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OBSTETRICS > DYSTOCIA > Flashcards

DYSTOCIA Flashcards

1
Q

What is the first stage of labor?

A

The first stage is from the onset of uterine contractions to full cervical dilatation (10 cm).

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2
Q

How long do contractions last during the first stage of labor?

A

3–5 minutes apart, lasting 45–60 seconds.

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3
Q

What is considered labor in terms of contraction frequency?

A

At least 1 contraction every 10 minutes is considered labor.

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4
Q

What is the second stage of labor?

A

The second stage is from full cervical dilatation to the delivery of the fetus.

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5
Q

How long do contractions last during the second stage of labor?

A

2–3 minutes apart, lasting 60–90 seconds.

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6
Q

What mnemonic represents the cardinal movements of labor?

A

Every Darn Fool in Egypt Eats Raw Eggs (ED FIE-ERE).

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7
Q

What are the cardinal movements of labor?

A

Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, Expulsion.

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8
Q

What is the third stage of labor?

A

The third stage is from the delivery of the fetus to placental delivery.

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9
Q

What is the fourth stage of labor?

A

The fourth stage is the 1-hour period following placental delivery.

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10
Q

Why is the fourth stage of labor critical?

A

Complications such as postpartum hemorrhage, retained placental fragments, uterine atony, or lacerations may occur.

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11
Q

What are the main causes of postpartum hemorrhage?

A

Retained placental fragments, uterine atony, placenta accreta/precreta/previa, coagulation disorders, lacerations, uterine rupture, and uterine inversion.

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12
Q

What are the degrees of perineal lacerations?

A

1st degree: Skin; 2nd degree: Fascia and perineal muscles; 3rd degree: Anal sphincter; 4th degree: Anus and rectum.

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13
Q

What is cervical laceration often mistaken for?

A

Bleeding from the uterus even when it is contracting.

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14
Q

What is Friedmann’s Curve used for?

A

It indicates whether labor is progressing normally and predicts the likelihood of vaginal delivery.

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15
Q

What are the three divisions of labor according to Friedmann’s Curve?

A

Preparatory division, Dilatational division, and Pelvic division.

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16
Q

What are the phases included in the Preparatory Division?

A

Latent and acceleration phases.

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17
Q

What phase occupies the maximum slope in Friedmann’s Curve?

A

Dilatational division.

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18
Q

What are the components of the Active Phase?

A

Acceleration phase, Phase of maximum slope, Deceleration phase.

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19
Q

What are the time limits for the latent phase in nulliparas and multiparas?

A

Nulliparas: <20 hours; Multiparas: <14 hours.

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20
Q

What cervical dilatation is reached by the end of the latent phase?

A

<4 cm.

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21
Q

What is the dilatation threshold for active labor?

A

Cervical dilatation of 3 to 6 cm or more with uterine contractions.

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22
Q

At what cervical dilatation does the phase of maximum slope occur?

A

7–8 cm.

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23
Q

What conditions can cause an overdistended uterus?

A

Multiple gestations or uterine exhaustion from excessive stimulation.

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24
Q

What is uterine atony, and why is it dangerous?

A

Uterine atony is the inability of the uterus to contract, leading to postpartum hemorrhage.

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25
Q

What are some risk factors for uterine rupture?

A

Previous cesarean sections or excessive uterine contractions.

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26
Q

What is the clinical importance of identifying protraction in the acceleration phase?

A

A dilatation rate <1.2 cm/hour in nulliparas or <1.5 cm/hour in multiparas suggests abnormal labor patterns.

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27
Q

What is dystocia?

A

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.

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28
Q

What are the main classifications of dystocia?

A

Obstructive dystocia/arrest disorder and non-obstructive dystocia/protraction disorder.

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29
Q

What is obstructive dystocia?

A

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.

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30
Q

What factors can lead to obstructive dystocia?

A

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).

31
Q

What is non-obstructive dystocia?

A

Labor is prolonged or ineffective due to factors like slow cervical dilatation, slow fetal descent, hypotonic contractions, maternal fatigue, or hormonal imbalances.

32
Q

What are the ‘4Ps’ causing dystocia?

A

Power (uterine contractions), Passenger (fetal abnormalities), Passage (maternal pelvis abnormalities), Psyche (stress or anxiety).

33
Q

What is the most common cause of dystocia?

A

Problem with uterine contractions (power).

34
Q

What is tachysystole?

A

More than 5 uterine contractions in 10 minutes, which reduces blood flow and may cause fetal distress.

35
Q

What are the characteristics of hypotonic uterine contractions?

A

Weak, infrequent contractions that lack the intensity and regularity needed for labor progress.

36
Q

What are the characteristics of hypertonic uterine contractions?

A

Frequent, uncoordinated contractions that cause painful and ineffective labor without adequate cervical dilation or fetal descent.

37
Q

What is cephalopelvic disproportion (CPD)?

A

A mismatch between the fetal size and the maternal pelvis, preventing labor progress.

38
Q

What are the types of pelvis and their implications for labor?

A

Gynecoid (favorable), Android (difficult, often leads to arrest), Anthropoid (posterior fetal presentation), Platypelloid (least favorable, flat shape).

39
Q

What fetal presentations can complicate labor?

