DYSTOCIA Flashcards
- 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
dystocia / dysfunctional labor
- Resulted in a prolonged labor
- Typically irregular in strength, timing, or both
- often arrest cervical dilatation
dystocia (uncoordinated uterine contraction)
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
analgesics
contraction; pelvic diameter
fetal position
uterine; contract
extension
overdistension
rigidity
rectum or bladder
exhausted
primigravida
- Ineffective uterine contractions of poor quality
- occur in the latent phase of labor
hypertonic contraction
- Contractions usually become more frequent, but their intensity may decrease
- Contractions are painful but ineffective in dilating & effacing cervix
- Prolonged latent phase
hypertonic contractions
true or false - hypertonic is more common than hypotonic
false - less common
hypertonic - how many contractions in a 10 minute period
5
hypertonic - where is the force of the contractions coming from?
midsection of the uterus
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
discomfort; anoxia
fatigue
stress
dehydration; infection
hypertonic - fetal neonatal risks
- f___ d___
- Prolonged pressure on the fetal head c___, c___ s___, or excessive molding
fetal distress
cephahematoma
caput succedaneum
management for hypertonic
- bedrest
- analgesics (meperidine, nalbuphine) or sedatives (zolpidem)
- tocolytic drugs - terbutaline
- Fewer than 2-3 contractions in a 10 min period
- Develops in the active phase
- Contractions are coordinated but too weak, infrequent & brief
hypotonic contractions
- 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.
hypotonic
hypotonic - maternal risk:
- Maternal e___
- S___ on coping abilities
- Postpartal h___ from insufficient uterine contractions following birth
- Intrauterine i___ if labor is prolonged
exhaustion
stress
hemorrhage
infection
hypotonic - fetal neonatal risks:
fetal distress
fetal sepsis
medical management - hypotonic
- ultrasound / xray to rule out CPD
- asses FHR, labor pattern, AF membrane
- oxytocin
- IV fluids for hydration
- amniotomy
- AMOL - active management of labor
if AF membrane is ruptured = ??
check for meconium
presence of meconium = ??
fetal stress
hypotonic - encourage the woman to void every ___ hours
2
true or false - Vaginal examinations should be kept to a minimum to decrease the risk of introducing an infection
true
- 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
prolonged latent phase
- 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
prolonged latent phase
- Uterus tends to be hypertonic
- Relaxation between contractions is inadequate
- Contractions are mild and ineffective
prolonged latent phase
Administration of ___ may relax hypertonicity, this usually allows labor to become effective & begin to progress
morphine
- 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
- 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)
No progress in cervical dilatation for more than 2 hrs.
secondary arrest of dilatation
occurs if the rate of descent is less than 1.0cm/hr in a nullipara or 2.0cm/hr in a multipara
prolonged descent
management for prolonged descent
- amniotomy
- oxytocin
- semifowlers, squatting, kneeling
- no descent for 1 hr in a multipara or 2 hrs in a nullipara
- most likely cause - CPD
- CS birth necessary
arrest of descent
2 types of retraction ring
physiologic
pathologic
- 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
aridgearoundtheinsideoftheuterusthatformsduringnormallaborat thejunctionofthethinned loweruterinesegmentand thickeneduppersegment.Itformsasaresultofprogressivelengthening ofthemusclefibers ofthelowersegmentandconcomitantshorteningof themusclefibersoftheuppersegment
physiologic retraction ring
- 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
usual cause of bandl’s ring
obstetric manipulation or administration of oxytocin
- 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
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
management of retraction rings
morphine sulfate
or inhalation of amyl nitrate
tocolytics
CS delivery
