Dysfunctional Labor (Moulton) Flashcards
Uterine relaxation
increase in cAMP
Uterine contraction
increase in intracellular calcium; promotes interaction of actin and myosin
Physiological changes of the uterus during labor
Upper segment - actively contracts & retracts to expel fetus
Lower segment - becomes thinner & passive
Physiological changes of the cervix during labor
contain collagen and smooth muscle; collagenolysis; increase in hyaluronic acid and decrease in dermatan sulfate to favor water content
Maximal dilation and descent in a nulliparous female?
dilation - 1.2 cm/hr
descent - 1.0 cm/hr
Maximal dilation and descent in a multiparous female?
dilation - 1.5 cm/hr
descent - 2.0 cm/hr
Protraction
slower than normal rate of dilation of labor
Arrest
complete cessation of dilation during labor
Abnormalities of active phase
can have increased risk of perinatal mortality
Prolonged latent phase
little effect on perinatal mortality
Dystocia
“difficult labor”; should not be diagnosed until the 3 P’s have been addressed
The three P’s
Power - uterine contraction strong enough
Passenger - presentation/size of fetus
Passage - maternal pelvis
Augmentation
stimulation of uterine contraction when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus
POWER
needs to be >200 MVU for at least 2 hours; before proceeding to C-section should document for at least 4 hours
PASSAGE
Gynecoid & Anthropoid pelvises have good prognosis
pubic arch >90
ischial tuberosity >8.5 cm
diagonal conjugate >11.5 cm
PASSENGER
fetal structure; macrosomia (big baby, >4500g); shoulder dystocia; fetal anomalies (hydrocephalus or immune hydrops)
Management of Persistent OT position
head fails to rotate and flex into OA position; if the 3 P’s are adequate start oxytocin and try rotation (manually or w Keilland forceps); if 3 P’s not adequate, proceed to C-section
Shoulder dystocia
delivery that requires additional obstetric maneuvers following the failure of gentle downward traction of the fetal head to effect delivery of shoulders; “turtle sign”
Erb-Duschenne
most common; C5 and C6; upper arm palsy
Klumpke
less common; C8 and T1; lower arm palsy
“turtle sign”
shoulder dystocia; retraction of the delivered fetal head against the maternal perineum
Management of shoulder dystocia
apply suprapubic pressure; do NOT apply fundal pressure;
McRoberts Maneuver
zavanelli maneuver - last resort
What is the last resort maneuver for shoulder dystocia?
zavanelli maneuver
