Abnormal Labor Flashcards
Protracted active phase dilatation is when the mother has regular contractions and the rate of cervical dilation is
<1.2cm/hr: Nulli
<1.5cm/hr: Multi
A diagnosis of arrest disorder can be made when the mother is in active phase with at least how much cervical dilation?
3-4cm
Criteria for arrest of 2nd stage of labor is how many hours with and without epidural?
>4 hours no progress with epid >3 hours no progress without epid
Prolonged latent phase in an nulli and multigravid (0-3cm)
>20 hours in nulli >14 hours in multi
Intervention for prolonged latent phase
Bed rest Oxytocin
Prolonged deceleration phase (8-10cm) is how many hours in a nulli and multigravid?
>3 hours nulli >1 hour multi
Secondary arrest in dilatation (max slope) occurs after
>2 hours
Arrest of descent happens if the fetus is in what level for more than 1 hour?
Station +1 onwards
Criteria for arrest disorder: Beyond latent phase Uterine contraction >200 Montevideo units for ___ hours without cervical change
2 hours
CONSIDER CS, IF WITH:
- ______ of uterine contractions of >200 MVU without cervical change
- ______ of oxytocin augmentation for inadequate contractions
4 hours
6 hours
This describes the number of contractions x average uterine pressure in a 10 min strip
Montevideo unit
Inappropriate leg positioning in stirrups in prolonged second stage may be die to compression of what nerve?
Common peroneal nerve
Zavanelli maneuver requires restoring the fetal head back into this position
Occiput anterior or posterior
Shoulder dystocia happens when the anterior shoulder becomes wedged behind this structure in the pelvis
Symphysis pubis
Head to body delivery time of more than ____ seconds indicates shoulder dystocia
>60 seconds
Lifting the legs in McRobert’s maneuver increases
AP diameter
This maneuver attemps anterior shoulder disimpaction by applying suprapubic pressure over posterior aspect of anterior shoulder
Mazzanti
This maneuver attemps anterior shoulder disimpaction by inserting 2 fingers vaginally and pushing the posterior shoulder toward the chest
Rubin
This maneuver puts 2 fingers on the anterior aspect of the posterior shoulder to rotate obliquely
Wood corkscrew
This maneuver puts patient into all fours, grasp posterior arm of the fetus, sweeps against chest and deliver
Gaskin
Which maneuver is applied to reduce the nuchal arm in breech delivery
Loveset maneuver
This maneuver in breech delivery is where the assistant applies suprapubic pressure to favor flexion and engagement of fetal head
Mauriceau-Smellie-Veit maneuver
Intervals shorter than how many months between pregnancies have been associated with an increased risk for preterm birth?
18 months
One of the most common causes for indicated preterm birth
Placenta previa
Indomethacin as tocolytic promotes this effect on the fetus
Premature closure of the ductus arteriosus
Neonate that has the function expected of a newborn at <37 weeks with underdeveloped organ functions
Premature
One of the contributing factors to preterm birth is a threatened abortion during this period
6-13 weeks AOG
Intervals LONGER than how many months between pregnancies have been associated with an increased risk for preterm birth?
59 months
Infection usually associated with preterm birth
Bacterial vaginosis
Single most powerful predictor of preterm birth
Transvaginal sonogram
One of the sonographic signs of preterm birth is shortening of cervix to less than 25mm at how many weeks AOG?
16-24 weeks
Loading dose of magnesium sulfate for preterm labor
4g slow IV push over 20 mins
Antidote for Magnesium Sulfate toxicity
Calcium gluconate
Tocolytic agent of choice for preterm birth
Nifedipine 10mg Q6
Prophylactic cerclage is done during
10-12 weeks AOG
Corticosteroid can also be given for preterm birth during
24-34 weeks AOG
Only reliable indicator for chorioamnionitis
Maternal fever
Criteria for chorioamnionitis include maternal fever plus one of the ff
Fetal tachycardia Uterine tenderness Purulent or foul smelling discharg Incresed ESR Leukocytosis
Management of chorioamnionitis
-
Seven (7) day regimen:
- First 48 hours: Ampicillin 2 grams/IV q6, Erythromycin 250 mg q6
- After 48 hours: Oral amoxicillin 250 mg q8, Erythromycin 250 mg q8
-
Three (3) day regimen:
- Ampicillin or Ampicillin-Sulbactam
- Ampicillin IV q6 and Gentamicin q8 until delivery
- Clindamycin or Metronidazole q8 added for anaerobic coverage
*Amoxicillin-clavulanate not recommended due to the increased incidence of NEC.
Birth must be delayed for this amount of time after initiation of corticosteroid therapy to reduce rates of respiratory distress
24 hours after last dose
Reversible complication of indomethacin
Oligohydramnios
Administration of magsul to preterm birth can reduce rates of which neonatal outcome?
Cerebral palsy
