23 Flashcards
What is dystocia in the context of labor?
Dystocia refers to complications during labor that can arise from issues related to power, passenger, passageway, or the psyche.
What are the three complications associated with ‘power’ during labor?
- Hypotonic
- Hypertonic
- Uncoordinated
Define hypotonic uterine contractions.
Hypotonic uterine contractions are characterized by fewer than 2 to 3 contractions in a 10-minute period and a strength that does not rise above 25 mm Hg.
What are common interventions for hypotonic uterine contractions?
- Continuous reassurance
- Encourage ambulation
- Empty bladder
- Maintain hydration
- Provide pain relief
What defines hypertonic uterine contractions?
Hypertonic uterine contractions have a resting tone of more than 15 mm Hg and are strong but ineffective.
What are common interventions for hypertonic contractions?
- Provide comfort measures
- Bedrest or position changes
- Hydration
- Mild sedation
- Tocolytics
What characterizes uncoordinated uterine contractions?
Uncoordinated contractions occur when more than one pacemaker is active, leading to difficulty resting between contractions.
What is the average time span for the first stage of labor in nullipara?
8.6 hours
What is considered a prolonged latent phase in labor?
Longer than 14 hours in nullipara and more than 20 hours in multipara.
What are the interventions for prolonged latent phase?
- Provide adequate fluids
- Provide a dark and quiet environment
- Change linen and gown
- Administer terbutaline
- Provide pain medication
What indicates a prolonged active phase in labor?
Cervical dilatation does not occur at 1.2 cm/h in nullipara or 1.5 cm/h in multipara.
What is precipitate labor?
Precipitate labor is when cervical dilatation occurs at a rate of 5 cm or more/hour in primipara or 10 cm or more/hour in multipara.
What is the purpose of cervical ripening?
Cervical ripening involves changing the cervical consistency from firm to soft, preparing it for dilation and coordination of uterine contractions.
What scoring indicates that the cervix is ready for birth?
A total score of 8 or greater indicates that the cervix is ready for birth.
What are the symptoms of uterine rupture?
- Sudden pain during labor
- Rapid weak pulse
- Hemorrhage
- Signs of hypotensive shock
What is the classification of uterine inversion?
- Incomplete
- Complete
- Prolapsed
What are the classic symptoms of amniotic fluid embolism?
- Sudden hypoxia
- Hypotension
- Coagulopathy
Fill in the blank: The first stage of labor includes the time span from the beginning of regular contractions to _______.
[complete cervical dilatation]
True or False: Hypertonic contractions are characterized by infrequent contractions.
False
What is a common risk factor for uterine rupture?
Previous cesarean scar
What interventions should be taken for uterine inversion?
- Call primary care provider
- Stop oxytocin if used
- Administer oxygen via mask
What is the proper administration method for oxytocin during labor induction?
1 – 2 mU/min IV infusion, increased at a rate no more than 1 – 2 mU/min every 30 – 60 minutes.
What is the significance of monitoring during oxytocin administration?
Monitor pulse and BP every hour, uterine contractions, and fetal heart rate.
What triggers the inflammatory cascade in Amniotic Fluid Embolism?
Exposure to fetal antigens during delivery
This exposure leads to the release of vasoactive substances.
What are the classic symptoms of Amniotic Fluid Embolism?
- Sudden Hypoxia
- Hypotension
- Coagulopathy
The fetus may be at high risk unless delivered immediately via cesarean section.
What are some risk factors associated with Amniotic Fluid Embolism?
- Induction of labor
- Multiple pregnancy
- Polyhydramnios
These factors can increase the likelihood of developing this condition.
What does the prognosis of Amniotic Fluid Embolism depend on?
- Size of embolism
- Speed of detection
- Skill & speed of emergency interventions
Early recognition and intervention are crucial for improving outcomes.
What interventions should be taken in case of Amniotic Fluid Embolism?
- Oxygen administration via mask or cannula
- CPR if cardiac arrest occurs
- ET intubation if survived and DIC occurred
- Fibrinogen therapy
- Placed in ICU
These interventions aim to stabilize the patient’s condition.
What complications can arise during childbirth due to fetal issues?
- Immature infant
- Fetal distress
- Umbilical cord prolapse
- More than one fetus
- Problem with fetal position
- Fetus being too large
These factors can complicate the labor and delivery process.
What is umbilical cord prolapse?
A loop of the umbilical cord slips down in front of the presenting fetal part
It may occur at any time after the membranes rupture.
