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OBSTETRICS > ABNORMAL LABOR > Flashcards

ABNORMAL LABOR Flashcards

1
Q

What does dystocia refer to?

A

“Dystocia refers to difficult labor

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2
Q

What are the three primary causes of dystocia?

A

“The three primary causes are abnormalities of the
1. powers (uterine contractility and maternal effort)
2. passenger—the fetus;
3. passage, the pelvis and lower reproductive tract.

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3
Q

What is the term used to describe obstructed labor due to a disparity between fetal head size and the maternal pelvis?

A

“Cephalopelvic disproportion (CPD).”

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4
Q

What does the term ‘failure to progress’ in labor refer to?

A

“Failure to progress refers to lack of progressive cervical dilation or halted fetal descent during labor.”

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5
Q

What fetal characteristics are common causes of dystocia?

A

“Fetal characteristics include abnormal presentation (face

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6
Q

What maternal characteristics increase the risk of dystocia?

A

“Maternal characteristics include nulliparity

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7
Q

What is uterine dysfunction?

A

“Uterine dysfunction refers to insufficient or uncoordinated uterine contractions that prevent cervical dilation and fetal descent during labor.”

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8
Q

What are the two types of uterine dysfunction?

A

“The two types are hypotonic uterine dysfunction

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9
Q

What risk factors contribute to uterine dysfunction?

A

“Risk factors include neuraxial analgesia

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10
Q

What is the definition of a prolonged latent phase of labor?

A

“A prolonged latent phase is defined as greater than 20 hours in nulliparas and greater than 14 hours in multiparas.”

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11
Q

How is the diagnosis of uterine dysfunction in the latent phase typically made?

A

“The diagnosis of uterine dysfunction in the latent phase is often made retrospectively

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12
Q

What are the criteria for diagnosing protraction disorder in active-phase labor?

A

“Protraction disorder is diagnosed when cervical dilation is less than 1 cm per hour for at least 4 hours during active labor.”

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13
Q

What defines active-phase arrest?

A

“Active-phase arrest is defined as no cervical dilation for 2 hours or more

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14
Q

What is the recommended threshold for diagnosing active labor in current guidelines?

A

“The recommended threshold for diagnosing active labor is 6 cm of cervical dilation.”

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15
Q

How does the new definition of active labor differ from previous standards?

A

“The new definition proposes 6 cm as the threshold for active labor

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16
Q

How does oxytocin augmentation affect labor progress?

A

“Oxytocin augmentation typically increases uterine activity

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17
Q

What is the second-stage labor limit for nulliparas with regional analgesia?

A

“The second-stage labor limit for nulliparas with regional analgesia is typically extended to 3 hours.”

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18
Q

How do newer guidelines modify second-stage labor duration?

A

“Newer guidelines recommend a maximum of 3 hours for nulliparas and 2 hours for multiparas in second-stage labor

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19
Q

Why is it difficult to determine a maximal time for second-stage labor?

A

“There is no robust data supporting a specific maximal time beyond which all women should undergo operative delivery

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20
Q

How did the change in cervical dilation thresholds impact cesarean rates?

A

“Despite the change in cervical dilation thresholds to 6 cm

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21
Q

What is a key concern with allowing prolonged second-stage labor?

A

“The key concern is that prolonged second-stage labor may increase maternal morbidity

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22
Q

How common is membrane rupture at term without spontaneous uterine contractions?

A

It complicates approximately 8 percent of pregnancies.

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23
Q

What management strategy was found to be preferred for labor induction with ruptured membranes at term?

A

Intravenous oxytocin was preferred over expectant management.

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24
Q

What is the benefit of prophylactic antibiotics in women with ruptured membranes before labor at term?

A

The benefit is unclear, but antibiotics are given for group B streptococcal infection if membranes are ruptured for more than 18 hours.

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25
Q

What is precipitous labor?

A

Precipitous labor is labor that terminates in expulsion of the fetus in less than 3 hours.

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26
Q

Which factors increase the risk of uterine rupture or extensive lacerations during precipitous labor?

A

Vigorous uterine contractions, a long, firm cervix, and a noncompliant birth canal increase the risk.

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27
Q

What are common complications for the neonate during precipitous labor?

A

Trauma, intracranial injury, and lack of appropriate fetal oxygenation.

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28
Q

What is the main cause of fetal intracranial injury in precipitous labor?

A

Resistance of the birth canal can cause intracranial injury.

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29
Q

What is the main treatment for precipitous labor when there is a nonreassuring fetal heart rate pattern?

A

A single intramuscular 250-ug dose of terbutaline may be given, balancing the risk of uterine atony if delivery is imminent.

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30
Q

What is the most common cause of fetopelvic disproportion?

