Normal Labor, Abnormal Labor, L+D Path Flashcards
Stage 1 labor
Includes latent and active labor
Latent is from onset of contractions to 4cm dilation. Lasts 28h for primip, 14h for multip.
Active is from 4cm to 10 cm dilated.
How long does latent labor last for primip or multip
28 h for primi, 14h for multi
How fast is dilation for primip and multip during active stage 1?
1.2cm/h for primi 1.5cm/h for multi
Stage 2 labor
From 10cm to delivery
Stage 3
From delivery to placental delivery
Stage 4 labor
All things after placental delivery
Four states of cervical change
Dilation, effacement, softening, position
What causes cervical change?
Breakage of disulfide bonds in collagen stimulated by PGE2 when fetal head or balloon engages cervix.
Four cardinal fetal movements
First flexion, then internal rotation, then extension and external rotation.
Components of the bishop score?
Dilation, effacement, station, consistency, position.
Higher score leads to vaginal delivery. Lower score is for c-section
Prolonged latent labor time course?
Longer than 20 hours for primi and longer than 14 hour for multi
What usually causes prolonged latent phase?
Opioids, but if not that then passenger, power, pelvis
How to diagnose prolonged latent phase?
Place IUPC, normal contractions occur 3 in 30 minutes and >40mmhg.
How to treat prolonged latent phase?
If due to opioids rest and wait. If not, place a balloon and dilate, C/s if fails. Augment labor with pitocin.
Arrested/prolonged active labor
Stage when cervix goes from 4 cm to 10 cm.
Arrested active is when cervix dilates less than 1.2 cm/h for primip and less than 1.5 cm/h for multip.
How to treat arrested or prolonged active labor?
Augment with pitocin, otherwise c/s
Prolonged stage II
Phase where 10cm dilated to delivery.
Considered prolonged when greater than 3 hours if epidural or greater than 2 hours with no epidural.
What causes prolonged stage II
Usually passenger or pelvis issue
How to treat prolonged stage II
Augment with pitocin, if baby is at advanced station (1 or 2) then use vacuum or forceps. If baby is not, then C/s
Prolonged stage III caused by?
Usually power issue, tired uterus, placenta isn’t delivered.
How to treat prolonged stage III?
Uterine massage, pitocin, manual manipulation.
Risk of prolonged stage III?
Usually high risk of post partum hemorrhage.
Rupture of membranes pathogenesis
Sac ruptures, rush of fluid, can happen spontaneously within 1 hour of delivery of can happen artificially/pathologically.
How to diagnose rupture of membranes?
Speculum exam shows pooling of fluid at the back of vagina, nitrazine test turns blue, ferning on microscopy
pROM pathogenesis
Premature rupture of membranes caused by ascending infection at term, no contractions present
How to treat pROM?
Antibiotics. Amp/gent and deliver baby (augment)
ppROM pathogenesis
Preterm premature ROM, ascending infection baby isn’t at term and there are no contractions
How to treat ppROM?
If baby is >36 weeks, deliver (though this is technically pROM).
If
What to never do during pROM or ppROM?
Never do digital exam, will spread infection into uterus
Prolonged ROM
If >18h from ROM to delivery. Increased risk of GBS
How to treat prolonged ROM?
PPX with amox (i think he meant amp)
Chorioamionitis
Ascending infection with baby in
Endometritis
Ascending infection with baby out
How does patient with chorio/endometritis present?
With pROM and fever
How to diagnose chorio/endometritis?
Rule out other infeciton (UTI/PNA/etc) so get urine, CXR
How to treat chorioamnionitis/endometritis
Broad spectrum antibiotics = Zozyn
Pathogenesis of preterm labor? Risk factors?
Unknown. Risk factors include smoking, young, multiparous, ppROM, uterine anatomy issues
How does patient in preterm labor present?
With contractions but gestational age less than term (20-36)
How to treat preterm labor
Delay delivery (give mag, beta agonists (like terbutaline) CCB(nifedapine), prostaglandins), develop baby steroids until L:S>2.
When to manage emergently?
When patient is preeclamptic, there is fetal demise, pROM, and placental abruption.
What time is considered post-dates?
GA greater than 40, greater than 42 weeks from LMP.
Problems with post dates baby?
Macrosomia causing shoulder dystocia, dysmature baby
How to treat post-dates?
Deliver, give pitocin if sure post dates. If not sure, get an NST, AFI, and u/s for bpp.