What factors increase the likelihood of umbilical cord prolapse?
- Premature rupture of membranes
- Fetal presentation other than cephalic
- Placenta previa
- Intrauterine tumors
- Small fetus
- CPD
- Polyhydramnios
- Multiple gestation
The incidence is about 0.5% in cephalic births but can be higher with breech or transverse lie.
What are the assessment methods for umbilical cord prolapse?
- Cord may be felt as the presenting part
- Can be visualized on ultrasound
- Monitor FHR after rupture of membranes
FHR is typically slow with variable deceleration patterns.
What interventions can be applied for umbilical cord prolapse?
- Manually elevate fetal head from compressed cord
- Knee-chest or Trendelenburg position
- Administer oxygen via mask
- Tocolytic agent
- Cover any exposed portion of the cord with sterile saline compress
- Cesarean birth
These measures aim to relieve cord compression and ensure fetal safety.
What does fetal intolerance of labor indicate?
The fetus is not getting enough oxygenated blood from the placenta or umbilical cord
FHR pattern may show variable decelerations.
What could cause fetal intolerance of labor?
- Underlying condition of the fetus
- Placental insufficiency
- Fetal growth restriction
- Unknown cause
Identifying the cause is important for intervention.
What interventions should be taken for fetal intolerance of labor?
- Stop oxytocin infusion if present
- Amnioinfusion
- Tocolytic agent
- Cesarean birth
These interventions help manage fetal distress.
What is amnioinfusion?
A sterile double lumen catheter is introduced through the cervix into the uterus and attached to IV tubing for saline infusion
This procedure aims to relieve umbilical cord compression.
What should be monitored during amnioinfusion?
- FHR
- Uterine contractions
Adjust the infusion to maintain FHR without variable decelerations.
What are the complications associated with multiple gestation?
- Abnormal fetal presentation
- At risk for cord prolapse
- Overstretched uterus
- Premature separation of the placenta
- Uterine dysfunction
Early detection of multiple gestation is crucial.
What are the special considerations for vaginal delivery in multiple gestation?
- Vaginal delivery if both fetuses are in vertex or vertex/breech position
- Cesarean birth if cord prolapse occurs after delivery of the first fetus
Proper monitoring is essential to ensure safety.
What is occiput posterior position?
The fetal head is down but facing upward instead of downward
This position can complicate labor.
What are the risks associated with occiput posterior position?
- Umbilical cord prolapse
- Intense pressure and pain in lower back
This position can lead to prolonged labor and complications.
What are interventions for occiput posterior position?
- Apply back rub
- Rebozo method
- Advise to void every 2 hours
- Provide oral sports drink or IV glucose solution
- Cesarean birth if necessary
These interventions aim to alleviate discomfort and facilitate labor.
What is breech presentation?
Fetus is in a longitudinal lie with the buttocks or lower extremity entering the pelvis first
Types include frank, complete, and incomplete or footling.
What are the complications of breech presentation?
- Hip dysplasia
- Anoxia
- Intracranial hemorrhage
- Fracture of spine or arms
These complications can arise from the delivery method.
What are the assessment methods for breech presentation?
- Fetal heart sounds heard high in abdomen
- Leopold’s maneuvers
- Ultrasound
This helps confirm fetal position prior to delivery.
What interventions are available for breech presentation?
- Vaginal birth if no complications
- Cesarean birth if preterm labor, prolapsed cord, or fetal distress
The mode of delivery should ensure the safety of both mother and child.
What is face presentation?
The presenting part is the chin or mentum with hyperextension of the neck
This can complicate vaginal delivery.
What are the risk factors for face presentation?
- Contracted pelvis
- Placenta previa
- Relaxed uterus of a multipara
- Polyhydramnios
- Fetal malformation
These factors can influence the likelihood of face presentation.
What interventions should be taken for face presentation?
- Vaginal birth if chin is anterior and pelvic diameter is normal
- Cesarean birth if chin is posterior
Monitoring is essential for safe delivery.
What is brow presentation?
Neck is not extended as much as in face presentation nor flexed as in vertex
This occurs in multipara or relaxed abdominal muscles.
What interventions are necessary for brow presentation?
- Cesarean birth if not corrected spontaneously
This ensures safe delivery for the baby.
What is transverse lie presentation?
The fetus is lying sideways or horizontal across the uterus
This position complicates delivery.
What conditions may lead to transverse lie presentation?
