Abnormal Labor

Question 1

What are the stages of labor?

Answer 1

First stage = onset of labor up to full cervical dilation (10cm)

Second stage = from full cervical dilation up to delivery of the baby

Third stage = from delivery of the baby to delivery of the placenta

Question 2

What are the phases of labor curve?

Answer 2

Latent phase = from 0-4 cm cervical dilation

Active phase = early and true active phase

Question 3

What are the subdivided active phases?

Answer 3

Early active phase = from 4-6cm cervical dilation

True active phase = from 6-8cm cervical dilation

Deceleration Phase = from 8-10cm cervical dilation; dilation is slower compared tot he true active phase

Question 4

what are the common patterns of abnormal labor?

Answer 4

Arrest disorders = cervical dilation stops (cannot diagnose in <6cm cervical dilation)

Descent disorders = problem with how the presenting part/head is descending (after 8cm)

Question 5

What are the divisions of labor?

Answer 5

Preparatory = 0-6cm cervical dilation
DIlatational = 6-8cm cervical dilation
Pelvic = 8cm to delivery of the baby

Question 6

What is the main characteristic of Dystocia?

Answer 6

Abnormally slow progress of labor

Question 7

What are the different complications that can occur due to Dystocia?

Answer 7

Infection
Uterine atony
Uterine rupture
Pathologic retraction ring
Fistula
Pelvic floor injury
LE nerve injury
Fetal injury

Question 8

What is an initial response of the contracting uterus to an obstruction?

Answer 8

Pathologic retraction ring
- extreme thining of the lower uterine segment (seen in obstructed labor)

Question 9

What are the 3 important causes of dystocia?

Answer 9

Power = uterine contractions
Passenger = baby
Passage = pelvis

Question 10

What is the expected presentation for px with dystocia?

Answer 10

Cephalic presentation

Question 11

What are the diff measurements of the diameter of the baby’s head?

Answer 11

Occipitomental diameter = longest diameter

Occipitofrontal diameter= aka fronto-occipital & mentoccipital

Suboccipitobregmatic diameter

Biparietal diameter = transverse diameter

Question 12

What is the poorest prognosis for vaginal delivery?

Answer 12

If the mento-occipital diemeter can be measured
Face is presented

Question 13

What is the military presentaiton?

Answer 13

Aka sinciput presentation where the head does not flex

Question 14

What is the best position for babys during vaginal deivery?

Answer 14

Occiput presentation

Question 15

What is the compound presentation?

Answer 15

Hand goes out first during crowning => does not affect eate of vaginal delivery

Question 16

What is the transverse lie presentation?

Answer 16

Baby is perpendicular to the longitudinal axis of the mom
+

Should be assessed by Leopold’s maneuver

Question 17

What can be used to augment labor when uterus is hypotonic?

Answer 17

Oxytocin

Question 18

What aer the types of abnormalities in power?

Answer 18

Hypotonic uterine dysfunction = uterus is not contracting very well

Hypertonic or incoordinate uterine dysfunction = leads to fetal injury or nonreassuring fetal status

Question 19

What are the causes of hypotonic uterine dysfunction?

Answer 19

Epidural analgesia = given during active phase

Infection

Maternal positioning during labor = better if px stands and walks to improve uterine contracitons

Birthing position - squatting best position

Question 20

What happens during hypertonic or incoordinate uterine dysfunction?

Answer 20

Strong but irregular interval of contractions

Question 21

What are the measurements of the pelvic inlet?

Answer 21

Diagonal conjugate = measured from the inferior border of the pubic symphysis to the sacral promontory

• biparietal diameter: place where the baby passes through the inlet

Question 22

What is the measurement used for midplane?

Answer 22

Interspineous or bispinous diameter = posterior sagittal diameter

Question 23

What is the measurement used for the pelvic outlet?

Answer 23

2 ischial tuberosities: Fist is used

Question 24

Are nulliparas or multiparas more prone to dystocia?

Answer 24

Nulliparas = longer latency, slwoer protraction, longer arrest periods than multiparas

Question 25

When are descent disorders diagnosed?

Answer 25

During deceleration phase

Question 26

When is the secondary arrest of dilation diagnosed?

Answer 26

True active phase

Question 27

What is the difference betw failure of descent vs arrest of descent?

Answer 27

Failure of descent = does not go beyond station 0

Arrest of descent = went beyond station 0

Question 28

When do you do a cesarean section?

Answer 28

If there is failure/arrest of descent is accompanied with either prolonged deceleration phase/prolonged 2nd stage

Question 29

What is the management with prolonged latent phase?

Answer 29

Treat with rest or labor augmentation

Question 30

What is the management in protraction disorders?

Answer 30

Identify underlying cause of slow dilation

Question 31

What is the management of arrest disordes?

Answer 31

Do cesarean section
Failure of arrest of descent only = no cesarean section

Question 32

What is an extermely rapid labor and delivery?

Answer 32

Precipitous labor
- fetus is delivered <3 hrs
- rate of dilation: >5cm/hr