abnormal labor

Question 1

when is active phase arrested or prolonged

Answer 1

if no change in 4 hours arrest,

if process longer than 5 hours prolonger

Question 2

what do we do for passenger or pelvis?

Answer 2

C section

Question 3

what do we do for power

Answer 3

pitocin/oxytocin

Question 4

adequate contraction frequency

Answer 4

3 in 10

Question 5

how to assess power?

Answer 5

IUPC and then calculate montevideo units

Question 6

treatment for arrest of active

Answer 6

oxytocin

Question 7

what if oxytocin fails

Answer 7

C-section

Question 8

If the contractions are normal but there is arrest what?

Answer 8

C-section

Question 9

what if stage II arrest?

Answer 9

oxytocin

Question 10

what if oxytocin fails in stage II with negative position

Answer 10

C-section

Question 11

what if oxytocin fails in stage II with positive position

Answer 11

vacuum or forceps

Question 12

what if arrested stage III

Answer 12

1) uterine massage
2) oxytocin
3) manual extraction -reach hand in and pull it out

Question 13

what is normal ROM

Answer 13

at term with contractions

Question 14

what is PROM

Answer 14

at term with no contractions

Question 15

what is PPROM

Answer 15

premature with ROM without contraction

Question 16

what is prolonged labor/ROM?

Answer 16

> 18 hrs.

Question 17

define Rupture of membranes

Answer 17

when the sac opens, baby engages. this is normal

Question 18

what typically causes PROM?

Answer 18

infection. check GBS status.

Question 19

what is the treatment for PROMI

Answer 19

if GBS + or unknown amipicillin

delivery!

Question 20

what typically causes PPROM

Answer 20

infection. check GBS status

Question 21

what is the treatment for PPROM

Answer 21

look at GBS. If + or unknown must treat with ampicillin.

If >34 wks deliver.
if <24 wks deliver (abortion)
If in between steroids and assess risk/benefits.

Question 22

what is the risk of prolonged ROM

Answer 22

ascending infection. if GBS (-) then wait and see. if + ampicillin.

Question 23

what is endometritis

Answer 23

infection of the endometrial lining after birth. typically from ascending infection from vaginal flora or GBS.

Question 24

what is chorioanionitis

Answer 24

infection of the chorion sac. baby is not delivered.

Question 25

what causes endometritis/chorioamnionitis and what is the diagnostic step?

Answer 25

ascending infection/GBS from prolonged ROM (longer the time of ROM, increased risk). diagnostic step is to rule out other infections by chest X, U/A and blood cultures.

Question 26

how do we treat endometritis and chorioamnionits

Answer 26

gentamycin, amipcillin, clindamycin

Question 27

what is the leadig cause of morbidity and mortality for mom and baby

Answer 27

preterm labor

Question 28

what is the nunmber 1 cause of preterm labor

Answer 28

idiopathic

Question 29

what are the risks for preterm labor

Answer 29

smoking, multiple births, young maternal age, preterm ROM, anatomical defects.

Question 30

what must you have to diagnose preterm labor

Answer 30

cervical change and contractions. if NO cervical change, no preterm.

Question 31

can stop labor once it starts?

Answer 31

no. you can delay it

Question 32

what happens with post date babies? and when are they post date

Answer 32

42 wks, macrosomia and dysmaturity

Question 33

what is the treatment for postdate

Answer 33

depends on how sure you are of the dating.
if sure and have good cervix induce and deliver.
if sure and do not have good cervix, c-section
if not sure, NST/BPP.