A

Fetopelvic disproportion arises from diminished pelvic capacity or abnormal fetal size, structure, presentation, or position.

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31
Q

What is considered a contracted pelvic inlet?

A

A contracted pelvic inlet is when the anteroposterior diameter is less than 10 cm or the transverse diameter is less than 12 cm.

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32
Q

How is the obstetrical conjugate measured?

A

It is approximated by measuring the diagonal conjugate, which is about 1.5 cm greater.

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33
Q

How is a contracted midpelvis suspected?

A

A midpelvis is likely contracted if the interspinous diameter is less than 10 cm.

34
Q

How can a contracted pelvic outlet be defined?

A

A contracted pelvic outlet is defined as an interischial tuberous diameter of 8 cm or less.

35
Q

What is the main complication of a contracted pelvic outlet?

A

The main complication is an increased risk of perineal tears during delivery.

36
Q

Which type of trauma commonly causes pelvic fractures during pregnancy?

A

Trauma from automobile collisions is the most common cause of pelvic fractures during pregnancy.

37
Q

What is the role of x-ray pelvimetry in diagnosing cephalopelvic disproportion (CPD)?

A

X-ray pelvimetry has poor predictive value for diagnosing CPD.

38
Q

What is the primary cause of dystocia related to fetal head size?

A

Fetal head malposition, such as asynclitism or occiput posterior position, is more likely to obstruct passage through the birth canal than fetal size alone.

39
Q

How is face presentation diagnosed?

A

Face presentation is diagnosed by vaginal examination, with facial features palpated, and confirmed with sonography if necessary.

40
Q

What is the management strategy for a mentum posterior face presentation?

A

Mentum posterior presentations often convert spontaneously to an anterior position during labor.

41
Q

How is face presentation delivery achieved?

A

For mentum anterior face presentation, internal rotation of the face brings the chin under the symphysis pubis, allowing delivery.

42
Q

What is the preferred method for monitoring fetal heart rate during labor to avoid face or eye injury?

A

External devices are preferred for fetal heart rate monitoring during labor.

43
Q

Why are cesarean delivery rates higher in face presentations compared to occiput presentations?

A

Face presentations among term-size fetuses are more common with some degree of pelvic inlet contraction.

44
Q

What type of delivery can be completed in a mentum anterior face presentation?

A

Low or outlet forceps delivery may be completed for a mentum anterior face presentation if indicated.

45
Q

Why is vacuum extraction not recommended in face presentations?

A

Vacuum extraction is associated with eye trauma and is not recommended in face presentations.

46
Q

What should not be attempted for managing a face presentation during labor?

A

Attempts to manually convert a face presentation to an occiput presentation or to rotate a posterior chin to a mentum anterior position are dangerous and not recommended.

47
Q

What is a brow presentation?

A

A brow presentation is diagnosed when the portion of the fetal head between the orbital ridge and anterior fontanel presents at the pelvic inlet.

48
Q

What percentage of births does brow presentation occur in?

A

Brow presentation occurs in approximately 0.1 to 0.2 percent of births.

49
Q

How is a brow presentation typically diagnosed?

A

Brow presentation is typically diagnosed by vaginal examination, feeling for the frontal sutures, anterior fontanel, and orbital ridges, but the mouth or chin is not palpable.

50
Q

What is the risk of a persistent brow presentation?

A

A persistent brow presentation may result in failure to engage the fetal head and increased risk for molding and deformities.

51
Q

How is a persistent brow presentation managed?

A

Management principles for a persistent brow presentation mirror those for a face presentation, often requiring cesarean delivery.

52
Q

What is the definition of a transverse lie in labor?

A

In a transverse lie, the fetus’ long axis is perpendicular to the mother’s axis, and the shoulder is positioned over the pelvic inlet.

53
Q

What are common causes of transverse lie?

A

Common causes include high parity, preterm fetus, placenta previa, abnormal uterine anatomy, hydramnios, and contracted maternal pelvis.

54
Q

How can a transverse lie be recognized?

A

A transverse lie can often be recognized by the wide abdomen, no fetal pole detected in the fundus, and palpation of both the head and breech on opposite sides of the abdomen.

55
Q

What is the risk of a transverse lie during labor?

A

Spontaneous delivery is impossible, and labor may cause the fetal shoulder to become impacted in the pelvic inlet, leading to uterine contraction rings and increased risk for uterine rupture.

56
Q

What is the management for a transverse lie during active labor?

A

Active labor with a transverse lie typically requires cesarean delivery, with a vertical hysterotomy incision often indicated.

57
Q

Can external cephalic version (ECV) be attempted in a transverse lie?

A

Yes, ECV can be attempted before or early in labor when the membranes are intact, with a high success rate for transverse lie.

