delivery problems Flashcards
what is dystocia?
difficult labor or abnormally slow progress of labor.
what are the 3 categories of dystocia?
power, passenger, and passage
what is power?
purely dysfunctional dystocia, in which uterine contractility is inadequate in effecting dilation and descent
what is passenger dystocia?
presentation size or position of fetus
what is shoulder dystocia?
one or both shoulders lodged at pubic symphysis after delivery of the head
+/- Erb’s palsy (brachial plexus shoulder injury) especially in macrosomic kids, multiparity, gest. DM
what is passage dystocia?
uterus or soft tissue abnormalities
management of shoulder dystocia
non-manipulative (first line) McRoberts maneuver increase pelvic opening w/ hip hyperflexion
what is the manipulative management of dystocia?
Woods “ Corkscrew’ maneuver: 180 shoulder rotation
what is PROM?
premature rupture of membranes
rf for PROM?
STDs, smoking, prior preturm delivery, multiple gestations
dx of PROM?
1) sterile speculum exam–> visual inspection–> pooling of secretions–> assess for infections
nitrazine paper test –> turns blue if pH> 6.5 = PROM is likely
2) US
3) avoid digital exam in most cases
hwat is normal amniotic fluid ph?
7.0-7.3
what is the fern test?
anminotic fluid fern pattern–> crystallization of estrogen and amniotic fluid
management of PROM?
await for spontaneous labor
monitor for infectsion: chorioamnionitis or endometritis
what s the criteria for Premature labor?
regular uterine contractions (> 4-6/hr) w/ progressive cervical changes BEFORE 37 WKS
**mMC cuase of perinatal mortality
s/sx of PTL?
cramps, uterine contractions, back pain, pelvic pressure, and vaginal d/c
dx of PTL based on cervical dilation?
> 3cm: PTL
2-3 cm: PTL is likely
<2 cm: PTL is unlikely
dx of PTL based on effacement?
> 80 %: PTL
< 80: PTL is likely/unlikely
fetal distress
> 160 tachycardic
<120 bradycardic
what is non stress testing?
reocreds movement, heartbeat, and contractions; noes changes in h eart rhytm when the baby goes from resting to moving, or during contractions if the mom is in labor
what is a good NST?
“reactive” > 2 accelerations in 20 mins defined by increased FHR of at least 15 bpm from baseline lasting > 15 secs= fetal well being
bad NST?
nonreactive NST no fetal heart acels, or < 15 bpm increase lasting < 15 secs
*if this is the case, then get CST
Contraction Stress Test
measures fetal response to stress at times of uterus contraction
negative CST (aka Good)
no late decels in the presence of 2 contractions in 10 mins
positive CST (aka bad)
repetitive late decels in the presence of 2 contractions in 10 mins–> worrisome espectially if nonreactive NST
what can repetitive late decles of the FHR mean?
uteroplacental insufficiency
how is a late decel defined?
gradual decrease and return to the baseline FHR during the contraction with the lowest point occurring after the peak of the the contractions. doen’t return to baseline until contraction is over
how is a variable decel defined?
characterized by an abrupt decrease in FHR below the baseline with the onset to lowest point less than 30 secs. can occur anytime during the contraction cycle ans last at least 15 seconsd
**happen in approximatley halft of all labors and are usually transietn and correctable
what is characteristic on the fetal monitor during variable decels?
U, V, or W shapes and noted by their rapid descent and ascent
what may variable decels suggest?
umbilical cord compression, especially in the presence of oligohydramnios or amniotomy
what is oligohydramnios?
deficiency of amniotic fluid
what is amniotomy?
artificial rupture of membranes