Labor, Delivery and Anesthesia Flashcards
What are the stages of delivery
- onset of contractions until fully dilated
- From full dilation until delivery
- From delivery of the baby until delivery of placenta
What are the stages within the first stage?
latent and active
What is a prolonged latent phase?
> 20 hrs in a nulliparous patient
14 hrs in a multiparous patient
not dilating
What is a protracted active phase?
rate of dilation in active phase <1.2 cm/hr in a nulliparous patient
rate of dilation in active phase is less than 1.5 cm/hr in a multiparous patient
What is an arrest of dilation
active phase of labor
no change in dilation over a period of two hours
what is a protraction-arrest disorder?
protracted active phase
subsequent arrest of dilation
during the second stage of labor what is the mean duration without epidural?
nullipara- 60 min
multipara- 20 min
during the second stage of labor what is the mean duration with epidural?
nullipara 90-120 min
multipara 40-60 min
What is a protracted descent?
2nd stage > 2hr in a nullipara
2nd stage >1hr in a multipara
What is an arrest of descent?
no change in station over a period of 1 hr
What are causes of abnormal labor?
poor uterine contractility over sedation intrauterine infection malpresentation malposition fetopelvic disproportion
How do you manage abnormal labor?
evaluate fetal presentation evaluate fetal position evaluate uterine contractility evaluate maternal pelvis Treat maternal infection if present preform amniotomy administer oxytocin
What is the optimal anesthetic for both labor and delivery?
Epidural
What anesthetic do you give for an emergency cesarian?
general
What anesthetic do you give for an operational vaginal or cesarian delivery?
spinal
Episiotomy
Should only be preformed in selected cases where the perineum fails to distend and delivery is obstructed.
midline episiotomy is preferred
What are the most common indications for cesarean delivery?
dystocia repeat distress bleeding malpresentation
What is the most common intraoperative complication with a cesarean delivery?
hemorrhage- <2% in scheduled
What is the most common postoperative complication with a cesarean delivery?
infection, specifically endometritis: 10% in emergency c/s, 5% in scheduled
What is the preferred incision for a cesarean section?
low transverse, Kerr
Why would a woman have a chance of getting a UTI during child birth?
catheter
What do you do if the mothers membrane is not broken and she is having contractions?
break her water and give patosin
