2: High Risk or With Complications during Labor and Delivery

Question 1

High Risk Factors

Answer 1

1. Powers
2. Passenger
3. Passageway
4. Psyche or Psychologic state
5. Position

Question 2

1. Powers (________)
2. Passenger (________)
3. Passageway (________)
4. Psyche (________)
5. Position (________)

Answer 2

1. Uterine Contractions
2. Fetus and Placenta
3. Pelvic Bones and Other Pelvuc Structures
4. Woman and Family Perception of the Event
5. Woman’s Position which Influence Labor and Birth

Question 3

Complications with Power

Answer 3

Dystocia
Ineffective Uterine Force

Question 4

Dystocia is ________, ________, or ________ labor

Answer 4

Long
Difficult
Abnormal

Question 5

S/Sx of Dystocia

Answer 5

— Alteration in the characteristics of uterine contractions
— Lack of progress in the rate of cervical dilatation
— Lack of progress in fetal descent and expulsion

Question 6

Causes of dystocia

Answer 6

— Dysfunctional labor (most common cause)
— Alteration in Pelvic Structure
— Fetal causes (malpresentation, anomalies, excessive size, no. of fetuses)
— Maternal Position during labor and birth
— Psychological response of the mother to labor

Question 7

Risk Factors (Dystocia)

Answer 7

— Body Fluid (Overweight or Short Structure)
— Uterine Abnormalities (Congenital Malformations)
— Malpositoon and Malpresentation of fetus
— Cephalopelvic Disproportion (CPD)
— Overstimulation with oxytocin
— Maternal Factirs (fear, fatigue, dehydration, electrolyte imbalance)
— Inappropriate timing of anesthetic

Question 8

Normal fetal heartbeat (FHB)
Bradycardia:
Tachycardia:

Answer 8

120-160 bpm
Brady: <120 bpm
Tachy: >160 bpm (Fetal distress)

Question 9

External Cephalic Version (ECV) and values

Answer 9

— Oligohydramnios (<500 ml)
— Normohydramnios (800 ml)
— Polyhydramnios (>800-1200 ml)
— Anhydramnios (absence of amniotic fluid)

Question 10

Signs of Cervical Ripening

Answer 10

1. Bishop’s Score
2. Cervical Dilatation
3. Cervical Effacement
4. Cervical Ripening Agents (Buscopan, prostaglandins, etc.)

Question 11

Artifical rupturing of the amniotic membrane

Answer 11

Amniotomy

Question 12

What are Operative or Assisted Birth Procedures

Answer 12

Vacuum or Forceps Assisted Birth

Question 13

3 types of Ineffective Uterine Force

Answer 13

1. Hypotonic Uterine Contraction
2. Hypertonic Uterine Contraction
3. Uncoordinated Contractions

Question 14

Hypotonic Uterine Contraction is when number of contractions is ___________ (number _______ of occurence in ________ period)

Answer 14

Usually low or infrequent
No more than 2 or 3
10-minute

Question 15

Hypotonic Uterine Contraction
Resting tone of uterus:
Strength of contractions:

Answer 15

Resting tone: less than 10 mmHg
Strength: does not rise above 25 mmHg

Question 16

True or False.
Hypotonic Uterine Contraction increases chance of postpartum hemorrhage

Answer 16

TRUE
because uterus can’t contract effectively due to exhaustion from prolonged labor which requires more uterine contractions to achieve cervical dilatation

Question 17

Risk Factors
(Hypotonic Uterine Contraction)

Answer 17

1. Maternal obesity unaccompanied by diabetes
2. Bowel or bladder distention which prevents descent or firm engagement
3. Uterus overstretched by multiple gestation, macrosomia, hydramios, or lax abdominal muscles from grand multiparity
4. Pharmacological agents used for pain relief

Question 18

Hypertonic Uterine Contraction is occurs because muscle fibers of ___________ do not __________ or _______ after contraction

Answer 18

Myometrium
Repolarize
Relax

Question 19

Hypertonic Uterine Contraction
Contractions:
Resting tone:

Answer 19

Contractions: frequently
Resting tone: increased, >15 mmHg

Question 20

True or False.
Hypertonic Uterine Contraction can cause fetal anoxia because of lack of relaxation between contractions may not allow optimal uterine artery filling

Answer 20

TRUE

Question 21

Risk Factors
(Hypertonic Uterine Contraction)

Answer 21

1. Increased Maternal Catecholamine Release (epinephrine, norepinephrine)
2. Maternal anxiety (primiparous labor, fear of loss of control, history of sexual abuse, lack of support, cultural differences)
3. Fetal occiput-posterior malposition

Question 22

Uncoordinated Contractions occur when ______________ may be initiating contractions. A fetal external monitor reveals an ________________.

Answer 22

More than one pacemaker
Abnormal pattern