- Pendulous abdomen
- Uterine fibroid tumors
- Congenital abnormalities of the uterus
- Polyhydramnios
- Hydrocephalus
- Multiple gestation
These factors can affect fetal positioning.
What is macrosomia?
Fetus weighing more than 4,000 to 4,500 grams (9 to 10 lbs.)
This condition is often associated with diabetes.
What complications are associated with an oversized fetus?
- Uterine dysfunction
- Fetal pelvic disproportion
- Uterine rupture
- Perineal laceration
- Cervical nerve palsy
- Diaphragmatic nerve injury
- Fractured clavicle
These complications can arise during labor and delivery.
What is shoulder dystocia?
The anterior fetal shoulder becomes stuck on the maternal pubic symphysis
This condition requires immediate intervention.
What are the common risks for shoulder dystocia?
- Diabetes
- Multiparas
- Fetus large for gestational age
- Postdate pregnancies
These factors can increase the likelihood of shoulder dystocia.
What are the two main procedures to complete at the onset of shoulder dystocia?
- McRoberts Maneuver
- Suprapubic Pressure
These techniques help to free the impacted shoulder.
What does a problem with the passage refer to in labor?
Contraction or narrowing of the passageway or birth canal
This can occur at the inlet, mid-pelvis, or outlet.
What is inlet contraction?
Narrowing of the AP diameter of the pelvis to less than 11 cm or of the transverse diameter to 12 cm or less
This condition can complicate labor.
What is the problem with the passage in childbirth?
Contraction or narrowing of the passageway or birth canal
Where can the narrowing of the birth canal occur?
- Inlet
- Mid-pelvis
- Outlet
What is cephalopelvic disproportion?
A condition where the baby’s head is too large to fit through the mother’s pelvis
What defines inlet contraction?
Narrowing of the AP diameter of the pelvis to less than 11 cm or of the transverse diameter to 12 cm or less
What is the main cause of inlet contraction?
Rickets
What is outlet contraction?
Narrowing of the transverse diameter, the distance between the ischial tuberosities at the outlet to less than 11 cm
What intervention is encouraged if cephalopelvic disproportion is suspected?
Trial labor
What should be monitored during trial labor?
- Fetal heart sounds
- Uterine contractions
How often should the patient void during trial labor?
Every 2 hours
What should be explained to a patient regarding vaginal birth?
The importance of vaginal birth
What should be explained if trial labor fails?
Why cesarean section (CS) is the best route for birth
What is external cephalic version?
The turning of the fetus from breech to a cephalic position before birth
When is external cephalic version usually performed?
By 37 to 38 weeks
What is a tocolytic agent used for in external cephalic version?
To relax the uterus
What conditions contraindicate external cephalic version?
- Multiple gestation
- Severe oligohydramnios
- Small pelvic diameter
- A cord that wraps around the fetal neck
- Unexplained third trimester bleeding
What are obstetric forceps made of?
Steel
What are the primary indications for forceps birth?
- Prolonged 2nd stage of labor
- Fetus in an abnormal position
- Fetal distress during 2nd stage of labor
What conditions must be assessed before applying forceps?
- Membranes must be ruptured
- CPD must not be present
- The cervix must be fully dilated
- The patient’s bladder must be empty
What is vacuum extraction used for?
Assisting in the delivery of the fetus when it is positioned low in the birth canal
What may occur more frequently with vacuum extraction compared to natural birth?
Perineal lacerations
What is the weight and size of a normal placenta?
Weighs 500 grams, 15 to 20 cm in diameter, 1.5 to 3.0 cm thick
What is placenta succenturiata?
A placenta with one or more accessory lobes connected to the main placenta
What is a potential issue with placenta circumvallata?
The membranes of the placenta fold back around its edges
What characterizes battledore placenta?
The cord is inserted marginally rather than centrally
What is velamentous insertion of the cord?
The cord is separated with small vessels that reach the placenta by spreading across the fold of amnion
What is vasa previa?
A condition where the velamentous cord insertion crosses the cervical os before the fetus
What happens during cervical dilatation in vasa previa?
Sudden, painless bleeding may occur
What is placenta accreta?
Deep attachment of the placenta to the uterine myometrium
What can occur during manual removal of the placenta in placenta accreta?
Extreme hemorrhage
What is a two-vessel cord associated with?
Congenital heart and kidney anomalies
What can result from an unusual cord length?
- Short cord: premature separation of the placenta or abnormal fetal lie
- Long cord: high tendency to be twisted or knotted
What is a nuchal cord?
Umbilical cord wrapped around the fetal neck 360 degrees
