[CLMD] Dysfunctional Lab [Moulton] Flashcards
How do Uterine Contractions work Physiologically?
Stimulation of Oxytocin recptors activates actin myosin element
(Gap Jxns help faciliatate entire uterine contractions simulataneously)
– So we get an INCREASE in Intracellular Ca stores
– promoting interaction of actin and myosin causing uterine contractions
What are the two distinct segments of the uterus that are formed during labor – and what do they do?
Upper Segment – actively contracts and retracts to expel the fetus
Lower Segment/Cervix – Becomes thinner and passive
How does the cervix change during labor?
It becomes soft, pliable, and dilatable
(from collagenolysis, increase in hyaluronic acid, decrease in dermatan sulfate, which favors water content)
What are the stages of Labor?
Stage 1 – Onset of contractions to full dilation of cervix
Stage 2 – full dilation of cervix to delivery of infant
Stage 3 – delivery of infant to delivery of placenta
Stage 4 – delivery of placenta to stabilization of mother
What are the normal limits for nulliparious/multiparous women during the latent phase?
Null – up to 20 hours
Multi – up to 14 hours
What are the normal limits of the active phase for cervical dilation of Nulliparous/Multiparous women?
Fetal descent in active phase?
Null – cervical dilation of 1.2 cm/hr
Multi – cervical dilation of 1.5 cm/hr
[fetal descent]
Null – descent of 1 cm/hr
Multi – descent of 2 cm/hr
What is the difference between protraction and arrest?
Protraction – slower than normal rate
Arrest – complete cessation of progress (no further dilation or descent)
What are some of the causes of a prolonged latent phase of labor?
Entered labor w/o substantial cervical change
Excessive use of sedatives/analgesics
Fetal Malposition
What are some of the causes of active phase problems?
Inadequate Uterine Activity (contractions arent strong enough)
Cephalopevlic Disproportion (pelvis shape inadequate for birth)
Fetal Malposition
Anesthesia (mom aint pushing – she sleeping)
(POWER, PASSENGER, PASSAGE) – Dystocia (difficult labor)
How do you manage a patient who is having trouble with the active phase of labor?
Augmentation – stimulation of uterine contractions, when spontaneous contractions have failed
(use if contractions are less than 3 in 10 mins)
Oxytocin – after assessing, Maternal Pelvis, Fetal Position, Station, Maternal and Fetal status
How do you assess the Power component of a patients dystocia?
IUPC (Intrauterine Pressure Catheter) – to assess the Power component (of their Dystocia
**The patient must have already had their MEMBRANES RUPTURED**
Calculate their Montevideo Units (MVU); >200 MVU for at least 2 hours
Start Pitocin – to stimulate labor
How do you assess the Passage component of active labor?
CPD (Cephalopelvic Disproportion) – the size of the pelvis to the fetal head
Measure
Pubic Arch
Ischial Tuberosities
Diagonal Conjugate,
Prominence of Ischial Spines
(This tells you the type of Pelvis they have: Arthropoid, Gynecoid etc)
How do you assess the Passenger component of the active phase?
Determine Fetal Position:
- Occiput Status (OA, LOP, LOA etc.)
Note possibility of
Macrosoma/LGA
Dystocia
Hydrocephalus
Fetal Ascites
Immune Hydrops – Rh Isoimmunization
Non-Immune Hydrops
Conjoined/Locked twins
What is the usual way the fetal head engages the pelvis?
OT position, then rotates to OA
(sometimes rotates to OP)
If the fetal head doesnt rotate and flex into the OA position, what are the likely causes?
CPD
Android/Platypelloid pelvis
Relaxed Pelvic Floor (Epidural)
What are the 3 Brachial Plexus Injuries?
Erb-Duschenne – upper arm palsy [C5/C6]
Klumpke – lower arm palsy [C8/T1]
Paralysis of Entire Arm – [all 4 nerve roots]
