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Obstetrics and Gynecology > Labor Disorders > Flashcards

Labor Disorders Flashcards

1
Q

Onset of regular painful uterine contractions up to full cervical dilatation (0-10 cm)

A

Firsr stage of labor

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2
Q

Full cervical dilatation up to full expulsion of the baby

A

Second stage of labor

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3
Q

Expulsion of the baby up to the delivery of the placenta

A

Third stage of labor

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4
Q

Phases of the first stage of labor

A

Latent

Active

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5
Q

0-4 cm dilatation

0-8 HOURS

A

Latent phase

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6
Q

4-10 cm dilatation

8-16 HOURS

A

Active phase

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7
Q

Active phase 3 subphases

A

Acceleration
Phase of Maximum Slope
Deceleration Phase

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8
Q

Rapid cervical dilatation

4-6cm, 2-3 hours

A

Acceleration Phase of Active Phase of First Stage of Labor

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9
Q 
Descent of the presenting part (can be head or breach)
Happens at midmaximum slope
Fastest rate of dilatation
6-8cm
30 minutes to 1 hour
A

Phase of Maximum Slope of the Active Phase of the First Stage of Labor

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10
Q 
Maximum descent
Diagnosis of failure of descent
Dilatation slows down
8-10 cm 
2-3 hours
A

Deceleration phase of the Active Phase of the First Stage of Labor

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11
Q

Functional Divisions of Labor

A

Preparatory
Dilatational
Pelvic

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12
Q

The uterus is prepared for dilatation and effacement (0-6cm)

Coincides with latent phase and acceleration phase

A

Preparatory division (Functional)

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13
Q

Where maximum dilatation occurs which corresponds to the phase of maximum slope

A

Dilatational division (Functional division)

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14
Q

Where there is maximum descent at 8cm of dilatation
Presenting part is in the pelvis already
Coincides with the deceleration phase and second stage of labor

A

Pelvic division (Functional)

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15
Q

Difficult labor

Abnormally slow labor progress

A

Dystocia

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16
Q

Dystocia four distinct abnormalities

A

Abnormalities of the expulsive force
Abnormalities of presentation, position or development of fetus
Abnormalities of maternal bony pelvis
Abnormalities of Soft tissue of the reproductive tract that form the obstacle to fetal descent

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17
Q

Complications of dystocia

A

Infection - chorioamnionitis of endometrium and fetal infection

Uterine atony - tired, postpartum hemorrhage

Uterine rupture - contraction against obstruction

Pathologic retraction ring (band) - stretching of uterine segment, prelude to rupture

Fistula - impacted head, ischemia of lower vaginal wall (rectovaginal)

Pelvic floor injury

LE injury - dorsal lithotomy (sciatic and peroneal nerve)

Feral injury

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18
Q

Distance between two parietal diameter (9.5 cm)

A

Biparieral diameter

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19
Q

Bregma to subocciput measuring 9.5 cm

Shortest diameter

A

Suboccipitobregmatic

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20
Q

Frontal bone to occipital bone

12 cm

A

Frontooccipital/occipitofrontal

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21
Q

Mentum to occiput
13.5 cm

We don’t want this

A

Mentooccipital/occipitomental

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22
Q

When the most dependent portion of the presenting part is at the level of ischial spine

Passage of the biparieral diameter through pelvic inlet

Station:

5th station above the spine

A

Engagement

Station 0

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23
Q

Contractions would keep pushing the baby down but the baby encounters the pelvic floor (resistance) leading to flexion of the head

A

Descent

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24
Q

The baby has to flex its head to adapt to the pelvis from the Frontooccipital (12) diameter to the Suboccipitobregmatic (9.5) now that presents

A

Flexion

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25
Q

The head must do this movement so that the presenting diameter becomes the Biparieral diameter (9.5) from SOB (9.5)

Traverses the bispinous diameter (9-9.5)

Uses symphysis pubis as fulcrum for extension so that it can come out of the introitus

You still cannot see the baby at this point

A

Internal rotation

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26
Q

Point at which the baby is seen
Head on introitus

Sharply flexed head reaches vulva and goes extension

Failure to extend would lead to head impingement on posterior portion of perineum

A

Extension

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27
Q

Body of the baby does not move. Only the head.
Happens very fast.
Rotation of the fetal body and serves to bring its BISACROMIAL DIAMETER (outermost shoulder) into relation with the anteroposterior diameter of pelvic outlet.

