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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
Q

What term is synonymous with dysfunctional labor?

A

Dystocia

– labor not progressing normally

26
Q

Dysfunctional labor results from abnormalities of?

A

3 P’s

  • Power
  • Passenger
  • Passage
27
Q

Dysfunctional labor results from abnormalities in?

A

3 P’s

  • Power
  • Passenger
  • Passage
28
Q

Power abnormalities involve?

A

Uterine contractions

Maternal expulsive forces

29
Q

Passenger abnormalities involve?

A

Position, size, presentation of fetus

30
Q

Passage abnormalities involve?

A

Maternal pelvic bone contractures

31
Q

What are 2 ways to assess Power?

A
  • Intrauterine Pressure Catheter

- MVU (montevideo units)

32
Q

What does the Intrauterine Pressure Catheter measure? What does it require?

A

= Measures intensity of uterine contractions

– requires rupture of membranes

33
Q

What does MVU (monteviedo units) measure?

A

= Measures peaks of contractions in a 10 minute period

34
Q

What is the minimal effective uterine activity?

A

3 contractions in 10 minutes that are 25 mmHg above baseline

35
Q

MVU should be above ___ for at least 2 hours

A

> 200

36
Q

How do you measure MVU?

A

Peaks of contractions above baseline added together in a 10 minute period

37
Q

What pelvis shapes have good prognosis for delivery?

A

Gynecoid

Anthrapoid

38
Q

What is Cephalopelvic Disproportion?

A

Disparity between the size of the maternal pelvis and the fetal head
= precludes vaginal delivery

39
Q

Presentations other than _____ for the fetal head are abnormal

A

Occiput Anterior (OA) = normal

40
Q

If the fetal head persists in the OccipitoTransverse position, what is that called? How does it arise?

A

Transverse arrest of descent

– no head flexion into OA position

41
Q

What are your treatment options for a persistent OccipitoTransverse position of the baby’s head?

A

C-section

Start Pitocin and manually/forceps rotate

42
Q

Large for Gestational Age

A

Birth weight is > 90% for given gestational age

43
Q

Macrosomia

A

Fetus weighs more than 4500 grams

44
Q

Fetus weighs more than 4500 grams

A

Macrosomia

45
Q

List risk factors for Macrosomia

A
  • Maternal diabetes, obesity, weight gain during pregnancy
  • Gestational age > 40, male fetus, multiparity
  • Maternal age < 17, maternal height and birth weight
46
Q

List risk factors for Macrosomia

A
  • Maternal diabetes, obesity, weight gain during pregnancy
  • Gestational age > 40, male fetus, multiparity
  • Maternal age < 17, maternal height and birth weight
47
Q

Treatment for Macrosomia in non and diabetics?

A

Non-diabetics : C -section if > 5000 g

Diabetics : C-section if > 4500 g

48
Q

Delivery that requires additional maneuvers following failure of downward traction on fetal head to effectively deliver shoulders

A

Shoulder Dystocia

49
Q

Where can the shoulders be impacted with Shoulder Dystocia?

A

Anterior - behind pubic symphysis

Posterior - on sacral promonotory

50
Q

What is the turtle sign?

A

Retraction of delivered fetal head against the maternal perineum
=> Shoulder dystocia

51
Q

What are some Antepartum risk factors for Shoulder Dystocia?

A
  • Macrosomia, post-term
  • Maternal diabetes, obesity
  • Short stature
52
Q

What are some during labor risk factors for Shoulder Dystocia?

A
  • Labor induction
  • Prolonged labor
  • Epidural
53
Q

What are 3 possible fetal adverse effects due to Macrosomia?

A
  • Shoulder Dystocia
  • Clavicle fracture
  • Brachial plexus injury
54
Q

What are 4 possible fetal adverse effects from Shoulder dystocia?

A
  • Brachial plexus injuries
  • Fractured clavicle/humerus
  • Encephalopathy
  • Death
55
Q

What are the 2 initial maneuvers for Shoulder Dystocia?

A
  1. McRobert’s

2. Suprapubic pressure

56
Q

McRobert’s Maneuver for Shoulder Dystocia

A

Hyperflexion and ABduction of maternal hips

57
Q

What maneuver may dislodge impacted anterior shoulder?

A

Suprapubic pressure

58
Q

You can also try rotational maneuvers or delivering the posterior fetal arm with Shoulder Dystocia. What are 2 rotational maneuvers?

A
  • RUBIN = push shoulder towards anterior fetal chest

- Wood’s Corkscrew = apply anterior pressure posterior to the infant

59
Q

What is the last resort option for Shoulder Dystocia?

A

Zavenelli maneuver = fetal head returned up into vagina

60
Q

Zavenelli maneuver for Shoulder Dystocia

A

Fetal head returned up into vagina

– followed by C-section

ENRP (45 decks)

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