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Womens Health > 5-Labor Dystocia > Flashcards

5-Labor Dystocia Flashcards

1
Q

What are the 3 causes of shoulder dystocia ?

A

Power- inability of the uterus to produce powerful contraction to change the cervix
Passenger- Size of the fetus
Passage- contracted maternal pelvis

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2
Q

When should you only consider elective C- section?

A

Fetus greater than 5000 grams in non diabetic

Fetus greater than 4500 grams in diabetic

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3
Q

What is protraction disorder?

A

Labor is progressing but slowly

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4
Q

What is arrest disorder?

A

Labor has stopped progressing

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5
Q

What are the first stage labor disorders?

A

Prolonged latent phase
Prolonged active phase
Arrest of the active phase

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6
Q

What is the prolonged latent phase of first stage disorder?

A

When latent labor lasts longer than 20 hours in a nulliparous patient and 14 hours in a multiparous patient

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7
Q

What is the prolonged active phase of first stage disorder?

A

When cervical dilation occurs less than 1 cm/hr in a nulliparous patient and 1.5cm/hr in a mutiparous patient

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8
Q

What is the arrest of the active phase of first stage of labor ?

A

No cervical change in 2 hours with adequate uterine contractions

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9
Q

What is the second stage labor disorder ?

A

No descent of the fetal head in 1 hour of pushing

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10
Q

What is the purpose of pitocin?

A

Synthetic form of oxytocin used to increase the frequency and intensity of uterine contractions
Dose is titrated to reach effect with adequate contractions frequency of every 2-3 mins

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11
Q

What are the adverse effects of pitocin?

A

Uterine hyper stimulation which can increase the stress of fetus and lead to hypoxia
Water intoxication- rare
Uterine rupture- mor rare

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12
Q

What is the treatment of fetal distress caused by oxytocin ?

A

Stop pitocin immediately
Increase mainline IV fluid rate to increase maternal cardiac output
Administer O2 @ 6L/min
Turn patient on left side
If excessive uterine activity present administer Terbutiline 25 mg

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13
Q

What are the adverse effects of abnormal labor on the fetus?

A

Distress leading to hypoxia,acidosis and neurologic injury

Chorioamnionitis leading to neonatal sepsis

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14
Q

What the adverse effects of abnormal labor on the mother?

A

Exhaustion
Fistula formation
Uterine rupture
Postpartum endomyometritis

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15
Q

What is the diagnosis of breech?

A

Head occupies fundus
Heart sounds above umbilicus
Sacrum and ischial tuberosities palpated on vaginal exam
Presentation confirms by ultrasound

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16
Q

What are the types of breech?

A

Frank
Incomplete- most problematic
Complete

17
Q

What are the delivery considerations for breech?

A

External cephalic version @ 35-36 weeks attempting to move the fetus
Vaginal delivery with Frank or complete breech,normal gynecoid pelvis well flexed fetus weighing between 2000-3800 grams
Knowledgeable obstetrician with type of delivery

18
Q

What is the diagnosis of face presentation ?

A

Mouth, nose, orbits palpated on vaginal exam

If mentum posterior must do a C-section

19
Q

What is a brow presentation ?

A

Partial deflection of the head
Usually unstable presentation
Will convert to occiput or face as labor progresses

20
Q

What is persistent occiput posterior?

A

Occiput rotates posteriorly as descent progresses
May lead to prolonged 2nd stage labor,increase perineal lacerations
Scanzoni maneuver with midforceps to try to move to occiput anterior

21
Q

What is tranverse lie?

A

Shoulder or acromium presentation
Caused by placenta previa,extreme prematurity, multiparity with relaxation of abdominal wall
Do C- section

22
Q

What is the management of a cord prolapse?

A

Manually elevate presenting part from cord

Do immediate C- section

23
Q

What is theMcRobert’s maneuver?

A

Hyperflexion and abduction of maternal hips causing a flattening of the lumbar curve and opening the pelvis which frees the impacted shoulder

24
Q

What is the Zavanelli maneuver ?

A

Placing fetal head back into the uterus and proceeding with C- section
Absolute last resort

Womens Health (26 decks)

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