A

External rotation

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28
Q

Head is the biggest part of the baby so when it has already passed, everything else can easily pass through.

Know the cephalometric measurements so you can justify to the mother that she should undergo Caesarian section

A

Expulsion/delivery

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29
Q

Occiput presentation
Normal, most common

Fully flexed head

A

SOB 9.5

BPD 9.5

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30
Q

Sinciput presentation/Military presentation

Head is not flexed

Inadequate or contracted pelvis
Big fetal head despite adequate pelvis

When IE is done, this is seen

Poor prognosis

Tx

A

Frontooccipital diameter 12.5

Diamond shaped fontanel instead of triangle

CS

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31
Q

Brow presentation

Poorest prognosis

Midway between full flexion and extension

Neck slightly extended

On IE?

Tx

A

Mentooccipital 13.5 NO

Brow prominence

CS

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32
Q

Face

Fetal head too extended

IE?

A

Chin protrusion
9.5 cm
SOB

Mouth

33
Q

Cephalometric measurements that may pass through. 9.5 cm

A

Occiput

Face

34
Q

Face presentation where mentum is above the symphysis pubis

Tx

A

NSD

Symphysis as fulcrum

35
Q

Face presentation where mentum is posterior

Tx

A

Mentum posterior

Coccyx obstructs the flexion snd passage of head, CS

36
Q

Hand is lying in front of vertex
Not risk factor for dystocia or CS

Hand and arm may retract from the birth canal and the head may descend normally

Sweep up the hands and labor can proceed

A

Compound presentation

37
Q

Right acromiodorsoposterior (RAPD)

Shoulder of fetus is to the mother’s right, and the back is posterior.

This baby cannot be delivered vaginally.

Tx

A

Transverse lie

CS

38
Q

The primary purpose of uterine contraction is to

A

Efface the cervix (thinning and eventually obliterating) at the SECOND STAGE

39
Q

Baseline uterine pressure - peak contracture pressure for each contraction in a 10-minute window

Add pressures generated by each contraction

A

Montevideo units

40
Q

> /= 200 Montevideo units for 10 minutes equals

Less than 200 Montevideo units

A

Adequate contraction

Abnormal (hypotonic or inadequate uterine contraction)

41
Q

Abnormalities in power

A

Hypotonic uterine dysfunction

Hypertonic incoordinate uterine dysfunction

42
Q

Contractions are not enough
Weak, short, infrequent, inadequate and will not lead to cervical dilatation
<200 Montevideo units

A

Hypotonic uterine dysfunction

43
Q

Hypotonic uterine dysfunction causes

A 
Excessive anesthesia
Overworked uterus (prolonged labor)
Anemia
Abnormal uterine contour
Malpositioning/malpresentation 
Pelvic contraction 
Infection
Full bladder or rectum
44
Q

Hypotonic Uterine Dysfunction Tx

A

Amniotomy

Uteritonic (oxytocin infusion) if without CPD

45
Q

Releases prostaglandin which aid in uterine contraction

A

Amniotomy

46
Q

Very strong, yet uncoordinated uterine contractions
Strong >200 Montevideo units
Prolonged, frequent but asynchronous, irregular
Too much contraction compromises blood flow to baby due to compression of blood vessels -> fetal distress

Excessive oxytocin, abruptio placenta

A

Hypertonic Incoordinate Uterine dysfunction

47
Q

Hypertonic Incoordinate Uterine Dysfunction Tx

A

Stop oxytocin, tocolytics or sedation

CS if with distress

48
Q

May cause insignificant but prolonged first and second stages

Pain of labor does not go away, it is just less pain

A

Epidural anesthesia

49
Q

Epidural anesthesia is given only at this phase so there will be no chance for delay in contraction

A

Active phase

50
Q

Abnormalities in power causes

A

Epidural anesthesia
Maternal position - ambulation
Birthing position - upright (delivery shorter by 4 minutes); dorsal lithotomy (prolonged labor, affect contraction and power)

