Chapter 23 Flashcards
Defined as the abnormal or difficult labor
Dystocia
Dystocia or difficult of labor can arise from four components:
*power (uterine contractions)
*passenger (fetus)
*passageway (birth canal)
*psyche (perception of the pregnancy)
Time-honored term to denote sluggishness of contractions
Inertia
Common causes of dysfuntional labor:
*Primigravida status
*CPD
*failure of the uterine muscle to contract properly
*nonripe cervix
*patient exhausted from labor
*rectum or urinary bladder is full that impedes fetal descent
Are the basic force that moves the fetus through the birth canal
Uterine contractions
Contractions not more than two or three occuring within a 10-minute period
Hypotonic uterine contractions
What is the resting tone and strength in hypotonic uterine contractions
*Resting tone remains less than 10 mmHg
*Strength of contraction does not rise above 25 mmHg
Occur during active phase of labor and tend to occur after administration of analgesia
Hypotonic Uterine Contractions
Are marked by an increase in resting tone to more than 15 mmHg
Hypertonic Contractions
Occurs frequently and are most commonly seen in the latent phase of labor
Hypertonic Uterine Contractions
Lack of relaxation between conteactions that prevent optimal uterine artery filling leading to
Anoxia
During this contraction, lack of relaxation between contractions that prevent optimal uterine artery filling leading to anoxia
Hypertonic Uterine Contractions
Administer ______ to soften cervix for cervical thinning
Hyoscine
More than one pacemaker may be initiating contractions, or receptor points in the myometrium may be acting independently of the pacemaker.
Uncoordinated Contraction
Can occur so closely together that they can interfer with the blood supply to the placenta.
Uncoordinated contractions
_______ administration is helpful in uncoordinated labor to stimulate better pattern of conteactions
Oxytocin
Dysfunction occurs with the first stage of labor involves a
*prolonged latent phase
*protracted active phase
*prolonged deceleration phase *secondary arrest of diltation
In prolonged latent phase, how long does latent phase lasts
*longer than 20 hours in nullipara
*14 hours in multipara
With a prolonged latent phase, the uterus tends to be in
Hypertonic State
What is the management of a prolonged latent phase?
*helping uterus to rest
*provide adequate fluid for hydration
*administer pain relief drugs like morphine sulfate or epidural
Is simple measures of management does not work for prolonged latent phase
Cesarean birth or amniotomy or oxytocin infusion to assist labor may be necessary
This phase if prolonged if cervical dilatation does not occur at a rate of at least 1.2 cm per hour for nullipara or 1.5 cm for multipara
Protracted Active Phase
If the active phase lasts longer than 12 hours in a primigravida or 6 hours in a multigravida
Protracted Active Phase
Extends beyond 3 hours in a nullipara or 1 hour in a multipara
Prolonged Deceleration Phase
Occured if there is no progress in cervical dilatation for longer than 2 hours (for nullipara) and 1 hour for multipara
Secondary Arrest of Dilatation
A prolonged decelertion phase most often results from
Abnormal fetal head position
Occurs if the rate of descent is less than 1 cm per hour for nullipara or 2 cm per hour in multipara
Prolonged Descent
Results when no descent has occured for 2 hours in nullipara or 1 hour in multipara
Arrest of Descent
When expected descent of the fetus does not begin or movement beyond 0 station does not occur.
Arrest of descent
Most likely cause for arrest of descent during the second stage is
CPD or Cephalopelvic Disproportion
Cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more for multipara per hour.
Precipitate Labor
Occurs when uterine contractions are so strong a parent gives birth with only a few, rapidly occuring contractions
Precipitate birth
Often defined as a labor that is completed in fewer than 3 hours.
Precipitate Birth
Contractions can be so forceful they lead to
Premature separation of the placenta or lacerations of the perineum
Labor is started artificially
Induction of Labor
Refers to assisting labor that has started spontaneously but is not effective.
Augmentation of Labor
Induction of labor is not used unless the fetus is
At term (39 weeks)
Even if the fetus is less than 39 weeks, induction can still be done if
Fetus was proven to have adequate lung surfactant by amniocentesis
Before induction of labor is done, the following conditions should be present:
*fetus is in longitudinal lie
*cervix is ripe
*presenting part is engaged
*no suspected CPD
*fetus is estimated to be mature (over 39 weeks)
Change in the cervical consistency from firm to soft.
Cervical Ripening
Simplest method for ripening the cervix
Stripping (or sweeping) the membranes
Most common method to promote cervical ripening
Insertion of prostaglandin like dinoprostone into the posterior fornix of the vagina
A synthetic form of naturally occuring pituitary hormone
Oxytocin
In case of hyperstimulation, a primary care provider may prescribe ______ to relax the uterus
Terbutaline
If hyperstimulation occurs, these interventions are done
*Turn patient to their left side to improve blood flow to the uterus
*administer IV fluid bolus to dilute level of oxytocin in bloostream
*administer oxygen by mask at 8 to 10 L
Fetus needs ___________ between contractions to receive adequate oxygenation from blood vessels in the placenta.
60 to 90 seconds
Uterine rupture occurs most often in patients who have _________
Previous cesarean scar
If uterus should rupture, patient experiencea
“Tearing sensation”
If uterus should rupture, what will be visible on the patient’s abdomen
Retracted Uterus and the extrauterine fetus
With an incomplete rupture, a patient may experience
Only a localized tenderness and a persistent aching pain over the lower uterine segment
Refers to the uterus turning inside out with either birth of the fetus or delivery of the placenta
Uterine Inversion
In uterine inversion, a patient will likely be given
General anesthesia or possibly nitroglycerin or a tocolytic drug by IV to relax the uterus
These may speed the descent
Semi-fowler position, squatting, kneeling, or more effective pushing.
A loop of the umbilical cord slips down in front of the presenting fetal part
Umbilical Cord Prolapse
Umbilical cord prolapse tends to occur most often with:
*premature rupture of membranes
*fetal presentation other than cephalic
*placenta previa
*small fetus
*CPD preventing firm engagement
Management for cord prolapse
*elevating the fetal head off the cord
*placing the patient in a knee-chest or Trendelenburg position
