DYSTOCIA Flashcards
1
Q
- long, difficult, or abnormal labor
- caused by various conditions associated with the five factors affecting labor
- described as abnormal uterine contractions that prevent the normal progress of cervical dilatation, effacement and fetal descent
A
dystocia / dysfunctional labor
2
Q
- Resulted in a prolonged labor
- Typically irregular in strength, timing, or both
- often arrest cervical dilatation
A
dystocia (uncoordinated uterine contraction)
3
Q
common causes of dysfunctional labor
- Inappropriate use of a___
- Pelvic bone c___ that has narrowed the p___ d___ so that the fetus cannot pass
- Poor f___ p___ (posterior rather than anterior)
Failure of the u___ muscle to c___ properly - E___ rather than flexion of the fetal head
- O___ of the uterus
- Cervical r___
- Presence of a full r___ or u___ b___ that impedes fetal descent
- Mother becoming e___ from labor
- P___ status
A
analgesics
contraction; pelvic diameter
fetal position
uterine; contract
extension
overdistension
rigidity
rectum or bladder
exhausted
primigravida
4
Q
- Ineffective uterine contractions of poor quality
- occur in the latent phase of labor
A
hypertonic contraction
5
Q
- Contractions usually become more frequent, but their intensity may decrease
- Contractions are painful but ineffective in dilating & effacing cervix
- Prolonged latent phase
A
hypertonic contractions
6
Q
true or false - hypertonic is more common than hypotonic
A
false - less common
7
Q
hypertonic - how many contractions in a 10 minute period
A
5
8
Q
hypertonic - where is the force of the contractions coming from?
A
midsection of the uterus
9
Q
hypertonic - maternal risks:
- Increased d___ due to uterine muscle cell a___
- F___ as the pattern continues & no labor progress results
- S___ on coping abilities
- D___ & increased incidence of i___ if labor is prolonged
A
discomfort; anoxia
fatigue
stress
dehydration; infection
10
Q
hypertonic - fetal neonatal risks
- f___ d___
- Prolonged pressure on the fetal head c___, c___ s___, or excessive molding
A
fetal distress
cephahematoma
caput succedaneum
11
Q
management for hypertonic
A
- bedrest
- analgesics (meperidine, nalbuphine) or sedatives (zolpidem)
- tocolytic drugs - terbutaline
12
Q
- Fewer than 2-3 contractions in a 10 min period
- Develops in the active phase
- Contractions are coordinated but too weak, infrequent & brief
A
hypotonic contractions
13
Q
- The uterus is easily indented, even at the peak of contractions.
- It may occur when the uterus is overstretched from a twin gestation, or in the presence of a large fetus, hydramnios, or grand multiparity. Bladder or bowel distension and CPD may also be associated with this pattern.
A
hypotonic
14
Q
hypotonic - maternal risk:
- Maternal e___
- S___ on coping abilities
- Postpartal h___ from insufficient uterine contractions following birth
- Intrauterine i___ if labor is prolonged
A
exhaustion
stress
hemorrhage
infection
15
Q
hypotonic - fetal neonatal risks:
A
fetal distress
fetal sepsis
16
Q
medical management - hypotonic
A
- ultrasound / xray to rule out CPD
- asses FHR, labor pattern, AF membrane
- oxytocin
- IV fluids for hydration
- amniotomy
- AMOL - active management of labor
17
Q
if AF membrane is ruptured = ??
A
check for meconium
18
Q
presence of meconium = ??
A
fetal stress
19
Q
hypotonic - encourage the woman to void every ___ hours
A
2
20
Q
true or false - Vaginal examinations should be kept to a minimum to decrease the risk of introducing an infection
A
true
21
Q
- Major dysfunction that occurs in the 1st stage of labor
- According to Friedman, it is a latent phase that is longer than 20hrs in a nullipara & 14hrs in multipara.
- Uterus tends to be hypertonic
A
prolonged latent phase
22
Q
- may occur if the cervix is not ripe at the beginning of labor & time must be spent getting truly ready for labor
- may occur if there is excessive use of an analgesic early labor
A
prolonged latent phase
23
Q
- Uterus tends to be hypertonic
- Relaxation between contractions is inadequate
- Contractions are mild and ineffective
A
prolonged latent phase
24
Q
Administration of ___ may relax hypertonicity, this usually allows labor to become effective & begin to progress
A
morphine
25
- Usually associated with CPD or fetal malposition
- If cervical dilatation does not occur at a rate of at least 1.2cm/hr in nulliparas or 1.5cm/hr in a multipara, or if the active phase last longer than 12hrs in a primigravida or 6hrs in multigravida
- uterus tends to be hypotonic
protracted active phase
26
- A d___ phase has become p___ when it extends beyond 3hrs in a nullipara or 1 hr in a multipara
- most often results from abnormal fetal head position
- A CS birth is frequently required
deceleration; prolonged
(prolonged deceleration phase)
27
No progress in cervical dilatation for more than 2 hrs.
secondary arrest of dilatation
28
occurs if the rate of descent is less than 1.0cm/hr in a nullipara or 2.0cm/hr in a multipara
prolonged descent
29
management for prolonged descent
- amniotomy
- oxytocin
- semifowlers, squatting, kneeling
30
- no descent for 1 hr in a multipara or 2 hrs in a nullipara
- most likely cause - CPD
- CS birth necessary
arrest of descent
31
2 types of retraction ring
physiologic
pathologic
32
- can occur at any point in the myometrium and at any time during labor (1st, 2nd, and 3rd stage)
- a line of demarcation between the upper and lower uterine segment present during normal labor and cannot usually be felt abdominally
physiologic retraction ring
33
a ridge around the inside of the uterus that forms during normal labor at the junction of the thinned lower uterine segment and thickened upper segment. It forms as a result of progressive lengthening of the muscle fibers of the lower segment and concomitant shortening of the muscle fibers of the upper segment
physiologic retraction ring
34
- most common form of constriction ring responsible for dysfunctional labor
- occurs at the junction of the upper & lower uterine segments
- occurs during the second stage of labor as a horizontal indentation across the abdomen
pathologic retraction ring / bandl's ring
35
usual cause of bandl's ring
obstetric manipulation or administration of oxytocin
36
- When this occurs in early labor it is usually caused by uncoordinated contractions
- A warning sign of impending uterine rupture.
pathologic retraction / bandl's ring
37
It is the rising up retraction ring during obstructed labor due to marked retraction and thickening of the upper uterine segment while the relatively passive lower segment is markedly stretched and thinned to accommodate the fetus.
pathologic retraction / bandl's ring
38
management of retraction rings
morphine sulfate
or inhalation of amyl nitrate
tocolytics
CS delivery