A

Breech, transverse lie, shoulder presentation, or abnormalities like hydrocephalus and macrosomia.

40
Q

What maternal psychological factors affect labor?

A

Stress, anxiety, fear, and hormonal imbalances (e.g., increased catecholamines or cortisol).

41
Q

What is protraction disorder?

A

Slow labor progress, often due to inadequate contractions or fetal descent. Diagnosed based on Friedman’s curve and progress rates.

42
Q

What is arrest disorder?

A

Labor stops completely, including prolonged deceleration phase, secondary arrest of dilatation, arrest of descent, or failure of descent.

43
Q

What interventions can address inadequate uterine contractions?

A

Oxytocin, nipple stimulation, amniotomy, maternal repositioning, hydration, and uterine stimulation.

44
Q

What are Montevideo Units (MVUs) and their significance?

A

MVUs measure uterine contraction strength. Adequate labor requires at least 200-250 MVUs.

45
Q

How is fetal station measured?

A

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.

46
Q

What is the treatment for protracted labor in the latent phase?

A

Monitor the mother and fetus. If stable, encourage rest or administer oxytocin for augmentation. Perform CS if complications arise (e.g., fetal distress, CPD).

47
Q

How is arrest of descent managed?

A

If beyond station 0 and descent stops, perform CS after reassessing maternal and fetal conditions.

48
Q

How is uterine contraction intensity classified?

A

Mild: 10-50 mmHg; Moderate: 50-75 mmHg; Strong: 75-100 mmHg.

49
Q

What is the significance of a cardiotocogram (CTG)?

A

CTG measures uterine contraction strength and frequency. Normal labor requires 3-5 contractions in 10 minutes and 200+ MVUs.

50
Q

What should be done if there is tachysystole?

A

Discontinue uterotonics, hydrate the patient, and reposition them in left lateral decubitus to improve uteroplacental blood flow.

51
Q

What is the management for a macrosomic baby in labor?

A

Assess for CPD. If fetal distress or prolonged labor occurs, perform CS.

52
Q

What is the expected cervical dilation rate during active labor?

A

For nulliparas: ≥1.2 cm/hr; for multiparas: ≥1.5 cm/hr.

53
Q

How does maternal fatigue affect labor?

A

Fatigue reduces the effectiveness of uterine contractions and pushing efforts, leading to prolonged labor.

54
Q

What is fetopelvic disproportion?

A

Cephalopelvic disproportion, which is a problem in the pelvis.

55
Q

What are the measurements that define a contracted pelvic inlet?

A

Shortest AP diameter < 10 cm or greatest transverse diameter < 12 cm. Diagonal conjugate < 11.5 cm.

56
Q

How is the pelvic inlet measured?

A

From the sacral promontory to the symphysis pubis or by the diagonal conjugate.

57
Q

What complications are associated with a contracted pelvic inlet?

A

Face and shoulder presentations occur 3x more frequently, and cord prolapse occurs 4-6x more often.

58
Q

What should you check after a spontaneous rupture of membranes?

A

Perform an IE to check for prolapse, but remove fingers if cord prolapse is palpated and mobilize the team for an emergency.

59
Q

What is the landmark for diagnosing midpelvic contraction?

A

The ischial spine; prominent spines or converging pelvic sidewalls indicate contraction.

60
Q

What measurement indicates a contracted midpelvis?

A

Sum of interspinous and posterior sagittal diameters < 13.5 cm or interspinous diameter < 8 cm.

61
Q

What can cause transverse arrest of the fetal head?

A

Midpelvic contraction.

62
Q

What are the measurements that define a contracted outlet?

A

Inter-ischial tuberous diameter of 8 cm or less.

63
Q

What perineal tears are associated with contracted outlet?

A

1st degree: Skin and mucosa, 2nd degree: Muscles, 3rd degree: Sphincters, 4th degree: Rectum.

64
Q

What treatments are used for power problems in labor?

A

Oxytocin stimulation and amniotomy (artificial rupture of membranes).

65
Q

How much time does amniotomy accelerate labor?

A

2 hours.

66
Q

What management options exist for malposition during labor?

A

Manual rotation or vacuum.

67
Q

What management options exist for posterior asynclitism or malpresentation?

A

Cesarean delivery (CS).

68
Q

What are key strategies for managing maternal psyche during labor?

A

Emotional support, effective communication, pain management, relaxation exercises, informed consent, and addressing fear of labor.

69
Q

What complications are associated with fetopelvic disproportion for the mother?

A

Increased risk of cesarean delivery, maternal hemorrhage, infection, and uterine rupture.

70
Q

What complications are associated with fetopelvic disproportion for the fetus?

A

Hypoxia, birth trauma (e.g., brachial plexus injury), and increased neonatal morbidity and mortality.

71
Q

How can fetal size and macrosomia be identified early?

A

Prenatal monitoring, fundal height measurement, and fetal weight estimation via ultrasound.

72
Q

What is the recommended management for shoulder dystocia?

A

Elective cesarean delivery if macrosomia is identified prenatally.

73
Q

What factors can help prevent fetopelvic disproportion?

A

Early identification of fetal size, regular prenatal monitoring, and monitoring labor progress.

OBSTETRICS (13 decks)

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