58
Q

What is the success rate for ECV in transverse lie compared to breech presentations?

A

The success rate for ECV is higher for transverse lie than for breech presentations.

59
Q

What should be done if a transverse lie persists and the fetus is small with a large pelvis?

A

In rare cases, spontaneous delivery may be possible if the fetus is small and the pelvis is large, with the fetus passing through the pelvic cavity in a doubled position.

60
Q

How can the position of the shoulder in a transverse lie be distinguished?

A

In a transverse lie, the acromion determines the designation as right or left acromial, and the back can be anterior or posterior.

61
Q

Why is cesarean delivery often required for transverse lie?

A

Cesarean delivery is required due to the difficulty of fetal extraction with the shoulder blocking the pelvic inlet.

62
Q

What percentage of births are complicated by umbilical cord prolapse?

A

Umbilical cord prolapse complicates 0.1 to 0.2 percent of births.

63
Q

What factors increase the risk of umbilical cord prolapse?

A

Umbilical cord prolapse is more common with pelvis contraction, unengaged presenting part, hydramnios, breech presentation, transverse lie, small or preterm fetus, preterm rupture of membranes, and multifetal gestation.

64
Q

What is a funic presentation?

A

A funic presentation occurs when the umbilical cord is the presenting part and is a potent risk factor for prolapse.

65
Q

What is the recommended delivery approach for a funic presentation?

A

Cesarean delivery is recommended for funic presentations prior to labor.

66
Q

How is umbilical cord prolapse usually diagnosed?

A

Umbilical cord prolapse is typically diagnosed clinically, by palpating the cord loop lower in the vaginal canal than the head or beside it.

67
Q

What is the management for most cases of umbilical cord prolapse?

A

In most cases, prompt manual elevation of the fetal head relieves cord compression, followed by rapid transfer to an operating room for cesarean delivery.

68
Q

Is vaginal or operative vaginal delivery possible in cases of umbilical cord prolapse?

A

Vaginal or operative vaginal delivery may be reasonable only if it can be completed much more rapidly than emergent cesarean delivery.

69
Q

What is a compound presentation in obstetrics?

A

A compound presentation occurs when an extremity, such as a hand or arm, prolapses alongside the presenting part in the pelvis.

70
Q

What is the incidence of compound presentations in deliveries?

A

Compound presentations occur in approximately 1 in 1000 singleton fetuses.

71
Q

How should a prolapsed extremity in a compound presentation be managed?

A

In most cases, the prolapsed extremity should be left alone as it typically does not impede labor and often retracts with descent of the presenting part.

72
Q

What should be done if a prolapsed extremity fails to retract in a compound presentation?

A

If the prolapsed extremity fails to retract and prevents descent of the head, the prolapsed part can be gently pushed upward while the head is pushed downward by fundal pressure.

73
Q

What are the complications associated with compound presentations?

A

Perinatal morbidity and mortality rates increase, mainly due to preterm birth, prolapsed umbilical cord, and traumatic obstetric procedures.

74
Q

What rare complication can result from pressure in a compound presentation?

A

Pressure-induced forearm ischemia, which can lead to surgical amputation, has been described in rare cases of compound presentations.

75
Q

What is dystocia in obstetrics?

A

Dystocia refers to abnormal or difficult labor, often resulting in prolonged labor and increased risk of complications for both mother and fetus.

76
Q

What complications are associated with prolonged labor due to dystocia?

A

Prolonged labor increases the risk of maternal infection, postpartum hemorrhage, uterine tears, and uterine rupture.

77
Q

Why does uterine rupture occur in prolonged labor?

A

Uterine rupture occurs due to abnormal thinning of the lower uterine segment, which becomes increasingly stretched when fetal descent is arrested.

78
Q

What is a Bandl ring?

A

A Bandl ring is a pathological retraction ring that appears as a sharp indentation in the uterus, signifying impending lower segment rupture.

79
Q

What complications can result from dystocia and pressure on the presenting part?

A

Fistula formation, such as vesicovaginal, vesicocervical, or rectovaginal fistulas, can result from pressure-induced necrosis of tissues between the presenting part and the pelvic wall.

80
Q

How can lower-extremity nerve injury occur during labor?

A

Prolonged second-stage labor can lead to lower-extremity nerve injury in the mother, typically resulting in sensory deficits that resolve within 6 months.

81
Q

What are common peripartum complications in the fetus during prolonged labor?

A

Caput succedaneum, molding, mechanical trauma such as nerve injury, fractures, and cephalohematoma are common complications during prolonged labor.

82
Q

What is the impact of prolonged labor on fetal sepsis?

A

The incidence of peripartum fetal sepsis increases with prolonged labor.

OBSTETRICS (13 decks)

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