6. Variations of Labor Flashcards
Define “Labor Dystocia”
Long, difficult or abnormal labor
Define “Dysfunctional Labor”
Ineffective uterine contractions (POWERS)
Hypertonic Uterus Characteristics of Contractions
Uncoordinated, irregular
Hypotonic Uterus: Characteristics of contractions
Coordinated but weak
Become shorter, farther apart
Hypertonic uterus Uterine resting tone
Higher than normal
**Reduces blood flow
At what phase does Hypertonic Uterus occur?
LATENT
At what phase does Hypotonic uterus occur?
ACTIVE
Management of Hypertonic Uterus (4)
- Relaxation (warm shower)
- Rest
- Tocolytics
- Hydration
Management of Hypotonic uterus (4)
- Amniotomy
- Oxytocin
- Position changes
- C-section
Two passageway problems that can cause dysfunctional labor
- Pelvic dystocia – We cannot change this
* Soft tissue dystocia – We can change these somewhat
Soft tissue changes
- Anatomic abnormality
- Full bladder or rectum
- Cervical edema
Four passenger problems that can cause dysfunctional labor. Which is counter-indicated with vaginal delivery?
- Fetal anomalies
- Cephalopelvic disproportion (CPD)**
- Malpresentation
- Suboptimal fetal position
CPD is counterindicated with vaginal delivery
What does CPD stand for?
Cephalopelvid Disproportion
Four categories of malpresentation. Which is most common?
- Face
- Shoulder
- Complete
- Breech – Most common (3-4%)
Types of breech (3)
- Frank Breech (butt first)
- Single footing breech
- complete breech (cannon ball)
Six risks of turning a breech
- Fetal distress
- Rupture of membranes
- Maternal-fetal hemorrhage
- Placental abruption
- Could stimulate preterm labor
- Fetal death
When is a breech baby turned?
Done between 36-37 weeks
Exercises to encourage spontaneous version
Pelvic lifts
What is Friedman’s Classification?
A way of monitoring progress in terms of cervical dilation and fetal descent
What categories are represented on Friedman’s curve? (5)
- Precipitous labor
- Multipara
- Nullipara
- Secondary Arrest
- Prolonged latent phase
What is precipitous labor?
Total labor process is complete in less than 3 hours
Precipitous labor is associated with…
- Increased risk of maternal and fetal complications
- Cocaine use
Complications of precipitous labor
- Mom (2)
- Fetus (1)
- Mom: Tearing, Hemorrhage
- Fetus: Intercranial bleeds
“Trial of Labor” : Def
Allowance of a “reasonable period” of spontaneous active labor to determine safety
Indications of Trial of Labor (3)
- Maternal pelvis is a questionable size/shape
- Vaginal birth after cesarean (VBAC)
- Abnormal presentation
Induction of Labor (def)
Contractions initiated before spontaneous onset
Two methods of induction of labor
- Pitocin
* Amniotomy
When is success of IOL greater?
If Cervix is “favorable”
Bischop Scoring Method (def)
What does a higher score indicate?
Evaluating the “favorability” of a cervix
Likelihood that an induction of labor will result in a vaginal birth. Higher score = more likely to succeed
What five components does the Bishop scale measure?
- Dilation
- Effacement
- Station
- Cervical consistency
- Cervical position
Name five components of a top-scoring bishop scale
- Dilation of 5-6
- Effacement of 80%
- +1 station
- Soft cervix
- Anterior position
Chemical agents applied to “ripen” cervix
- Prostaglandins (prepidil, Cervidil)
* Misoprostol (Cytotec)
Three results of chemical cervical ripening
- Higher success of induction
- Lower doses of pitocin
- Shorter induction times
Pitocin: Methods of administration
- Intravenous titration
- IM
**Antepartum pitocin must ALWAYS be a pump
What must you monitor with pitocin?
Monitor FHR and contraction patterns Q15
Indications of IOL (7)
Unsuitable environment: • Suspected fetal jeopardy: Is the baby better out or in? • Chorioamnionitis: Amniotic infection • Maternal Medical Problems • PIH: Pregnancy Induced Hypertension
Pre/Post term
• PROM
• Post-term: The uterus is a union worker
Death
• Fetal Demise (FD)
What does PIH stand for?
Pregnancy Induced Hypertension
Risks of IOL (5)
- Fetal distress
- Failed induction
- Uterine rupture
- Water intoxication
- Hyperstimulation with Pitocin
Hyperstimulation with pitocin (def)
Very frequent, intense contractions with non-assuring FHR
Hyperstimulation with pitocin:
• CTX
• Resting time
• Uterine resting tone
- CTX Q2m x >90 seconds
- Resting time less than 30 seconds
- Uterine resting tone >20mmHg
What is an augmentation of labor?
• Two methods
An intervention after labor begins spontaneously, but CTX stop or abnormal labor is diagnosed.
- Pitocin
- Amniotomy
