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Year 2 OBGYN > Abnormal labor > Flashcards

Abnormal labor Flashcards

1
Q

what are the abnormal labor patterns in the 1st stage?

A
  • protraction

- arrest

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2
Q

what are the abnormal labor patterns in the active phase of stage 1 labor?

A
  • protraction
  • secondary arrest
  • combined disorder
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3
Q

what is most diminished in a protracted disorder?

A

rate of cervical change

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4
Q

protracted disorders carry what risks?

A
  • secondary arrest

- poor perinatal outcome

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5
Q

primary dysfunctional labor is what type of disorder? what is the cause in nulliparous women? multiparous women? what can you do for each?

A
  • protracted
  • nulliparous: inadequate uterine activity (hypocontractile - manage with amniotomy and/or oxytocin augmentation)
  • multiparous: cephalopelvic disproportion (mange by C-section)
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6
Q

an arrest can be called at what cervical dilation size?

A

6 cm

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7
Q

what needs to be excluded before calling a secondary arrest?

A

malpresentation

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8
Q

what can be administered to augment labor when 1st stage protraction or arrest disorders are noted?

A

oxytocin

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9
Q

what are the risks of IV oxytocin?

A
  • uterine hyperstimulation
  • water intoxication
  • hypotension if bolused
  • uterine rupture
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10
Q

what is a combined disorder? how is it managed?

A
  • arrest of dilation when pt has previously shown primary dysfunctional labor
  • managed by C-section
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11
Q

what are the abnormal labor patterns in the 2nd stage?

A
  • protracted descent

- arrested descent

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12
Q

what is the best management for protraction of descent during stage 2 of labor?

A

expectant management (if everything else is going okay with the fetus)

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13
Q

what are the adverse maternal outcomes during arrest?

A
  • hemorrhaage
  • trauma
  • chorioamnionitis
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14
Q

definition: episiotomy

A

incision into the perineal body maade during second stage labor to facilitate delivery

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15
Q

what are the indications for an episiotomy?

A
  • arrest or protracted descent
  • shoulder dystocia
  • instrument (operative) delivery
  • expedite delivery if abnormal fetal heart pattern
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16
Q

what are the benefits of a midline episiotomy? risks?

A

BENEFITS:

  • straight
  • reduction of second stage
  • reduction of trauma to pelvic floor muscles

RISKS:

  • increased blood loss (if too early)
  • potential fetal injury
  • localized pain
  • increased incidence of 3rd and 4th degree lacerations
  • long term incontinence and pelvic prolapse
17
Q

what are the benefits of a mediolateral episiotomy? risks?

A

BENEFITS:

  • less damage to anal sphincter
  • better for IBD

RISKS:

  • unsatisfactory cosmetic result
  • inclusion cysts within scar
  • greater blood loss
18
Q

what type of episiotomy is good for patients with IBD?

A

mediolateral

19
Q

3rd degree episiotomy laceration? 4th?

A

3rd - into anal sphincter

4th - into rectum

20
Q

what is the McRoberts maneuver? what is it used for?

A
  • mother brings knees up to armpits

- used to aid in delivery of fetus with possible shoulder dystocia

21
Q

definition: operative vaginal delivery

A

any operative procedure designed to effect vaginal deliver (forceps, vacuum)

22
Q

what are the maternal indications for using forceps / operative delivery?

A
  • maternal exhaustion
  • inadequate expulsive efforts
  • lack of expulsive efforts
  • need to avoid maternal expulsive efforts
23
Q

what are the fetal indications for using forceps / operative delivery?

A
  • nonreassuring fetal heart tracing

- prolonged second stage

24
Q

what are the necessary criteria for delivering a baby with forceps?

A
  • head first
  • known position
  • engaged in pelvis
  • station greater than or equal to 2
  • attitude of vertex, presence of caput or moulding
25
Q

what are the maternal risks of forceps?

A
  • perineal injury
  • vaginal and cervical lacerations
  • postpartum hemorrhage
26
Q

what are the fetala risks of forceps?

A
  • intracranial hemorrhage
  • cephalic hematoma
  • facial / brachial palsy
  • injury to soft tissues of face and forehead
  • skull fracture
27
Q

what are the maternal indications for C-section?

A
  • obstructive benign and malignant tumors
  • large vulvar condyloma
  • abdominal cervical cerclage (stitch in cervix)
  • prior vaginal colporrhaphy
  • prior classical cesarean delivery or full thickness myomectomy
  • prior uterine rupture
28
Q

what are the maternal-fetal indications for C-section?

A
  • cephalopelvic disproportion
  • failure to progress or arrest
  • placental abruption
  • placenta previa
  • uterine dehiscence or prior classical uterine scar
  • maternal request (controversial)
  • large pelvic mass
29
Q

what are the fetal indications for C-section?

A
  • nonreassuring fetal heart tracing
  • malpresentation
  • HSV
  • ITP
  • major congenital abnormalities
  • cord prolapse
30
Q

what are the risks of C-section?**

A
  • blood loss
  • infection
  • injury
  • thrombotic events / PE
  • risk of future C-sections
  • maternal mortality about 10x greater than vaginal births

Year 2 OBGYN (33 decks)

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