Abnormal Labor Flashcards
What are the two most common abnormalities of the first stage of labor?
Protracted
Arrest
Do contractions stop if there is protraction or arrest of the first stage of labor?
No
What is arrest of labor in the latent phase?
Labor has not really begun, so there is no true arrest of labor
What is the definition of prolonged labor in the latent phase? (nulliparous and multiparous women)
More than 20 hours in nulliparous, or more than 14 in multiparous
Does a prolonged latent phase correlate with adverse perinatal outcomes?
No
Is prolonged latent phase an indication for a cesarean section?
No
What defines a protracted 1st stage of labor? Is this an indication for a cesarean section?
Rate of the active phase of cervical dilation is less than the 5th percentile
Not an indication for a C-section
Is there a risk for poor perinatal outcome with arrest in the active phase of labor? In whom (mother or baby)?
Yes– for mother and baby
What are the causes of protracted disorders (hypocontractile uterine activity) and how do you manage each? (2)
- Inadequate uterine activity (give oxytocin or amniotomy)
- Cephalopelvic disproportion (c-section)
What is an amniotomy? Why is this done?
AROM to help induce contractions
What is the definition of secondary arrest?
Cessation of a previously normal active phase–at least 6 cm for a period of 4 hours
How do you manage a secondary arrest?
- Verify dilation, presentation, position, and station
- Exclude malpresentation
When giving IV oxytocin for an arrested active phase, what is the goal amount of contractions in terms of frequency, duration, and pressure?
- q2-3 / min
- last 60 -90 secs
- 50-60 mmHg
When you augment contractions by administering oxytocin, what should you monitor?
Fetal heart pattern and uterine contractions
What are the four major complications that can arise from too oxytocin administration?
- Uterine hyperstimulation
- Water intoxication
- Hypotension if bolus
- Uterine rupture
What is a combined disorder? What is the significance of this in terms of outcomes? How do you manage this?
Arrest of dilation occurring when pt has previously shown primary dysfunctional labor
- Associated with less favorable outcome
- C-section
What defines protraction of descent? (nulliparous and multiparous)
Descent of presenting part during the second stage is less than 1 cm per hour in nulliparous and less than 2 cm in multiparous
True or false: protraction of the descent stage of labor is a subjective assessment
True
What are outcomes like with protraction of descent phase of labor?
Increase perinatal/maternal morbidity if overly aggressive attempts to shorten 2nd stage
True or false: expectant management of the descent phase of labor is appropriate if FHT reassuring
True
What are the three major adverse outcomes of the third stage of labor (placental delivery stage)?
- Hemorrhage
- Cord avulsion
- Uterine inversion
What causes the placenta to separate?
Consequence of continued contractions following delivery of fetus
What is uterine inversion?
When you pull on the placental cord, and the uterus inverts—EMERGENCY d/t severe hemorrhage
What is the average duration of the third stage of labor? When is intervention indicated? What should be done?
- Average = 15 minutes
- 30 minutes indicates need to intervene
- Give IV oxytocin or manual extraction
