Abnormal Labor Flashcards
What are the first/latent stage abnormal patterns of labor?
Protraction
Arrest
What is arrest in Latent stage?
Labor hasn’t begun
What are the Active stage abnormal patterns of labor?
Protraction
Arrest- stop of progress
What is secondary arrest?
Cessation of previously normal active phase
>6cm dilation for 4 hours
What is the management of secondary arrest?
Confirm adequate uterine contractions
Exclude Macro Fetus/Small Pelvis/MALPRESENTATION
verify dilation, presentation, position, and station
Break water
How can Labor be augmented?
IV Oxytocin
What are the risks of IV Oxytocin?
Uterine Hyperstimulation
Water intoxication
Hypotension
Uterine Rupture
What are the abnormal developments in the 2nd stage of labor?
Protraction of descent
Arrest of Descent
What is the Management of Arrest of Development?
Eval labor pattern, Pt well being, Cephalopelvic rel
Manage LP, Bladder, tissue resistance, Maternal Effort?
What are the adverse maternal outcomes of Arrrest of descent?
Hemmhorage, trauma, chorioamnionitis(infection)
What Complications from interference in the 3rd stage of labor?
Hemorrhage, cord avulsion, uterine inversion
When is an episiotomy indicated?
Arrest or protracted descent, Shoulder dystocia
Instrument (operative) delivery
What are the risks of an episiotomy?
Inc blood loss if done too early Fetal injury (rare) Localized pain 3rd and 4th degree lacerations assoc. with long term incontinence/prolapse
What is the benefit of a mediolateral epesiotomy?
don’t increase risk of 3-4th degree lacerations, less damage to anal sphincter,
good for IBD
What are the risks of a mediolateral episiotomy?
Worse cosmetic result
Inclusion cyst within scar
Greater blood loss
What is a 3rd degree laceration?
4th degree?
3rd: extends into the sphincter
4th: ext into the rectum
What are the risk factors for Shoulder Dystocia?
Fetal Macrosomia, maternal diabetes, maternal obesity, postdatism, prolonged deceleration
What is the maneuver used to manage shoulder dystocia?
McRoberts Maneuver- Knees to the armpits
What are the maternal indications for using forceps?
Exhaustion
Inadequate/lack of/need to avoid maternal expulisive efforts
What are the fetal indications for using forceps?
non-reassuring fetal heart tracing, Prolonged second stage
What are the maternal criteria for operative vaginal delivery?
Analgesia Lithotomy Bladder empty pelvimetry Consent
What are the fetal criteria for operative vaginal delivery?
Vertex
Position
Engaged in pelvis
Station >or= +2
What are the uteroplacental criteria for operative vaginal delivery?
Cervix fully dilated
Ruptured membranes
no placenta previa
What are the maternal Indications for C-section?
Cephalopelvic Disproportion Failure to progress Placental abruption Placenta Previa Uterine scar rupture pelvic mass
What are the fetal Indications for C-section?
Poor heart tracing Malpresentation Herpes Immune thrombocytopenic purpura (passed to baby) Major Congenital abn Cord prolapse
What are the Risks of C section?
Blood loss Infection Injury Thrombotic diseases Risk of futire C section Maternal risk 10x greater
What is the management of Breech presentation?
C-section
