Abnormal Labor

Question 1

What are the first/latent stage abnormal patterns of labor?

Answer 1

Protraction

Arrest

Question 2

What is arrest in Latent stage?

Answer 2

Labor hasn’t begun

Question 3

What are the Active stage abnormal patterns of labor?

Answer 3

Protraction

Arrest- stop of progress

Question 4

What is secondary arrest?

Answer 4

Cessation of previously normal active phase

>6cm dilation for 4 hours

Question 5

What is the management of secondary arrest?

Answer 5

Confirm adequate uterine contractions
Exclude Macro Fetus/Small Pelvis/MALPRESENTATION
verify dilation, presentation, position, and station
Break water

Question 6

How can Labor be augmented?

Answer 6

IV Oxytocin

Question 7

What are the risks of IV Oxytocin?

Answer 7

Uterine Hyperstimulation
Water intoxication
Hypotension
Uterine Rupture

Question 8

What are the abnormal developments in the 2nd stage of labor?

Answer 8

Protraction of descent

Arrest of Descent

Question 9

What is the Management of Arrest of Development?

Answer 9

Eval labor pattern, Pt well being, Cephalopelvic rel

Manage LP, Bladder, tissue resistance, Maternal Effort?

Question 10

What are the adverse maternal outcomes of Arrrest of descent?

Answer 10

Hemmhorage, trauma, chorioamnionitis(infection)

Question 11

What Complications from interference in the 3rd stage of labor?

Answer 11

Hemorrhage, cord avulsion, uterine inversion

Question 12

When is an episiotomy indicated?

Answer 12

Arrest or protracted descent, Shoulder dystocia

Instrument (operative) delivery

Question 13

What are the risks of an episiotomy?

Answer 13

Inc blood loss if done too early
Fetal injury (rare)
Localized pain
3rd and 4th degree lacerations assoc. with long term incontinence/prolapse

Question 14

What is the benefit of a mediolateral epesiotomy?

Answer 14

don’t increase risk of 3-4th degree lacerations, less damage to anal sphincter,
good for IBD

Question 15

What are the risks of a mediolateral episiotomy?

Answer 15

Worse cosmetic result
Inclusion cyst within scar
Greater blood loss

Question 16

What is a 3rd degree laceration?

4th degree?

Answer 16

3rd: extends into the sphincter
4th: ext into the rectum

Question 17

What are the risk factors for Shoulder Dystocia?

Answer 17

Fetal Macrosomia, maternal diabetes, maternal obesity, postdatism, prolonged deceleration

Question 18

What is the maneuver used to manage shoulder dystocia?

Answer 18

McRoberts Maneuver- Knees to the armpits

Question 19

What are the maternal indications for using forceps?

Answer 19

Exhaustion

Inadequate/lack of/need to avoid maternal expulisive efforts

Question 20

What are the fetal indications for using forceps?

Answer 20

non-reassuring fetal heart tracing, Prolonged second stage

Question 21

What are the maternal criteria for operative vaginal delivery?

Answer 21

Analgesia
Lithotomy
Bladder empty
pelvimetry
Consent

Question 22

What are the fetal criteria for operative vaginal delivery?

Answer 22

Vertex
Position
Engaged in pelvis
Station >or= +2

Question 23

What are the uteroplacental criteria for operative vaginal delivery?

Answer 23

Cervix fully dilated
Ruptured membranes
no placenta previa

Question 24

What are the maternal Indications for C-section?

Answer 24

Cephalopelvic Disproportion
Failure to progress
Placental abruption
Placenta Previa
Uterine scar rupture
pelvic mass

Question 25

What are the fetal Indications for C-section?

Answer 25

Poor heart tracing
Malpresentation
Herpes
Immune thrombocytopenic purpura (passed to baby)
Major Congenital abn
Cord prolapse

Question 26

What are the Risks of C section?

Answer 26

Blood loss
Infection
Injury
Thrombotic diseases
Risk of futire C section
Maternal risk 10x greater

Question 27

What is the management of Breech presentation?

Answer 27

C-section