Dysfunctional Labor

Question 1

Explain the basic principles of uterine contraction?

Answer 1

Need lots of calcium inside. Uterine contractions are localized, but labor is the whole uterus via gap junctions.

Question 2

What is the range of first stage, second stage, and third stage of labor?

Answer 2

Onset of contractions to full dilation
Full dilation to delivery of baby
Delivery of baby to delivery of placenta

Question 3

Normal limits of latent phase of stage 1 for nullipaous and multiparious? What are the two most common causes?

Answer 3

Up to 20 and up to 14 hours
Excessive use of sedative/pain meds
Malposition of baby

Question 4

What to do with a patient with prolonged latent phase? What will be the 3 results?

Answer 4

Let them rest and give morphine.
Progress to active
Stop
Need to be induced because labor is indicated

Question 5

Normal limits of active phase for cervical dilation and fetal descent?

Answer 5

Nulliparous 1.2 cm/hr and 1cm of descent /hr

Multifarious 1.5 cm/hr and 2 cm of descent /hr

Question 6

When do we say protraction disorder of dilation and descent and arrest of dilation and descent?

Answer 6

Cervical dilation is less than the norms and fetal descent is less than the norms
No cervical dilation has happened in 2 hours and no change in descent has occurred in 1 hour there is arrest

Question 7

4 causes of active phase abnormalities?

Answer 7

No uterine activity
Baby pelvic not fitting
Fetal malposition
Anesthesia

Question 8

What are the 3 P’s of dysfunctional labor?

Answer 8

Power - does mom have pushing power
Passenger - is baby positioned to come out, too big
Passage - moms pelvic bones

Question 9

When would we consider augmenting active phase?

Answer 9

Contractions are less than 3 in ten minutes or less than 25 pressure

Question 10

ACOG recommends what in protraction and arrest disorders afte doing what?

Answer 10

Assessing moms pelvis, fetal position, station and mom and baby status

Question 11

How do we assess power of mom and what do we need to do to accomplish it?

Answer 11

Intrauterine pressure catheter

Rupture membranes which can augment labor as well

Question 12

How do we define minimal effective uterine activity?

Answer 12

3 contractions in a 10 minute period averaging 25 pressure

Question 13

What two pelvis shapes have good prognosis for delivery? What should pubic arch angle be, ischial tuberosity to ischial tuberosity distance be, and diagonal conjugate?

Answer 13

Gynecoid and anthropoid
Greater than 90
Greater than 8.5
Greater than 11.5

Question 14

What head position does the fetus engage the maternal pelvis in, what provision is then normal presentation, and what are the two abnormal positions?

Answer 14

OT
Presents in OA
Can persist in OT or rotate to OP

Question 15

3 big time causes of Dystocia?

Answer 15

Macrosomia, shoulder dystocia, fetal anomalies

Question 16

What fails to happen when the head stays in OT?

Answer 16

Fetal head fails to rotate and flex

Question 17

If pelvis is good, baby is good size and the only problem is the contractions aren’t strong enough, what do we do with OT head baby? What is pelvis is not good size or baby’s is huge, what do we do?

Answer 17

Start oxytocin and use forceps or manually rotate

C section

Question 18

How do we manage OP head?

Answer 18

Usually goes just fine with a longer second stage of labor.

Consider vacuum or forceps.

Question 19

2 fetal anomalies to know that can cause dystocia?

Answer 19

Hydrocephalus and fetal ascites/hydrops fro rhesus

Question 20

How do we define macrosomia and large for gestational age?

Answer 20

Greater than 4500 grams

Birth weight greater than 90% of gestational age

Question 21

5 risk factors for macrosomia?

Answer 21

Diabetes, big mama, young mama, male baby, old baby.

Question 22

2 risks to mom from macrosomia?

3 risks to baby’s from macro?

Answer 22

C section and vaginal lacerations/bleeding

Shoulder dystocia, clavicle fracture, and brachial plexus injury

Question 23

3 injuries because of brachial plexus injuries?

Answer 23

Erb duschenne: upper arm palsy because of c5 and c6
Klumpke: lower arm palsy because damage to c8 and t1
Paralysis to whole arm

Question 24

ACOG recommends c sections with macro babies at what weights for non diabetic and diabetic patients?

Answer 24

5000

4500

Question 25

What is the fetal sign of shoulder dystocia?

Answer 25

Turtle sign, which is recreation of fetal head

Question 26

3 antepartum risk factors for shoulder dystocia?

Answer 26

Fat baby, fat mom, diabetic mom

Question 27

4 intralabor risk factors for shoulder dystocia?

Answer 27

Labor induction
Epidural
Prolonged labor
Operative vaginal deliveries

Question 28

What is the technique to manage shoulder dystocia?

Answer 28

Mcroberts maneuver, hyperflex and abduct maternal hips

Suprapubic pressure

Question 29

3 other maneuvers for shoulder dystocia?

Answer 29

Rubin, corkscrew and posterior arm

Question 30

What is the last resort maneuver for shoulder dystocia?

Answer 30

Zavanelli

Push the fetal head back into the birth canal to perform a c section.