Objectives 41-50

Question 1

41. What does a displaced uterus above the umbilicus indicate? What is your action?

Answer 1

• full bladder. Action is to get it emptied by having a woman void (either on toilet, bed pan) or if unable (due to epidural- straight cath)

Question 2

42. What is the most important component of the first hour postpartum?

Answer 2

• skin to skin, bonding, insure mom is stable: bleeding wnl, afebrile, normotensive. skin to skin is huge: surge of oxytocin that downreulates catecholamines, promotes thermal stability in newborn, improves success of breastfeeding
• The “golden hour” >> baby should remain on mom for the first hour (unless baby is not transitioning well and needs stim/care at the warmer), breast crawl, baby can be assessed on mom’s chest, prolongs the duration of exclusive breastfeeding

Question 3

43. What is the definition of precipitous birth? What are the possible sequalae?

Answer 3

• refes to delivery of infant in less than 3 hours.
• Occurs in 2% of deliveries.
• Associated with placental abruption (htn, cocaine); uterine tacysystole, multiparity.
• Sequalea: shoulder dystocia, pp hemmorrhage

Question 4

44. What is prolonged latent phase? What are the possible sequalae to this according to simkin?

Answer 4

• Latent phase arrest implies that labor has not truly begun.
• Primigravida > 20 hours; multigravid > 14 hours;
• Sequelae: (simkins, 121) this rarely indicates a complication, although its discouraging and exhausting to the woman.
  
  • Help women cope with discouragement, encourage rest, positions that are favorable for aligning fetus

Question 5

45. What is the definition for protracted active phase according to Alex referenced by Zhang?

Answer 5

• -less than 1 cm per hours for multiparous > 6 cm
• Simpkins (126): nulliparous (according to Zhang & Albers) may progress at a rate of 0.5 cm/hr between 3 and 7 cm; and less than 1 cm/hr at 7 to 10 cm of dilation
• Per 2010 Zhang article: if after the woman is 6cm..if it takes longer than 4 hours to get to 10cm it would be protracted active phase

Question 6

46. What are the possible etiologies for a protracted active phase?

Answer 6

• most common cause of a protraction disorder is inadequate uterine activity;
• others: abnormal positioning of the fetal presenting part (extended rather than flexed head, brow presentation), OP position, CPD (pelvic architecture and fetal weight being factors),
• iatragentic causes: dehydration, lack of movement, excessive oxytocin use, epidural

Question 7

47. What requisites are required to diagnose active phase arrest?

Answer 7

• DX: Simpkins (125): insufficient rate of dilation after active labor has been diagnosed.
• Well established diagnosis is less than 1 cm/hour for 2 hours after labor progress has been well established.
• Adequate contractions must be defined as contractions exerting a pressure greater than or equal to 200 MVU’s.

Question 8

48. What sequalae is common for disorders of the active phase of labor?

Answer 8

• may require delivery assistance with either c-section, vacuum, or forceps.
• Prolonged labor carries risks of uterine atony, lacerations, hemorrhage, infections, maternal exhaustion, fetal acidosis (Oxhorn)

Question 9

49. What is the definition of arrest of descent?

Answer 9

• no descent of presenting part for 2 hours

Question 10

50. Why does uterine rupture in an unscarred uterus occur?

Answer 10

• hyperstimulation of uterus, obstructed labor (uterus keeps working but baby won’t fit)- found most often in lower segment.
• inductions!, mid-high operative vaginal births, internal version (IPV), multiparity, macrosomia, trauma