51
Q

Inlet clinical pelvimetry

A

Diagonal conjugate

Obstetric conjugate

52
Q

From inferior border of symphysis pubis to the sacral promontory

Only clinically measurable diameter of the inlet

A

Diagonal conjugate

53
Q

Sacra promontory to the back of the symphysis pubis

Where baby’s head will pass through
Cannot be directly measured by IE

Diagonal conjugate - 1.5

A

Obstetric conjugate

54
Q

An inlet is contracted if the

DC
OC

A

DC <12
OC <10

Baby may not be able to pass through engagement

55
Q

Only cardinal movement that involves the inlet

A

Engagement

56
Q

Diagonal conjugate must be

A

11.5 to 12 cm

so Obstetric conjugate will be 10-15 cm

so BPD 9.5 can pass

57
Q

Midpelvis pelvimetry

A

Bispinous diameter - clinically measurable

Posterior sagittal diameter

58
Q

A midpelvis is said to be contracted if it measures

A

<10 cm

bec SOB, BPD is 9.5

59
Q

Cannot be measured clinically
Determines ROOMINESS of pelvis

Midpoint of bispinous diameter and distance from that point to the sacrum

Where all cardinal movements as far as internal rotation except engagement take place

A

Posterior sagittal diameter

60
Q

Posterior sagittal diameter is determined by assessing the

A

Width of the sacrosciatic notch

Indirect measure of the posterior sagittal diameter

Place 2 fingers in the space, must be at least 4.5 cm

Concavity of the midplane - flexion, internal rotation occurs

61
Q

This movement is needed so head can pass through bispinous diameter

A

Internal rotation

62
Q

Distance between the two tuberosities

Place fist in between the space

Must be at least 9-10 cm
<8, contracted

A

Bituberous diameter

63
Q

Does not go beyond 4 cm >20 h in Nulliparas
Does not go behond 4cm >14 h in Multiparas

Tx?

A

Prolonged latent phase

Dystocia but CS not yet indicated

Bed rest/oxytocin

64
Q

Exceptional treatment for prolonged latent phase

> 20 h Nulliparas
14 h Multiparas

A

Oxytocin

Caesarian delivery for urgent problems

65
Q

Rate of cervical dilatation <1.2 cm/h in Nullipara

Rate of cervical dilatation <1.5 cm/h in Multipara

A

Protracted active phase dilatation

66
Q

Rate of descent <1 cm/h in Nulliparas

Rate of descent <2 cm/h in Multiparas

A

Protracted descent

Diagnose only if 8cm dilated!!

67
Q

Protracted active-phase dilatation
Protracted descent

Tx

A

Expectant and support

CS for CPD

68
Q

> 3 h to reach 10 cm in Nullipara

>1 h to reach 10 cm in Multipara

A

Prolonged deceleration phase

69
Q

> 2 h in Nullipara
2 h in Multipara

No change in cervical dilatation for 2h

A

Secondary arrest of dilatation

70
Q

> 1 h in Nullipara
1 h in Multipara

At 8cm head descends but STOPS
Stops at a station for more than an hour

Must have descended first!

8cm station 0 -> after an hour 9cm station +1 -> after an hour 10 cm, station +1

A

Arrest of descent

71
Q

No descent in deceleration phase or second stage

At 8 cm station 0 -> after an hour 10 cm station 0

As long as there is no descent from 8cm onwards

A

Failure of descent

72
Q

Prolonged deceleration phase
Secondary arrest of dilatation
Arrest of descent
Failure of descent

Tx

A

Evaluate for CPD
CPD: Caesarian
No CPD: oxytocin

Rest if exhausted
CS

73
Q

Dilatation disorders are diagnosed after

A

4 cm of dilatation (Active phase) of First Stage of Labor

74
Q

Disorders of descent are diagnosed only after

A

8 cm of dilatation (Deceleration phase) of Active phase of the First stage of labor

75
Q

Consider protracted descent
prolonged deceleration phase
arrest of descent and failure of descent

once cervix is

A

> 8 cm

76
Q

Record of all the clinical observations made on a woman in labor, the central feature of which is the graphic recording of the dilatation of the cervix as assessed by vaginal examination, and descent of the head

A

Partograph

77
Q

Extremely rapid labor and delivery
Delivery of fetus in <3 hours
Dilatation of the cervix of 5 cm/h

A

Precipitous labor

78
Q

Complications of precipitous labor

A

Uterine atony
Genital tract lacerations
Placental abruption
Amniotic fluid embolism - vigorous contraction
Intracranial trauma, palsy, birth injuries

Obstetrics and Gynecology (18 decks)

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