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ENRP > Dysfunctional Labor > Flashcards

Dysfunctional Labor Flashcards

1
Q

Uterine smooth muscle cells become contractile when ____ increases

A

Calcium increases

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2
Q

When Calcium increases, it leads to the formation of?

A

Actin-myosin element

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3
Q

Besides calcium increasing, what else leads to the formation of the actin-myosin element?

A

(+) oxytocin receptors on the plasma membrane

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4
Q

How do uterine contractions compare during gestation and labor?

A

Gestation: localized areas
Labor: entire uterus contracts

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5
Q

Relaxation of the uterus involves an increase in?

A

cAMP

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6
Q

During labor, what is the job of the upper and lower uterus/cervix respectively?

A 
Upper = contracts and retracts to expel fetus
Lower = passive and becomes thinner
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7
Q

How does the cervix change during labor?

A

Starts firm

–> soft, pliable and dilatable structure

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8
Q

What are the 2 options for a labor abnormality?

A

Protraction - slower than normal

Arrest - complete cessation of progress

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9
Q

Which phase of labor does not fall into the protraction/arrest abnormality categorization?

A

Latent phase

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10
Q

What are the normal time limits for the Latent phase for primipara/multipara?

A 
Primipara = up to 20 hours
Multipara = up to 14 hours
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11
Q

A Latent phase that exceeds the norms is considered? What effect does it have on perinatal mortality?

A

Prolonged

– little effect on mortality

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12
Q

What are 3 possible causes of a Prolonged Latent Phase?

A
  • Little cervical change with labor
  • Fetal malposition
  • Excessive use of sedatives/analgesics
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13
Q

With a Prolonged Latent phase, what treatment can determine if it’s true or false labor? What else can be given?

A

Sleep

– Can also give Morphine

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14
Q

What are the normal rates for cervical dilation in the Active phase with primipara/multipara/

A 
Primipara = 1.2cm/hour
Multipara = 1.5cm/hour
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15
Q

Protraction disorder of dilation of the active phase

A

Dilation is SLOWER than normal

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16
Q

Arrest of dilation during the Active phase

A

2+ hours with NO cervical dilation

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17
Q

What are the normal limits of fetal descent with primipara/multipara?

A 
Primipara = 1 cm/hour
Multipara = 2cm/hour
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18
Q

Protraction disorder of descent of the Active phase

A

Fetal descent is SLOWER than normal

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19
Q

Arrest of descent of the Active phase

A

NO change ini descent/station of fetus for 1+ hour

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20
Q

Abnormalities in the Active phase of labor have an increased risk for?

A

Perinatal mortality

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21
Q

What are 4 possible causes for abnormalities in the Active phase?

A
  • Inadequate uterine activity
  • Fetal malposition
  • Anesthesia
  • Cephalopelvic Disproportion
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22
Q

What is the treatment for abnormalities in the Active phase?

A

Augmentation - stimulate uterine contraction

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23
Q

If contractions are less than ____ in 10 minutes and/or are at an intensity less than ____ consider Augmentation of labor

A

< 3 in 10 mins

< 25 intensity

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24
Q

What is given for augmentation of labor?

A

Oxytocin

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25
What term is synonymous with dysfunctional labor?
Dystocia | -- labor not progressing normally
26
Dysfunctional labor results from abnormalities of?
3 P's - Power - Passenger - Passage
27
Dysfunctional labor results from abnormalities in?
3 P's - Power - Passenger - Passage
28
Power abnormalities involve?
Uterine contractions | Maternal expulsive forces
29
Passenger abnormalities involve?
Position, size, presentation of fetus
30
Passage abnormalities involve?
Maternal pelvic bone contractures
31
What are 2 ways to assess Power?
- Intrauterine Pressure Catheter | - MVU (montevideo units)
32
What does the Intrauterine Pressure Catheter measure? What does it require?
= Measures intensity of uterine contractions | -- requires rupture of membranes
33
What does MVU (monteviedo units) measure?
= Measures peaks of contractions in a 10 minute period
34
What is the minimal effective uterine activity?
3 contractions in 10 minutes that are 25 mmHg above baseline
35
MVU should be above ___ for at least 2 hours
> 200
36
How do you measure MVU?
Peaks of contractions above baseline added together in a 10 minute period
37
What pelvis shapes have good prognosis for delivery?
Gynecoid | Anthrapoid
38
What is Cephalopelvic Disproportion?
Disparity between the size of the maternal pelvis and the fetal head = precludes vaginal delivery
39
Presentations other than _____ for the fetal head are abnormal
Occiput Anterior (OA) = normal
40
If the fetal head persists in the OccipitoTransverse position, what is that called? How does it arise?
Transverse arrest of descent | -- no head flexion into OA position
41
What are your treatment options for a persistent OccipitoTransverse position of the baby's head?
C-section | Start Pitocin and manually/forceps rotate
42
Large for Gestational Age
Birth weight is > 90% for given gestational age
43
Macrosomia
Fetus weighs more than 4500 grams
44
Fetus weighs more than 4500 grams
Macrosomia
45
List risk factors for Macrosomia
- Maternal diabetes, obesity, weight gain during pregnancy - Gestational age > 40, male fetus, multiparity - Maternal age < 17, maternal height and birth weight
46
List risk factors for Macrosomia
- Maternal diabetes, obesity, weight gain during pregnancy - Gestational age > 40, male fetus, multiparity - Maternal age < 17, maternal height and birth weight
47
Treatment for Macrosomia in non and diabetics?
Non-diabetics : C -section if > 5000 g | Diabetics : C-section if > 4500 g
48
Delivery that requires additional maneuvers following failure of downward traction on fetal head to effectively deliver shoulders
Shoulder Dystocia
49
Where can the shoulders be impacted with Shoulder Dystocia?
Anterior - behind pubic symphysis | Posterior - on sacral promonotory
50
What is the turtle sign?
Retraction of delivered fetal head against the maternal perineum => Shoulder dystocia
51
What are some Antepartum risk factors for Shoulder Dystocia?
- Macrosomia, post-term - Maternal diabetes, obesity - Short stature
52
What are some during labor risk factors for Shoulder Dystocia?
- Labor induction - Prolonged labor - Epidural
53
What are 3 possible fetal adverse effects due to Macrosomia?
- Shoulder Dystocia - Clavicle fracture - Brachial plexus injury
54
What are 4 possible fetal adverse effects from Shoulder dystocia?
- Brachial plexus injuries - Fractured clavicle/humerus - Encephalopathy - Death
55
What are the 2 initial maneuvers for Shoulder Dystocia?
1. McRobert's | 2. Suprapubic pressure
56
McRobert's Maneuver for Shoulder Dystocia
Hyperflexion and ABduction of maternal hips
57
What maneuver may dislodge impacted anterior shoulder?
Suprapubic pressure
58
You can also try rotational maneuvers or delivering the posterior fetal arm with Shoulder Dystocia. What are 2 rotational maneuvers?
- RUBIN = push shoulder towards anterior fetal chest | - Wood's Corkscrew = apply anterior pressure posterior to the infant
59
What is the last resort option for Shoulder Dystocia?
Zavenelli maneuver = fetal head returned up into vagina
60
Zavenelli maneuver for Shoulder Dystocia
Fetal head returned up into vagina | -- followed by C-section

ENRP (45 decks)

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