Ob/Gyn- Dysfunctional Labor- Dr. Moulton

Question 1

what are the physiologic changes of the Upper uterus and Lower uterus during labor?

Answer 1

upper- actively contracts & retracts to expel the fetus

lower- becomes thinner& passive

Question 2

what is the change of the cervix in labor?

Answer 2

changes from firm, intact sphincter to soft, pliable, dilatable structure.

Question 3

what is the definition of labor?

Answer 3

labor is defined as the presence of uterine contractions of sufficient intensity, frequency & duration to bring about demonstrable effacement & dilation of the cervix

Question 4

what occurs during the first stage of labor?

Answer 4

onset of contractions to full dilation of cervix

Question 5

what is the Second stage of labor?

Answer 5

full dilation of cervix to delivery of the infant

Question 6

what is the third stage of labor?

Answer 6

delivery of the infant to delivery of the placenta

Question 7

what are the two different phases of the first stage of labor? what differentiates the two?

Answer 7

Latent phase and active phase. active phase starts when cervix is dilated to 4 cm

Question 8

In a multiparous pt, what is the avg maximal dilation rate and what is the minimum rate (5th precentile) ?

Answer 8

5. 7 cm/ hr

1. 5 cm/hr

Question 9

in a multiparous pt what is the avg descent rate of the baby? and the minimum rate (5th%)?

Answer 9

6. 6cm/hr

2. 0cm /hr

Question 10

in a Nulliparous pt. what is the median maximal dilation rate? the minimum dilation rate?

Answer 10

3.0cm/hr

1/2 cm/hr

Question 11

in a nulliparous pt, what is the median descent rate? and the minimum rate?

Answer 11

3. 3 cm/hr

1. 0 cm/hr

Question 12

what do you call an abonormality of labor where the rate is slower than normal?

Answer 12

Protraction

Question 13

What is arrest?

Answer 13

disorder of labor characterized by complete cessation of progress (no further dilation or descent)

Question 14

what are the normal limits of the latent phase? in nulliparous and mutilparous women?

Answer 14

up to 20 hrs in nulliparous

up to 14 hrs in multiparous

Question 15

what is the main management of abnormalites in the Latent phase?

Answer 15

therapeutic rest (sleep)

Question 16

what if 2 or more hours elapse with no cervical dilation?

Answer 16

an arrest of dilation has occured

Question 17

what are the normal limits of active phase cervical dilation rates?

Answer 17

null= 1.2 cm/hr

multi=1.5 cm/hr

Question 18

what is defined as “difficult labor” it can be used interchangeably w/ dysfunctional labor characterizing that labor is not progressing normall?

Answer 18

Dystocia

Question 19

Dystocia is been categorized as abnormalities of what?

Answer 19

the Three P’s
Power
Passage
Passenger

Question 20

what is augmentation?

Answer 20

stimulation of uterine contraction when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus

Question 21

what is required when placing an IUPC to measure the POWER of the uterus?

Answer 21

requires membranes to be ruptured

Question 22

what is the minimal effective uterince activity? whats the units used to measure it (the power)

Answer 22

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

Question 23

what is the only FDA approved medicine for labor stimulation?

Answer 23

Pitocin

Question 24

What is the problem with Passage of the three p’s?

Answer 24

Cephalopelvic disproportion (CPD)

Question 25

this baby presentation is the only one considering normal. all others are considered abnormal.

Answer 25

vertex occiput anterior

Question 26

what is persistent Occipitotransverse position?

Answer 26

when the head fails to rotate and flex into the OA position. stuck in the Occipitotransverse position

Question 27

if pelvis is inadequate or infant deemed to be macrosomic proceed with what?

Answer 27

C-section

Question 28

what instrument can be used to rotate the head into the OA position?

Answer 28

Keilland forceps

Question 29

what is a persistent Occipitoposterior position most associated with upon delivery?

Answer 29

second stage may be prolonged. Assoc. w/ considerably more back discomfort.

Question 30

Macrosomia?

Answer 30

fetus weighing 4500 g

Question 31

Large for gestational age?

Answer 31

birth weight equal to or greater than the 90% for a given gestational age

Question 32

after assessing the three 3 P’s during the active phase, you can proceed with this procedure if still indicated

Answer 32

Cesarean section

Question 33

what are Risks to the fetus assoc. w/ Macrosomia?

Answer 33

shoulder dystocia
clavicle fracture
damage to nerves (Erb-Duschenne paralysis)

Question 34

what are the ACOG recommendations for prophylactic cesarean delivery for an estimated fetal weight of?

Answer 34

> 5000 g in non diabetic patients

>4500 g in Diabetic patients

Question 35

what is the Turtle Sign ?

Answer 35

retraction of the delivered fetal head against the maternal perineum. seen in Shoulder Dystocia

Question 36

what are some red flags during labor that indicate risk factors Shoulder Dystocia?

Answer 36

labor induction needed
epidural analgesia
prolonged labor

Question 37

what is the most common position used to help deliver a baby with Shoulder Dystocia?

Answer 37

McRobert’s Maneuver- hyperflexion & abduction of the maternal hips

Question 38

what kind of pressure should be used on the uterus in helping deliver a shoulder dystocia?

Answer 38

suprapubic pressure

Question 39

what is a last resort maneuver for helping deliver a shoulder dystocia?

Answer 39

Zavanelli maneuver

Question 40

What are the Rubin maneuver and Wood’s corkscrew maneuver used for?

Answer 40

rotational maneuvers for shoulder dystocia

Question 41

can shoulder dystocia be predicted or prevented and occurs mainly w/ macrosomia?

Answer 41

NO!!!