Dysfunctional Labor (Moulton)

Question 1

Uterine relaxation

Answer 1

increase in cAMP

Question 2

Uterine contraction

Answer 2

increase in intracellular calcium; promotes interaction of actin and myosin

Question 3

Physiological changes of the uterus during labor

Answer 3

Upper segment - actively contracts & retracts to expel fetus
Lower segment - becomes thinner & passive

Question 4

Physiological changes of the cervix during labor

Answer 4

contain collagen and smooth muscle; collagenolysis; increase in hyaluronic acid and decrease in dermatan sulfate to favor water content

Question 5

Maximal dilation and descent in a nulliparous female?

Answer 5

dilation - 1.2 cm/hr
descent - 1.0 cm/hr

Question 6

Maximal dilation and descent in a multiparous female?

Answer 6

dilation - 1.5 cm/hr
descent - 2.0 cm/hr

Question 7

Protraction

Answer 7

slower than normal rate of dilation of labor

Question 8

Arrest

Answer 8

complete cessation of dilation during labor

Question 9

Abnormalities of active phase

Answer 9

can have increased risk of perinatal mortality

Question 10

Prolonged latent phase

Answer 10

little effect on perinatal mortality

Question 11

Dystocia

Answer 11

“difficult labor”; should not be diagnosed until the 3 P’s have been addressed

Question 12

The three P’s

Answer 12

Power - uterine contraction strong enough
Passenger - presentation/size of fetus
Passage - maternal pelvis

Question 13

Augmentation

Answer 13

stimulation of uterine contraction when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus

Question 14

POWER

Answer 14

needs to be >200 MVU for at least 2 hours; before proceeding to C-section should document for at least 4 hours

Question 15

PASSAGE

Answer 15

Gynecoid & Anthropoid pelvises have good prognosis
pubic arch >90
ischial tuberosity >8.5 cm
diagonal conjugate >11.5 cm

Question 16

PASSENGER

Answer 16

fetal structure; macrosomia (big baby, >4500g); shoulder dystocia; fetal anomalies (hydrocephalus or immune hydrops)

Question 17

Management of Persistent OT position

Answer 17

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

Question 18

Shoulder dystocia

Answer 18

delivery that requires additional obstetric maneuvers following the failure of gentle downward traction of the fetal head to effect delivery of shoulders; “turtle sign”

Question 19

Erb-Duschenne

Answer 19

most common; C5 and C6; upper arm palsy

Question 20

Klumpke

Answer 20

less common; C8 and T1; lower arm palsy

Question 21

“turtle sign”

Answer 21

shoulder dystocia; retraction of the delivered fetal head against the maternal perineum

Question 22

Management of shoulder dystocia

Answer 22

apply suprapubic pressure; do NOT apply fundal pressure;

McRoberts Maneuver

zavanelli maneuver - last resort

Question 23

What is the last resort maneuver for shoulder dystocia?

Answer 23

zavanelli maneuver