4,5,6 Normal/abnormal labor/Labor pathology Flashcards
Postdates delivery
- what weeks
- what are we most concerned about and what do we do about it?
- What 2 things can happen to postdates baby?
>42 weeks
- Oligohydramnios is our main concern for waiting. Fluid protects cord from compression, but it needs to leave for baby to grow. So, we do 2x/week U/S to monitor amniotic fluid.
- macrosomic baby (shoulder dystocia), or dysmature baby (small baby w/o subQ tissue).
Stages/phases of labor?
what are normal durations?
Stage 1.
phase 1–Latent: start of CTX/dilation to 4cm (allow 20 hrs for prime, 14 hrs for multi)
phase 2–Active: dilation to 10cm (4 hours)
Stage 2: complete dilation to delivery of baby
Stage 3: delivery of placenta
Prolonged latent phase
- how to dx?
- MCC
- once diagnosed, then do what
- prime: >20 hrs
multi: >14 hrs
Also, pt has CTX and cervix <4cm
- opioids given too soon in latent phase.
- once diagnosed, decide if CTX are adequate (3 CTX in 30 min, and >40mmHg strength). Then, you can rest and wait, use balloon, or try oxytocin
Cervical effacement/ripening
- mechanism
- stimulated by what (2)
Cervical ripening/effacement:
breakage of disulfide bonds between collagen. Mediated by PGE2 and fetal head engagement.
(so, you can use both prostaglandins and Foley bulb to stimulate)
Preterm labor
- Tocolytics to use (4)
- When are they contraindicated?
Delay delivery with tocolytics:
- magnesium
- beta agonist (terbutaline)
- CCB (nifedipine)
- prostaglandin blockers (indomethacin)
These buy us 2 days at most. Contraindicated in preeclampsia, fetal distress, or in high OB risk (eg pROM, abruption)
Also give steroids to baby if lungs immature (L/S <2).
Labor definition
Contractions (3 in 30min), with cervical change.
Prolonged 2nd stage of labor
- how long should this last (epidural vs no epidural)
- What to check, what tx
- epidural–3 hrs
no epidural–2 hrs
- Check for adequacy of CTX, then use oxytocin if inadequate.
C/S vs forceps/vaccuum depending on station
Woman who delivered 2 days ago is complaining of new bleeding. It is a red discharge/spotting. What’s happening?
Normal. This is lochia rubra, which is a red vaginal d/c normal for the 1st few days after delivery.
Prolonged and Arrested active phase
- How long before prolonged?
- If prolonged time, then check for what?
- Tx
3 causes of arrest: Passenger, Pelvis, Power
- Allow 5 hrs for prime, 4 for multi
- Check for adequate CTX. Then, see if there is insufficient cervical change (prolonged) vs no cervical change (arrest)
- If CTX inadequate, use oxytocin. If no improvement after 2 hrs, do C/S.
if adequate, C/S
How to confirm ROM?
(3 steps)
- speculum exam looking for pooling of fluid in posterior vagina.
- With that fluid, do either nitrazine test (paper turns blue) or put on slide to see fern sign.
- Do U/S to make sure gush was from baby. U/S will now show oligohydramnios (no more fluid)
Pregnant mother has baby in breech position. What to do and at what weeks?
Try to manipulate first. At 37 weeks, do the Leopold maneuver (aka External version) to push baby into correct position. If this doesn’t work, do C/S
prolonged ROM
- what is it
- do what?
>18 hours between ROM and delivery.
- much increased GBS infection risk. Also risk of chorio/endometritis
- Give amoxicillin ppx.
pROM
- what is it
- cause
- tx
- what to be careful of
- premature ROM
- ROM before contractions have started. If also <36 weeks, then it is ppROM
- typically caused by ascending infection
- Tx with abx (Amp-Gent). most common bug is E Coli.
- don’t do vaginal exam! Will spread bacteria
ppROM
- what is it
- Tx, based on weeks
preterm, premature ROM
- rupture before 36 weeks.
- If <24 weeks, baby is nonviable. induce or do suction curettage
- If 24-36 weeks, we are balancing risk of chorio vs maturing baby’s lungs. Give steroids to mature baby’s lungs. Check amniotic fluid–if L/S ratio >2, fetal lungs are mature. If <2, keep baby inside longer if possible.
chorioamnionitis
- sx
- tx
ascending infection from vaginal flora with pROM
- pROM and Fever.
- Pip-Tazo (broad spectrum b/c vaginal flora), then delivery. Also, r/o other infections (possible UTI).
