Dysfunctional Labor (Moulton) Flashcards
Uterus is a large smooth muscle organ composed of billions of smooth muscle cells. Each of these cells becomes a contractile element when the intracellular ionic __1__ concentration increases to trigger an enzymatic process that results in the formation of the __2__ element.
Stimulation of __3__ receptors on the plasma membrane further activates the __2__ element.
Contractions occur in localized areas during gestation but during labor the entire uterus contracts in an organized fashion. These coordinated smooth muscle cells contractions are secondary to the __4__ that activate the movement of action potentials throughout the myometrium.
1) Calcium
2) Actin-myosin
3) Oxytocin
4) Gap junctions
Relaxation of the uterus is maintained by factors that increase levels of __1__.
Contraction of the uterus is from the increase intracellular __2__ stores which promotes interaction of __3__ and __3__ causing uterine contractions
1) Cyclic adenosine monophosphate (cAMP)
2) Calcium
3) Actin and myosin
During labor, two distinct segments of the uterus are formed, the __1__ segment which actively contracts and retracts to expel the fetus and the __2__ segment along with the cervix becomes thinner & passive.
1) Upper
2) Lower
What does the cervix contain?
Collagen and smooth muscle
In labor the cervix changes from firm, intact sphincter to soft, pliable, dilatable structure. These structural changes are the result of __1__, increase in __2__, decrease in __3__, which favors increased water content.
1) Collagenolysis
2) Hyaluronic acid
3) Dermatan sulfate
In the first stage of labor, the latent phase is characterized by cervical softening and effacement occur with minimal dilation which is defined as less than __1__ cm.
The active phase starts when the cervix is dilated to __1__ cm.
1) 6 cm
For all phases of labor (except the latent phase) an abnormality may be defined as either protraction or arrest. What does each mean?
1) Protraction: Slower than normal rate
2) Arrest: Complete cessation of progress (no further dilation or descent)
An arrested latent phase implies that?
Labor has not begun
Normal limits of the latent phase in a nulliparous mother can reach up to __1__ hours.
In a multiparous mother it can reach up to __2__ hours.
1) 20 hours
2) 14 hours
Latent phase that exceed the norms is considered prolonged but the outcome of prolonged latent phase has little effect on perinatal mortality. What are some causes of prolonged latent phase?
1) Excessive use of sedatives
2) Fetal malposition
What normal daily function is recommended with prolonged latent phase as it can provide patient with relief and aid in distinction between true and false labor?
What drug can be given that will progress the patient to the active phase or will stop contractions due to the patient undergoing false labor?
1) Sleep
2) Morphine
Normal limits of the active phase in nulliparous mothers for cervical dilation is __1__?
Normal limits of the active phase in multiparous mothers for cervical dilation is __2__?
Cervical dilation of less than the norms constitutes a __3__ disorder of dilation of the active phase.
If 2 or more hours elapsed with no cervical dilation an __4__ disorder of dilation has occurred.
1) 1.2 cm/hr
2) 1.5 cm/hr
3) Protraction
4) Arrest
Normal limits of the active phase in nulliparous mothers for fetal descent is __1__?
Normal limits of the active phase in multiparous mothers for fetal descent is __2__?
Fetal descent of less than the norms constitutes a __3__ disorder of descent of the active phase.
If no change in descent/station has occurred within 1 hr an __4__ disorder of descent has occurred.
1) 1 cm/hr
2) 2 cm/hr
3) Protraction
4) Arrest
____ is defined “difficult labor” it can be used interchangeably with dysfunctional labor characterizing that labor is not progressing normally.
Dystocia
The diagnosis of dystocia should NOT be made before what has been tried?
An adequate trial of labor
__1__ refers to stimulation of uterine contraction when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus.
This should be considered if contractions are less then __2__ in 10 minute period and/or the intensity is less than __3__ mm/Hg.
1) Augmentation
2) Three
3) 25 mm/Hg
ACOG recommends ____ in protraction and arrest disorders after assessing maternal pelvis, fetal position, station, and maternal/fetal status.
Oxytocin
The intrauterine pressure catheter (IUPC) is a soft plastic catheter placed transcervically that gives precise measurement of the __1__ of the uterine contractions in mmHg.
It require membrane to be __2__.
1) Intensity
2) Ruptured
Minimal effective uterine activity is defined as?
3 contractions in a 10 minute period averaging 25 mmHg above baseline
Montevideo Units are calculated by measuring the __1__ in mmHg in a 10 min period.
It should be greater than __2__ for at least two hours.
1) Peaks of contractions
2) 200
What is the only FDA approved medicine for labor stimulation due to inadequate uterine contractions?
Pitocin (oxytocin injection)
__1__ refers to a disparity between the size of the maternal pelvis & the fetal head that precludes vaginal delivery.
It causes a failure of __2__.
__3__ women who present in labor with an unengaged head indicates an increased likelihood.
1) Cephalopelvic disproportion
2) Descent
3) Nulliparous
____ and ____ shaped pelvises have a good prognosis for delivery.
Gynecoid and Anthropoid
Presentations other than vertex __1__ position are considered to be abnormal in the laboring patient.
Fetal head usually enters and engages the maternal pelvis in __2__ position but then rotates to __1__.
1) Occiput anterior
2) Occipitotransverse
