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OB > 12.2d Dysfunctional Labor (Dystocia) > Flashcards

12.2d Dysfunctional Labor (Dystocia) Flashcards

1
Q

Dystocia

A
  • Lack of progress of labor for any reason
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2
Q

Dysfunctional Labor

A
  • Long, difficult, abnormal labor

CAUSED BY

  • Ineffective contractions or bearing down efforts (the powers of labor)
  • Abnormal presentation, position, development of fetus
  • Pelvic Structure (abnormalities of bone or soft tissue)
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3
Q

Abnormal Uterine Activity

A
  • Hypertonic or Hypotonic contractions (ineffective contractions)
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4
Q

Latent-Phase Disorders

A
  • Issues that occur in latent phase of 1st stage of labor
  • Most common is hypertonic uterine dysfunction (painful frequent contractions that are ineffective in causing cervical effacement/dilation)
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5
Q

Active Phase Disorders

A
  • Slow progression of labor or ARREST DISORDERS (no progress in labor)
  • Most common cause is hypotonic uterine dysfunction (inadequate activity)
Also caused by
CEPHALOPELVIC DISPROPORTION (CPD) and fetal malposition
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6
Q

Secondary Powers

A
  • Mother bearing down

ISSUES DUE TO

  • Large amounts of analgesics given
  • Anesthesia preventing bearing down
  • Exhaustion from bearing down
  • Maternal positions against gravity decreases strength and efficiency of contractions
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7
Q

Abnormal Labor Patterns

A
  • Prolonged latent phase
  • Protracted active-phase dilation
  • Secondary arrest (no progression)
  • Protracted descent
  • Arrest of descent
  • Failure of descent

DUE TO

  • Ineffective contractions
  • Pelvic contractures
  • CPD (Cephalopelvic Disproportion)
  • Abnormal fetal presentation
  • Early use of analgesics
  • Nerve blocks
  • Anxiety/Stress
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8
Q

Precipitous Labor

A
  • Labor that lasts over 3 hours from onset of contraction to birth

COMPLICATIONS

  • Hypertonic Uterine Contractions (placental abruption, uterine tachysystole, cocaine)
  • Uterine Rupture
  • Lacerations of Birth Canal
  • Amniotic Fluid Embolus (AFE)
  • Postpartum hemorrhage
  • Hypoxia of Fetus
  • Intracranial Trauma related to rapid birth of fetus
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9
Q

Pelvic Dystocia

A

CAUSED BY

  • Contractures of pelvis diameters
  • Immature pelvic size (adolescents)
  • Pelvic deformities
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10
Q

Soft Tissue Dysotica

A
  • Obstruction of birth passageways from things other than bony pelvis

CAUSES

  • Placental Previa
  • Leiomyomas (uterine fibroids) in the lower uterine segment
  • Ovarian tumors
  • Full bladder/rectum
  • Cervical edema
  • STI (human papillomavirus)

FETAL CAUSES

  • Macrosomia
  • Malpresentation/position
  • Multifetal pregnancy
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11
Q

Complications of Soft Tissue Dystocia

A
  • Asphyxia
  • Fetal injury/fracture
  • Maternal vaginal lacerations
  • Forceps/Vacuum Assisted Birth
  • C-section
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12
Q

Fetal Causes of Prolonged Labor

A
  • Ascites
  • Large Tumors
  • Open NTD (Myelomeningocele)
  • Hydrocephalus
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13
Q

Cephalopelvic Disproportion

A
  • Fetus is too big to fit through maternal pelvis
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14
Q

Malposition

A
  • Most common malposition is occipitoposterior

Causes prolonged second stage of labor and severe back pain from occiput against sacrum

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15
Q

Care Management

A

Assess Risks

  • Assess history, signs of physical/physiological responses, factors that can contribute, effacement/dilation/contractions
  • FHR, Presentation, Station, Position, Status of Amniotic Membranes

INJURIES
- Anxiety from loss of control, Decreased ability to cope, exhaustion

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16
Q

Malpresentation

A

Breech is most common

Flank Breech - Hips flexed, knees extended
Complete Breech - Hips and knees flexed
Footling Breech - One foot or both feet present before butt

MALPRESENTATION ASSOCIATED WITH

  • Multifetal gestation
  • Preterm Birth
  • Poly/Oligohydramnios
  • Genetic/Neuromuscular Disorders
17
Q

Malpresentation

A
  • Descent is slow and risk of cord prolapse
  • Meconium in amniotic fluid is not a sign of fetal distress, it results from pressure on fetal abdominal wall.

RISKS OF BREECH
- Prolapse of cord, fetal head gets trapped, trauma of head and arms

VAGINAL BIRTH IS POSSIBLE IF

  • Weight is between 2000-3800g
  • Pelvis is normal
  • Fetus head is flexed
18
Q

Multifetal Pregnancy

A
  • More labor complications
  • Higher incidence of fetal complications
  • Greater risk of mortality due to LBW resulting from IUGR or Preterm Birth
  • Fetus risk of asphyxia
  • Cerebral Palsy Risk is Higher
  • Congenital Anomalies from dysfunctional labor, and even more risk for c-section
19
Q

Physiological Responses of Prolonged Labor

A
  • Hormones respond to stress (catecholamines) which increases anxiety and prolongs labor

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