II. Problems with the Passageway Flashcards
- result when there is a contracture (narrowing) in any of the passageway, if the fetus is larger than the pelvic diameter
- birth passage includes the maternal bony pelvis, beginning at the pelvic inlet and ending at the pelvic outlet, and the maternal
soft tissues within these anatomic areas
Cephalopelvic Disproportion (CPD)
With CPD, the fetus’s head doesn’t
(ANSWER)
Engage
occurs when the narrowing of the antero-posterior diameter is less than 11 cm or the maximum transverse diameter is 12 cm or
less
Inlet contraction
is a narrowing of the transverse diameter at the outlet to less than 11 cm
Outlet contraction
- occurs at the 2nd stage of labor, when
the fetal head is born, but the shoulder
are too broad to enter and be born
through the pelvic outlet - hazardous to the mother - can result
to vaginal or cervical tears - hazardous to the fetus if the cord is
compressed between the fetal body
and bony pelvis
Shoulder dystocia
Dystocia causes
3ps (FETUS)
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*
*
3ps (Mother)
*
*
*
Dystocia causes
3ps (FETUS)
Power
Passageway
Passenger
3ps (Mother)
Pysche
Placenta
Position
(answer) pressure may be applied to
help the shoulder escape from beneath
the symphysis pubis and be delivered.
suprapubic
Hypertonic uterine contraction
* marked by an increase in
resting tone to more than 15 mmHg
Dystocia (difficult labor)
What is the pain relief management drug for dystocia?
Morphine Sulfate
- number of contraction is usually low or
infrequent - most apt to occur:
1. during the active phase of labor
2. after administration of analgesia
3. in a uterus that is overstretched
Hypotonic uterine contraction
Pathologic retraction ring
Bandl’s ring
Types of Contraction rings
Constriction ring
Pathologic retraction ring (Bandl’s ring)
- occurs at the junction of the upper
and lower uterine segments - usually appears during the 2nd stage
of labor as a horizontal indentation
across the abdomen and is a warning
sign that severe dysfunctional labor is
occurring
Pathologic retraction ring (Bandl’s ring)
What type of contraction ring that can occur at any point in the myometrium and at any time during labor
Constriction Ring
- Usually occurs between 20 & 37 weeks gestation
- Fetal prognosis depends on birth weight and length of
gestation
Preterm Labor
neonates who weigh less than 737 g and are less than 26 weeks gestation have a survival rate of about (ANSWER)
those who weigh 737 – 992 and are between 27 – 28 weeks gestation have a survival rate of more than (ANSWER)
those who weigh 992 – 1,219 g and are more than 28 weeks gestation have a (ANSWER)
- 10%
- 50%
- 70-90%
What are the tocolytic agent responsible for delaying preterm labor?
Terbutaline (Brethine) - Beta adrenergic
Indomethacin (Indocin)
Tocolytics are contraindicated if:
1.
2.
3.
- Gestation is less than 20 weeks
- Cervical dilation is more than 4 cm
- Cervical effacement is more than 50%
What is the antidote for Terbutaline (Brethine)?
propanolol (Inderal)
- Prostaglandin synthesis inhibitor
- Typically not used after 32 weeks
AOG to avoid premature closure of
the ductus arteriosus
Mechanism: NSAID that decreases
production of prostaglandins
Indomethacin (Indocin)
- occur when uterine contractions are so strong that the woman gives birth with only a few, rapidly occurring contractions
- labor that is completed in
fewer than 3 hours - may occur:
1. grand multiparity
2. after induction of labor by
oxytocin or amniotomy
Precipitate Labor and Birth
- occurs when a uterus
undergoes more strain than it is
capable of sustaining - contributing factors:
1. prolonged labor
2. abnormal presentation
3. multiple gestation
4. unwise use of oxytocin
5. obstructed labor
6. traumatic maneuvers of
forceps or traction
d. Uterine Rupture
Change in abdominal contour during Uterine Rupture:
Distinct swelling:
1. retracted uterus
2. extrauterine fetus
a. Localized tenderness and persistent
ache over lower uterine segment
b. Gradual onset of fetal heart sounds,
absent contractions, and vital signs changes
Indications of incomplete rupture
