Abnormal Labor Flashcards
how to monitor strength of contractions
intrauterine pressure catheter (IUPC)
can only happen once membranes are ruptured
montevideo units
look for total of 200 montevideo units
in a 10-minute period, the number and power of contractions are assimilated into one number
prolonged latent phase
should last <20hrs (nullip) or <14hrs (multip)
okay to rest and wait
can also: cervical ripening with balloon (mechanical dilation), misoprostol (PGE1), dinoprostone (PGE2), oxytocin, or amniotomy
what are adequate contractions
3 in 10 averaged over 30 minutes
montevideo units >200 in 10mins (averaged over 30mins()
how to augment labor
balloon to stimulate engagement misoprostol dinoprostone oxytocin amniotomy
prolonged active phase
> 1.2cm/hr change first time
>1.5cm/hr change multip
expected change in active phase of labor
nullip - 1.2cm/hr
multip - 1.5cm/hr
arrest of active phase
no cervical change and
4hrs of adequate contractions
6hrs of any contractions
three causes of arrest in the active phase
passenger - size of baby
pelvis - mom’s anatomy
power - can be augmented with oxytocin and amniotomy
treatment of arrest of active phase of labor
consider cesarean delivery
frequency/adequacy: oxytocin
C-section if it isn’t
prolonged second stage of labor
multip - 2hrs
nullip - 3hrs
operative vaginal delivery with forceps or vacuum should be considered prior to moving to C-section
when to consider operative vaginal delivery
only consider if passenger and pelvis are adequate
fully dilated cervix, ruptured membranes, engagement of fetal head, known position of the head, adequate anesthesia, empty bladder, informed consent, willingness to move to C-section
prolonged third stage of labor
delivery of the placenta should occur within 30mins
may have an issue of power of contractions
oxytocin at time of deliver
how to facilitate delivery of placenta
perform uterine massage, then oxytocin
manual extraction if all else fails
