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RDS Test 1 > B8.017 The Labor Process at Term: Normal Labor and Potential Complications > Flashcards

B8.017 The Labor Process at Term: Normal Labor and Potential Complications Flashcards

1
Q

general facts about term in pregnancy

A

38-42 weeks of pregnancy
weeks of pregnancy are dates from the 1st day of the patient’s LMP
normal pregnancy lasts 40 weeks

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2
Q

how many pregnancies end in normal labor and delivery

A

over 2/3

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3
Q

stages of labor

A

1st stage: cervical
2nd stage: expulsion
3rd stage: placental

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4
Q

describe the events of the cervical stage of labor

A

begins with the onset of labor
ends when the cervix is fully dilated
follows a characteristic course in a normal labor
gets shorter with subsequent pregnancies

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5
Q

acceleration phase of cervical dilation

A

4-5 cm range

cervix is thinned and progresses more quickly through active phase

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6
Q

events of the expulsion stage

A

begins at full cervical dilatation
ends with delivery of the baby
aided by use of abdominal muscles in a valsalva-like maneuver to bring pressure to bear on the uterine fundus
“pushing” can double the expulsive force

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7
Q

events of the placental stage

A

begins with the delivery of the baby
ends with delivery of the placenta
relies on involution of the uterus through continued contractions to affect separation of the placenta

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8
Q

signs of placental separation

A

increased bleeding per vagina in the majority of cases
lengthening of the umbilical cord
change in uterine shape to a globular configuration
cephalad displacement of the uterus as the placenta descends in the birth canal

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9
Q

possible outcomes with placental delivery

A
  1. successful delivery of the placenta
  2. avulsion of the umbilical cord
  3. inversion of the uterus
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10
Q

result of uterus inversion with placenta delivery

A

pronounced vagal response

patient hemorrhages and rather than HR increasing, it drops

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11
Q

cardinal movements of labor from the fetal aspect

A
  1. engagement
  2. descent
  3. flexion
  4. internal rotation
  5. extension
  6. external rotation
  7. expulsion
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12
Q

engagement

A

presenting part (head) has reached the ischial spines on vaginal exam

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13
Q

internal rotation

A

face turns toward sacrum

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14
Q

flexion

A

chin to chest

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15
Q

extension

A

head begins to push through cervix

neck extended against pubic symphisis

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16
Q

external rotation

A

face sideways again after coming out of vaginal canal

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17
Q

labor complications

A

dystocia
emergencies:
-cord prolapse
-shoulder dystocia

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18
Q

dystocia

A

difficult labor or childbirth

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19
Q

protracted labor/descent

A

slow labor

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20
Q

arrested labor/descent

A

stopped labor

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21
Q

protracted labor

A

<1.2 cm/h nulligravida
<1.5 cm/h
multipara

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22
Q

protracted descent

A

<1.0 cm/h nulligravida
<2.0 cm/h
multipara

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23
Q

arrested labor

A

> 2 hr

24
Q

arrested descent

A

> 1 hr

25
Q

causes for dystocia

A

the 3 p’s
power
passenger
passage

26
Q

passage

A

birth canal = true pelvis

27
Q

issues assessed with clinical pelvimetry

A

pelvic inlet
sacral contour
bony prominences
pelvic outlet

28
Q

gynecoid pelvis

A

predominant female pelvis shape

29
Q

anthropoid pelvis

A

long A/P

30
Q

android pelvis

A

predominant male pelvis shape

heart shape

31
Q

platypelloid pelvis

A

short A/P

long in lateral direction

32
Q

frequency of pelvic types

A

gynecoid > android > anthropoid > platypelloid

33
Q

complications with android pelvis

A

head wedged in
descent stops due to narrowing of canal
arrest of descent

34
Q

complications with anthropoid pelvis

A

cant extend head all the way

persistent occiput posterior

35
Q

complications with platypelloid pelvis

A

head stuck in transverse position

36
Q

episiotomy

A

enlarges the vaginal outlet to facilitate delivery

prophylactic episiotomy controversial and has lost favor

37
Q

types of episiotomy

A

midline

mediolateral

38
Q

advantages of midline episiotomy

A

less pain
ease of repair
less blood loss

39
Q

disadvantages of episiotomy

A

greater risk of extension into anal spinchter and/or rectum

40
Q

umbilical cord prolapse

A

when the umbilical cord descends in advance of the presenting fetal part

41
Q

funic umbilical cord

A

4%

when the membranes are intact, and the cord can be felt in the bag of waters

42
Q

occult prolapse

A

11%

when the cord is lying beside the presenting part

43
Q

overt prolapse

A

45% cord protruding through the cervix into the vagina

39% cord escaping from vagina

44
Q

risk factors for cord prolapse

A 
low birth weight
preterm birth
breech presentation
multiple gestation
malpresentation
hydramnios
obstetrical interventions
45
Q

cord prolapse mortality

A

stable mortality rate: 36-162 per 1,000 cases

most deaths result from complications of prematurity rather than poor recognition or inadequate treatment

46
Q

cord prolapse management

A

recognize
call for help
relieve
remove

47
Q

recognition of cord prolapse

A

care provider should elevate the presenting part to prevent compression of the cord

48
Q

relief of cord prolapse

A

place patient in trendelenburg position of knee-chest position
manual elevation of the presenting part of the fetus above the pelvic inlet
monitor the fetus as the maneuvers are carried out

49
Q

removal of cord prolapse

A

if cervix is fully dilated, and there is no evidence of fetal distress, consider assisted vaginal delivery
if not fully dilated, emergency C section

50
Q

shoulder dystocia

A

after delivery of the fetal head, further expulsion of the infant is prevented by impaction of the fetal shoulders within the maternal pelvis

51
Q

epidemiology of shoulder dystocia

A

0.15-1.7% of all vaginal deliveries
severe asphyxia in 143 per 1,000 births with shoulder dystocia compared with 14 per 1,000 overall
mortality = 21-290 in 1,000

52
Q

risk factors for shoulder dystocia

A 
fetal macrosomia
materal diabetes
maternal obesity
post term gestation
prior history of either macrosomia or shoulder dystocia
operative vaginal delivery
53
Q

clinical findings that suggest possible shoulder dystocia

A

prolonged 1st stage of labor, especially the decelerative phase
protracted 2nd stage
fetal head draws back after delivery, with the chin tight to perineum

54
Q

maneuvers to alleviate a shoulder dystocia

A 
knees to chest
suprapubic pressure (not fundal pressure tho)
deliver the posterior arm
corkscrew maneuvers
fracture the fetal clavicle
55
Q

maternal complications of shoulder dystocia

A

11% rate of postpartum hemorrhage

3.8% rate of fourth degree lacerations

56
Q

neonatal complications of shoulder dystocia

A

fractures- clavicle and/or humerus

brachial plexus injuries- reported anywhere from 4-40% of deliveries complicated by shoulder dystocia

RDS Test 1 (22 decks)

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