DYSTOCIA Flashcards
What is the first stage of labor?
The first stage is from the onset of uterine contractions to full cervical dilatation (10 cm).
How long do contractions last during the first stage of labor?
3–5 minutes apart, lasting 45–60 seconds.
What is considered labor in terms of contraction frequency?
At least 1 contraction every 10 minutes is considered labor.
What is the second stage of labor?
The second stage is from full cervical dilatation to the delivery of the fetus.
How long do contractions last during the second stage of labor?
2–3 minutes apart, lasting 60–90 seconds.
What mnemonic represents the cardinal movements of labor?
Every Darn Fool in Egypt Eats Raw Eggs (ED FIE-ERE).
What are the cardinal movements of labor?
Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, Expulsion.
What is the third stage of labor?
The third stage is from the delivery of the fetus to placental delivery.
What is the fourth stage of labor?
The fourth stage is the 1-hour period following placental delivery.
Why is the fourth stage of labor critical?
Complications such as postpartum hemorrhage, retained placental fragments, uterine atony, or lacerations may occur.
What are the main causes of postpartum hemorrhage?
Retained placental fragments, uterine atony, placenta accreta/precreta/previa, coagulation disorders, lacerations, uterine rupture, and uterine inversion.
What are the degrees of perineal lacerations?
1st degree: Skin; 2nd degree: Fascia and perineal muscles; 3rd degree: Anal sphincter; 4th degree: Anus and rectum.
What is cervical laceration often mistaken for?
Bleeding from the uterus even when it is contracting.
What is Friedmann’s Curve used for?
It indicates whether labor is progressing normally and predicts the likelihood of vaginal delivery.
What are the three divisions of labor according to Friedmann’s Curve?
Preparatory division, Dilatational division, and Pelvic division.
What are the phases included in the Preparatory Division?
Latent and acceleration phases.
What phase occupies the maximum slope in Friedmann’s Curve?
Dilatational division.
What are the components of the Active Phase?
Acceleration phase, Phase of maximum slope, Deceleration phase.
What are the time limits for the latent phase in nulliparas and multiparas?
Nulliparas: <20 hours; Multiparas: <14 hours.
What cervical dilatation is reached by the end of the latent phase?
<4 cm.
What is the dilatation threshold for active labor?
Cervical dilatation of 3 to 6 cm or more with uterine contractions.
At what cervical dilatation does the phase of maximum slope occur?
7–8 cm.
What conditions can cause an overdistended uterus?
Multiple gestations or uterine exhaustion from excessive stimulation.
What is uterine atony, and why is it dangerous?
Uterine atony is the inability of the uterus to contract, leading to postpartum hemorrhage.
What are some risk factors for uterine rupture?
Previous cesarean sections or excessive uterine contractions.
What is the clinical importance of identifying protraction in the acceleration phase?
A dilatation rate <1.2 cm/hour in nulliparas or <1.5 cm/hour in multiparas suggests abnormal labor patterns.
What is dystocia?
Refers to a difficult or prolonged labor and delivery. It can arise from issues with the baby (passenger), the mother’s pelvis (passage), or uterine contractions (power). Stress-related hormones can also affect contractions. It is a major cause of CS and linked to increased maternal and fetal morbidity.
What are the main classifications of dystocia?
Obstructive dystocia/arrest disorder and non-obstructive dystocia/protraction disorder.
What is obstructive dystocia?
Occurs when there is a physical blockage preventing the baby from passing through the birth canal. Happens in the 1st and 2nd stages of labor.
What factors can lead to obstructive dystocia?
Fetal size (e.g., cephalopelvic disproportion, macrosomia), malpositions (e.g., breech, footling presentation), fetal abnormalities (e.g., hydrops fetalis, hydrocephalus, anencephaly), shoulder dystocia (e.g., turtle sign), or pelvic abnormalities (e.g., trauma, fractures).
What is non-obstructive dystocia?
Labor is prolonged or ineffective due to factors like slow cervical dilatation, slow fetal descent, hypotonic contractions, maternal fatigue, or hormonal imbalances.
What are the ‘4Ps’ causing dystocia?
Power (uterine contractions), Passenger (fetal abnormalities), Passage (maternal pelvis abnormalities), Psyche (stress or anxiety).
What is the most common cause of dystocia?
Problem with uterine contractions (power).
What is tachysystole?
More than 5 uterine contractions in 10 minutes, which reduces blood flow and may cause fetal distress.
What are the characteristics of hypotonic uterine contractions?
Weak, infrequent contractions that lack the intensity and regularity needed for labor progress.
What are the characteristics of hypertonic uterine contractions?
Frequent, uncoordinated contractions that cause painful and ineffective labor without adequate cervical dilation or fetal descent.
What is cephalopelvic disproportion (CPD)?
A mismatch between the fetal size and the maternal pelvis, preventing labor progress.
What are the types of pelvis and their implications for labor?
