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OB > 6. Variations of Labor > Flashcards

6. Variations of Labor Flashcards

1
Q

Define “Labor Dystocia”

A

Long, difficult or abnormal labor

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2
Q

Define “Dysfunctional Labor”

A

Ineffective uterine contractions (POWERS)

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3
Q

Hypertonic Uterus Characteristics of Contractions

A

Uncoordinated, irregular

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4
Q

Hypotonic Uterus: Characteristics of contractions

A

Coordinated but weak

Become shorter, farther apart

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5
Q

Hypertonic uterus Uterine resting tone

A

Higher than normal

**Reduces blood flow

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6
Q

At what phase does Hypertonic Uterus occur?

A

LATENT

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7
Q

At what phase does Hypotonic uterus occur?

A

ACTIVE

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8
Q

Management of Hypertonic Uterus (4)

A
  • Relaxation (warm shower)
  • Rest
  • Tocolytics
  • Hydration
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9
Q

Management of Hypotonic uterus (4)

A
  • Amniotomy
  • Oxytocin
  • Position changes
  • C-section
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10
Q

Two passageway problems that can cause dysfunctional labor

A
  • Pelvic dystocia – We cannot change this

* Soft tissue dystocia – We can change these somewhat

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11
Q

Soft tissue changes

A
  • Anatomic abnormality
  • Full bladder or rectum
  • Cervical edema
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12
Q

Four passenger problems that can cause dysfunctional labor. Which is counter-indicated with vaginal delivery?

A
  • Fetal anomalies
  • Cephalopelvic disproportion (CPD)**
  • Malpresentation
  • Suboptimal fetal position

CPD is counterindicated with vaginal delivery

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13
Q

What does CPD stand for?

A

Cephalopelvid Disproportion

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14
Q

Four categories of malpresentation. Which is most common?

A
  • Face
  • Shoulder
  • Complete
  • Breech – Most common (3-4%)
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15
Q

Types of breech (3)

A
  • Frank Breech (butt first)
  • Single footing breech
  • complete breech (cannon ball)
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16
Q

Six risks of turning a breech

A
  • Fetal distress
  • Rupture of membranes
  • Maternal-fetal hemorrhage
  • Placental abruption
  • Could stimulate preterm labor
  • Fetal death
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17
Q

When is a breech baby turned?

A

Done between 36-37 weeks

18
Q

Exercises to encourage spontaneous version

A

Pelvic lifts

19
Q

What is Friedman’s Classification?

A

A way of monitoring progress in terms of cervical dilation and fetal descent

20
Q

What categories are represented on Friedman’s curve? (5)

A
  • Precipitous labor
  • Multipara
  • Nullipara
  • Secondary Arrest
  • Prolonged latent phase
21
Q

What is precipitous labor?

A

Total labor process is complete in less than 3 hours

22
Q

Precipitous labor is associated with…

A
  • Increased risk of maternal and fetal complications

- Cocaine use

23
Q

Complications of precipitous labor

  • Mom (2)
  • Fetus (1)
A
  • Mom: Tearing, Hemorrhage

- Fetus: Intercranial bleeds

24
Q

“Trial of Labor” : Def

A

Allowance of a “reasonable period” of spontaneous active labor to determine safety

25
Q

Indications of Trial of Labor (3)

A
  • Maternal pelvis is a questionable size/shape
  • Vaginal birth after cesarean (VBAC)
  • Abnormal presentation
26
Q

Induction of Labor (def)

A

Contractions initiated before spontaneous onset

27
Q

Two methods of induction of labor

A
  • Pitocin

* Amniotomy

28
Q

When is success of IOL greater?

A

If Cervix is “favorable”

29
Q

Bischop Scoring Method (def)

What does a higher score indicate?

A

Evaluating the “favorability” of a cervix

Likelihood that an induction of labor will result in a vaginal birth. Higher score = more likely to succeed

30
Q

What five components does the Bishop scale measure?

A
  • Dilation
  • Effacement
  • Station
  • Cervical consistency
  • Cervical position
31
Q

Name five components of a top-scoring bishop scale

A
  • Dilation of 5-6
  • Effacement of 80%
  • +1 station
  • Soft cervix
  • Anterior position
32
Q

Chemical agents applied to “ripen” cervix

A
  • Prostaglandins (prepidil, Cervidil)

* Misoprostol (Cytotec)

33
Q

Three results of chemical cervical ripening

A
  • Higher success of induction
  • Lower doses of pitocin
  • Shorter induction times
34
Q

Pitocin: Methods of administration

A
  • Intravenous titration
  • IM

**Antepartum pitocin must ALWAYS be a pump

35
Q

What must you monitor with pitocin?

A

Monitor FHR and contraction patterns Q15

36
Q

Indications of IOL (7)

A 
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)

37
Q

What does PIH stand for?

A

Pregnancy Induced Hypertension

38
Q

Risks of IOL (5)

A
  • Fetal distress
  • Failed induction
  • Uterine rupture
  • Water intoxication
  • Hyperstimulation with Pitocin
39
Q

Hyperstimulation with pitocin (def)

A

Very frequent, intense contractions with non-assuring FHR

40
Q

Hyperstimulation with pitocin:
• CTX
• Resting time
• Uterine resting tone

A
  • CTX Q2m x >90 seconds
  • Resting time less than 30 seconds
  • Uterine resting tone >20mmHg
41
Q

What is an augmentation of labor?

• Two methods

A

An intervention after labor begins spontaneously, but CTX stop or abnormal labor is diagnosed.

  • Pitocin
  • Amniotomy

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