Abnormal labor Flashcards
what are the abnormal labor patterns in the 1st stage?
- protraction
- arrest
what are the abnormal labor patterns in the active phase of stage 1 labor?
- protraction
- secondary arrest
- combined disorder
what is most diminished in a protracted disorder?
rate of cervical change
protracted disorders carry what risks?
- secondary arrest
- poor perinatal outcome
primary dysfunctional labor is what type of disorder? what is the cause in nulliparous women? multiparous women? what can you do for each?
- protracted
- nulliparous: inadequate uterine activity (hypocontractile - manage with amniotomy and/or oxytocin augmentation)
- multiparous: cephalopelvic disproportion (mange by C-section)
an arrest can be called at what cervical dilation size?
6 cm
what needs to be excluded before calling a secondary arrest?
malpresentation
what can be administered to augment labor when 1st stage protraction or arrest disorders are noted?
oxytocin
what are the risks of IV oxytocin?
- uterine hyperstimulation
- water intoxication
- hypotension if bolused
- uterine rupture
what is a combined disorder? how is it managed?
- arrest of dilation when pt has previously shown primary dysfunctional labor
- managed by C-section
what are the abnormal labor patterns in the 2nd stage?
- protracted descent
- arrested descent
what is the best management for protraction of descent during stage 2 of labor?
expectant management (if everything else is going okay with the fetus)
what are the adverse maternal outcomes during arrest?
- hemorrhaage
- trauma
- chorioamnionitis
definition: episiotomy
incision into the perineal body maade during second stage labor to facilitate delivery
what are the indications for an episiotomy?
- arrest or protracted descent
- shoulder dystocia
- instrument (operative) delivery
- expedite delivery if abnormal fetal heart pattern
what are the benefits of a midline episiotomy? risks?
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
what are the benefits of a mediolateral episiotomy? risks?
BENEFITS:
- less damage to anal sphincter
- better for IBD
RISKS:
- unsatisfactory cosmetic result
- inclusion cysts within scar
- greater blood loss
what type of episiotomy is good for patients with IBD?
mediolateral
3rd degree episiotomy laceration? 4th?
3rd - into anal sphincter
4th - into rectum
what is the McRoberts maneuver? what is it used for?
- mother brings knees up to armpits
- used to aid in delivery of fetus with possible shoulder dystocia
definition: operative vaginal delivery
any operative procedure designed to effect vaginal deliver (forceps, vacuum)
what are the maternal indications for using forceps / operative delivery?
- maternal exhaustion
- inadequate expulsive efforts
- lack of expulsive efforts
- need to avoid maternal expulsive efforts
what are the fetal indications for using forceps / operative delivery?
- nonreassuring fetal heart tracing
- prolonged second stage
what are the necessary criteria for delivering a baby with forceps?
- head first
- known position
- engaged in pelvis
- station greater than or equal to 2
- attitude of vertex, presence of caput or moulding
what are the maternal risks of forceps?
- perineal injury
- vaginal and cervical lacerations
- postpartum hemorrhage
what are the fetala risks of forceps?
- intracranial hemorrhage
- cephalic hematoma
- facial / brachial palsy
- injury to soft tissues of face and forehead
- skull fracture
what are the maternal indications for C-section?
- 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
what are the maternal-fetal indications for C-section?
- cephalopelvic disproportion
- failure to progress or arrest
- placental abruption
- placenta previa
- uterine dehiscence or prior classical uterine scar
- maternal request (controversial)
- large pelvic mass
what are the fetal indications for C-section?
- nonreassuring fetal heart tracing
- malpresentation
- HSV
- ITP
- major congenital abnormalities
- cord prolapse
what are the risks of C-section?**
- blood loss
- infection
- injury
- thrombotic events / PE
- risk of future C-sections
- maternal mortality about 10x greater than vaginal births