Gynecoid (favorable), Android (difficult, often leads to arrest), Anthropoid (posterior fetal presentation), Platypelloid (least favorable, flat shape).
What fetal presentations can complicate labor?
Breech, transverse lie, shoulder presentation, or abnormalities like hydrocephalus and macrosomia.
What maternal psychological factors affect labor?
Stress, anxiety, fear, and hormonal imbalances (e.g., increased catecholamines or cortisol).
What is protraction disorder?
Slow labor progress, often due to inadequate contractions or fetal descent. Diagnosed based on Friedman’s curve and progress rates.
What is arrest disorder?
Labor stops completely, including prolonged deceleration phase, secondary arrest of dilatation, arrest of descent, or failure of descent.
What interventions can address inadequate uterine contractions?
Oxytocin, nipple stimulation, amniotomy, maternal repositioning, hydration, and uterine stimulation.
What are Montevideo Units (MVUs) and their significance?
MVUs measure uterine contraction strength. Adequate labor requires at least 200-250 MVUs.
How is fetal station measured?
Station is assessed relative to the ischial spines: -1, -2, etc., above the spine; 0 at the spine; +1, +2, etc., below the spine. +5 indicates crowning.
What is the treatment for protracted labor in the latent phase?
Monitor the mother and fetus. If stable, encourage rest or administer oxytocin for augmentation. Perform CS if complications arise (e.g., fetal distress, CPD).
How is arrest of descent managed?
If beyond station 0 and descent stops, perform CS after reassessing maternal and fetal conditions.
How is uterine contraction intensity classified?
Mild: 10-50 mmHg; Moderate: 50-75 mmHg; Strong: 75-100 mmHg.
What is the significance of a cardiotocogram (CTG)?
CTG measures uterine contraction strength and frequency. Normal labor requires 3-5 contractions in 10 minutes and 200+ MVUs.
What should be done if there is tachysystole?
Discontinue uterotonics, hydrate the patient, and reposition them in left lateral decubitus to improve uteroplacental blood flow.
What is the management for a macrosomic baby in labor?
Assess for CPD. If fetal distress or prolonged labor occurs, perform CS.
What is the expected cervical dilation rate during active labor?
For nulliparas: ≥1.2 cm/hr; for multiparas: ≥1.5 cm/hr.
How does maternal fatigue affect labor?
Fatigue reduces the effectiveness of uterine contractions and pushing efforts, leading to prolonged labor.
What is fetopelvic disproportion?
Cephalopelvic disproportion, which is a problem in the pelvis.
What are the measurements that define a contracted pelvic inlet?
Shortest AP diameter < 10 cm or greatest transverse diameter < 12 cm. Diagonal conjugate < 11.5 cm.
How is the pelvic inlet measured?
From the sacral promontory to the symphysis pubis or by the diagonal conjugate.
What complications are associated with a contracted pelvic inlet?
Face and shoulder presentations occur 3x more frequently, and cord prolapse occurs 4-6x more often.
What should you check after a spontaneous rupture of membranes?
Perform an IE to check for prolapse, but remove fingers if cord prolapse is palpated and mobilize the team for an emergency.
What is the landmark for diagnosing midpelvic contraction?
The ischial spine; prominent spines or converging pelvic sidewalls indicate contraction.
What measurement indicates a contracted midpelvis?
Sum of interspinous and posterior sagittal diameters < 13.5 cm or interspinous diameter < 8 cm.
What can cause transverse arrest of the fetal head?
Midpelvic contraction.
What are the measurements that define a contracted outlet?
Inter-ischial tuberous diameter of 8 cm or less.
What perineal tears are associated with contracted outlet?
1st degree: Skin and mucosa, 2nd degree: Muscles, 3rd degree: Sphincters, 4th degree: Rectum.
What treatments are used for power problems in labor?
Oxytocin stimulation and amniotomy (artificial rupture of membranes).
How much time does amniotomy accelerate labor?
2 hours.
What management options exist for malposition during labor?
Manual rotation or vacuum.
What management options exist for posterior asynclitism or malpresentation?
Cesarean delivery (CS).
What are key strategies for managing maternal psyche during labor?
Emotional support, effective communication, pain management, relaxation exercises, informed consent, and addressing fear of labor.
What complications are associated with fetopelvic disproportion for the mother?
Increased risk of cesarean delivery, maternal hemorrhage, infection, and uterine rupture.
What complications are associated with fetopelvic disproportion for the fetus?
Hypoxia, birth trauma (e.g., brachial plexus injury), and increased neonatal morbidity and mortality.
How can fetal size and macrosomia be identified early?
Prenatal monitoring, fundal height measurement, and fetal weight estimation via ultrasound.
What is the recommended management for shoulder dystocia?
Elective cesarean delivery if macrosomia is identified prenatally.
What factors can help prevent fetopelvic disproportion?
Early identification of fetal size, regular prenatal monitoring, and monitoring labor progress.
