5.3. The strogenst predictor of incorrect diagnosis of dystocia was the lack of administration of oxytocine. Other independent risk factors for failure of labor to progress, using a multivariable analysis, were: performing of cesarean in morning (OR=2.8 %95 CI 2.1 –3.5), performing of cesarean in afternoon (OR = 2.6 %95 CI 1.3-3), nulliparity (OR=2.1 %95 CI 1.7-3.2), incorrect clinical estimation of fetal macrosomia (OR= 2.3 %95 CI 1.5-2.9). %50 accuracy of failure of labor progress according to obstetrics standards implies that there is overdiagnosis in the dystocia. This study proposes that obstetricans should be managed conservatively protract dilatation in the patients to prevent of incorrect diagnosed dystocia cesarean. Active management of labor with accurate administration of oxytocine and amniotomy is another strategy that may be help to decrease cesarean with diagnostic dystocia.

Dystocia means difficult labor or childbirth, a period of non progression of labor≥4 hours after the cervix has dilated 3 cm due toabnormal presentation, birth canal stenosis or uterine dysfunction. In traditional Iranian medicine, dystocia is defined as “difficult birth" or "Osrolveladeh". This study aimed to review causes of dystocia in the Iranian traditional medicine and classic medicine. In Iranian traditional medicine texts, risk factors for dystocia included maternal cause, fetal cause, uterus and membranes organ around uterus, and external causes. This study is a literature review as result of continuous study on 6 credible books in traditional Iranian medicine. At first, causes of "difficult birth" or "Osrolveladeh" obtained from 6 credible books in traditional Iranian medicine then for each causes, related scientific themes in classic medicine were searched and obtained from Pubmed, SID, Ovid, Iran doc, Science direct databases using the following key words: dystocia, labor, malposition, newborn macrosomia, from 1995 to 2011. Causes of "difficult birth" or "Osrolveladeh" in Iranian traditional medicine included maternal, fetal, uterus and membrane, organs around the uterus, and external causes that compared with causes of "dystocia" in classical medicine. All dystocia causes mentioned in Iranian traditional medicine are proved by classic medicine, but some causes exist in Iranian traditional medicine that are not in the classic medicine so these causes need to be studied.

Shoulder dystocia is an obstetrics emergency which could be prevented by identifying its predictors and taking effective measures. The aim of this study was to determine the relationship between maternal factors and interventions for shoulder dystocia.

In this descriptive correlational study, we studied 6520 delivery files in a hospital in Sabzevar, Iran 2017-2018. All vaginal deliveries at 37-42 weeks with cephalic presentation were investigated and data of deliveries with shoulder dystocia (n=212) and without this condition (n=6308) were extracted using a researcher-made checklist. Mann-Whitney, Chi-square and logistic regression were applied for data analysis.

Findings showed significant differences between the two groups in mean age (P<0.001), body mass index (P<0.001), maternal weight (P=0.002), spontaneous labor (P<0.001), oxytocin augmentation (P=0.001), and vacuum extraction (P<0.001). In multiple logistic regression analysis, the only independent risk factor for shoulder dystocia was vacuum extraction (OR= 2.52, 95% CI: 1.596-3.978, P<0.001).

According to this study, shoulder dystocia can be predicted in vacuum-assisted vaginal deliveries which could be prevented by reducing this procedure and using alternative methods such as Caesarean section.

Labor pain is one of the most severe pain which only the females experience it. In all of the countries continuous epidural analgesia is known as the most reliable and safe method. In spite of this there are some concerns about the effects of analgesia on mother and fetus hence avoiding this technique in Iran. This article undertaken to show the effects of continuous segmental epidural analgesia on the labor process.Methods and materials: This study is a randomized clinical trial undertaken in Kermanshah UMSHS. Study conducted on 90 primipara cases ranging between 17-30 years old age which randomly allocated in two case and control groups. Segmental epidural block with bupivacaine combined with sufentanil was conducted in the study group. Data collected with check list and analized with SPSS software. Differences of labor duration in the first and second phases was compared with t-test, any unwanted cesarean section due to dystopia or fetal distress with exact Fischer test, apgar scores of newborns in two groups with corrected K square test aby use of devices for delivery with K square test and quality of analgesia was measured with visual analog score (VAS). In this study labor duration in two groups for first and second stages showed no significant difference (P<0.05), also unwanted sectarian section, use of vacuum or forceps and first minute apgar scores of nweborns didnt show any significant differences. Complete analgesia (VAS=0) obtained in 97.8% of cases and remaining 2.2% experienced partial analgesia (VAS≤ 2). If cases are selected correctly and confusing factors and partial and absolute contraindications of epidural technique are spared continuous segmental epidural analgesia hasnt any side effects on labor process and mother and fetus health.

Background and Macrosomia can increase maternal & neonatal complications.These complications and their relevance to macrosomia was evaluated in this study. This was a cohort study done, by selecting 5440 delivery files, in which 4400 cases had natural delivery and 104 patients with cesarean section. Patients with full term delivery of neonate with 4000 grams were selected as a case group and the patients with full term delivery of neonate with 25000-3999 grams weight were selected as a control group. Factors like, parity, and delivery status were the same for both groups, the patients with repeated cesarean were omitted in this study. The results of this study showed that the total rate of cesarean section in control group was 15.5% against the rate of 11.5% in control group (P<0.037), and the main reason of cesarean in macrosomic group was due to fetal distress. Shoulder dystocia and excretion of moconium was the only complication of Macrosomic infants, which showed no statistically significant difference (P<0.002), post delivery bleeding and administration of oxytocin for acceleration of labour in case groups showed no significant difference with cantrol groups (P<0.01). This study indicated that, despite high rate of vaginal delivery, of macrosomic infant, excluding shoulder dystocia, delivery of macrosomia and post delivery bleeding, there was no significant difference in maternal complications and further study is recemmonded in such type of deliveries.

This study was designed to analyze the outcomes of labor in uncomplicated, singleton pregnancies with reliable gestational age having their deliveries between 37-42 weeks. Using a cohort study, 206 women having their deliveries after 256-280 days of gesiation (37-40 weeks) were compared with 185 women having their deliveries after 281-294 days of gestation (40-42 weeks) who were admitted in Shohada, Hazrat Zeinab (SA) and Mahdieh Hospitals. The main variables analyzed were the meconium stained aminionic fluid, apgar score, fetal distress, labor induction, method of delivery, shoulder dystocia, and macrosomia. Meconium stained amnionic fluid (15.3% vs 10.2%, P=0.000), nduction of labor (40.4% vs 18% P=0.000), cesarean section (27.2% vs 15%, P=0.000) instrumental delivery (3.2% vs 0.48% (P=0.000) were found to be significantly higher in the 40-42 weeks group compared to the 3740 week group. Fetal distress (10.27% vs 5.8%) apgar score less than 7 in 5 and 10 minutes (0.6%vs 0.4%, P>0.05) were not significantly different in the two groups. There were no macrosomia, shoulder dystocia and stillbirth in the both groups. Maternal age and parity did not alter the risk of post date pregnancies, even though the history of post date pregnancy is a risk factor for post date pregnancy.