Ob/Gyn- Dysfunctional Labor- Dr. Moulton Flashcards
what are the physiologic changes of the Upper uterus and Lower uterus during labor?
upper- actively contracts & retracts to expel the fetus
lower- becomes thinner& passive
what is the change of the cervix in labor?
changes from firm, intact sphincter to soft, pliable, dilatable structure.
what is the definition of labor?
labor is defined as the presence of uterine contractions of sufficient intensity, frequency & duration to bring about demonstrable effacement & dilation of the cervix
what occurs during the first stage of labor?
onset of contractions to full dilation of cervix
what is the Second stage of labor?
full dilation of cervix to delivery of the infant
what is the third stage of labor?
delivery of the infant to delivery of the placenta
what are the two different phases of the first stage of labor? what differentiates the two?
Latent phase and active phase. active phase starts when cervix is dilated to 4 cm
In a multiparous pt, what is the avg maximal dilation rate and what is the minimum rate (5th precentile) ?
- 7 cm/ hr
1. 5 cm/hr
in a multiparous pt what is the avg descent rate of the baby? and the minimum rate (5th%)?
- 6cm/hr
2. 0cm /hr
in a Nulliparous pt. what is the median maximal dilation rate? the minimum dilation rate?
3.0cm/hr
1/2 cm/hr
in a nulliparous pt, what is the median descent rate? and the minimum rate?
- 3 cm/hr
1. 0 cm/hr
what do you call an abonormality of labor where the rate is slower than normal?
Protraction
What is arrest?
disorder of labor characterized by complete cessation of progress (no further dilation or descent)
what are the normal limits of the latent phase? in nulliparous and mutilparous women?
up to 20 hrs in nulliparous
up to 14 hrs in multiparous
what is the main management of abnormalites in the Latent phase?
therapeutic rest (sleep)
what if 2 or more hours elapse with no cervical dilation?
an arrest of dilation has occured
what are the normal limits of active phase cervical dilation rates?
null= 1.2 cm/hr
multi=1.5 cm/hr
what is defined as “difficult labor” it can be used interchangeably w/ dysfunctional labor characterizing that labor is not progressing normall?
Dystocia
Dystocia is been categorized as abnormalities of what?
the Three P’s
Power
Passage
Passenger
what is augmentation?
stimulation of uterine contraction when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus
what is required when placing an IUPC to measure the POWER of the uterus?
requires membranes to be ruptured
what is the minimal effective uterince activity? whats the units used to measure it (the power)
3 contractions in a 10 min period averaging 25 mmHg above baseline. Montevideo Units (MVU)= calculated by measuring the peaks of contractions in a 10 min period
what is the only FDA approved medicine for labor stimulation?
Pitocin
What is the problem with Passage of the three p’s?
Cephalopelvic disproportion (CPD)
this baby presentation is the only one considering normal. all others are considered abnormal.
vertex occiput anterior
what is persistent Occipitotransverse position?
when the head fails to rotate and flex into the OA position. stuck in the Occipitotransverse position
if pelvis is inadequate or infant deemed to be macrosomic proceed with what?
C-section
what instrument can be used to rotate the head into the OA position?
Keilland forceps
what is a persistent Occipitoposterior position most associated with upon delivery?
second stage may be prolonged. Assoc. w/ considerably more back discomfort.
Macrosomia?
fetus weighing 4500 g
Large for gestational age?
birth weight equal to or greater than the 90% for a given gestational age
after assessing the three 3 P’s during the active phase, you can proceed with this procedure if still indicated
Cesarean section
what are Risks to the fetus assoc. w/ Macrosomia?
shoulder dystocia
clavicle fracture
damage to nerves (Erb-Duschenne paralysis)
what are the ACOG recommendations for prophylactic cesarean delivery for an estimated fetal weight of?
> 5000 g in non diabetic patients
>4500 g in Diabetic patients
what is the Turtle Sign ?
retraction of the delivered fetal head against the maternal perineum. seen in Shoulder Dystocia
what are some red flags during labor that indicate risk factors Shoulder Dystocia?
labor induction needed
epidural analgesia
prolonged labor
what is the most common position used to help deliver a baby with Shoulder Dystocia?
McRobert’s Maneuver- hyperflexion & abduction of the maternal hips
what kind of pressure should be used on the uterus in helping deliver a shoulder dystocia?
suprapubic pressure
what is a last resort maneuver for helping deliver a shoulder dystocia?
Zavanelli maneuver
What are the Rubin maneuver and Wood’s corkscrew maneuver used for?
rotational maneuvers for shoulder dystocia
can shoulder dystocia be predicted or prevented and occurs mainly w/ macrosomia?
NO!!!
