abnormal labor Flashcards
when is active phase arrested or prolonged
if no change in 4 hours arrest,
if process longer than 5 hours prolonger
what do we do for passenger or pelvis?
C section
what do we do for power
pitocin/oxytocin
adequate contraction frequency
3 in 10
how to assess power?
IUPC and then calculate montevideo units
treatment for arrest of active
oxytocin
what if oxytocin fails
C-section
If the contractions are normal but there is arrest what?
C-section
what if stage II arrest?
oxytocin
what if oxytocin fails in stage II with negative position
C-section
what if oxytocin fails in stage II with positive position
vacuum or forceps
what if arrested stage III
1) uterine massage
2) oxytocin
3) manual extraction -reach hand in and pull it out
what is normal ROM
at term with contractions
what is PROM
at term with no contractions
what is PPROM
premature with ROM without contraction
what is prolonged labor/ROM?
> 18 hrs.
define Rupture of membranes
when the sac opens, baby engages. this is normal
what typically causes PROM?
infection. check GBS status.
what is the treatment for PROMI
if GBS + or unknown amipicillin
delivery!
what typically causes PPROM
infection. check GBS status
what is the treatment for PPROM
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.
what is the risk of prolonged ROM
ascending infection. if GBS (-) then wait and see. if + ampicillin.
what is endometritis
infection of the endometrial lining after birth. typically from ascending infection from vaginal flora or GBS.
what is chorioanionitis
infection of the chorion sac. baby is not delivered.
what causes endometritis/chorioamnionitis and what is the diagnostic step?
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.
how do we treat endometritis and chorioamnionits
gentamycin, amipcillin, clindamycin
what is the leadig cause of morbidity and mortality for mom and baby
preterm labor
what is the nunmber 1 cause of preterm labor
idiopathic
what are the risks for preterm labor
smoking, multiple births, young maternal age, preterm ROM, anatomical defects.
what must you have to diagnose preterm labor
cervical change and contractions. if NO cervical change, no preterm.
can stop labor once it starts?
no. you can delay it
what happens with post date babies? and when are they post date
42 wks, macrosomia and dysmaturity
what is the treatment for postdate
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.
