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three p’s
powers, passenger, pelvic
Arrested of active phase
no cervical dilation for 4 hours in the active phase (>6cm dilation) with rupture of membranes, and adequate contractions.
cephalopelvic disproportion
where the pelvis is too small for the fetus and a cesarean is required. this can be caused to small a pelvis or too big a baby.
adequate contractions
every 2-3 min. firm on palpation and lasting at least 40-60 sec/.
what is suspected if late decelerations occur in the context of decreased variability
acidosis is strongly suspected.
what causes fetal tachycardia
variety of disorders such as maternal fever.
when does fetal bradycardia require interventions
profound and prolonged
what are the most common decelerations and what causes them. when are they merely observable
variables. cord compression.
When the variables are intermittent and abruptly return to baseline then they can be observed.
early decelerations are what?
caused by head compression and are benign
late decelerations are what
they are suggestive of fetal hypoxia and if recurrent can indicate fetal acidosis
what are the most common reasons for C-section
dystocia, abnormal fetal heart rate, malpresentation, multiple gestation, fetal macrosomia
what does scalp stimulation that induces accelerations indicate
normal cord pH (pH>7.20)
is prolonged latent stage an indication for cesarean
no. in the absence of cephalopelvic disproportion
when is C-section during active phase indicated
when they are >6cm, with ruptured membranes, who fail to progress for 4 hours of adequate uterine activity or >6hrs of oxytocin with inadequate uterine activity and no cervical change.
What are the parameters for arrest in the second stage of labor
at least 2 hours of pushing in multiparous and 3 hours of pushing in nulliparous
NOTE: these are longer with epidural or malposition
why use scalp stimulation?
it can reflect fetal acid-base status. If stimulated and it causes accelerations, then that suggests normal cord pH.
what are the indications for using C-section to avoid shoulder or birthing trauma?
when the estimated fetal weight _>5,000 for non-diabetics and _>4,500 for diabetics.
How do we fix occiput posterior or occiput transverse
manual rotation or forceps (but forceps are no longer used typically)
tachysystole
uterine contractions >5/10min. averaged over 30 min.
what is the intervention for tachysystole
decrease or stop oxytocin or administer beta-mimetic agent.
what are the common etiologies of prolonged decelerations
tachysystole, hypotension, rapid cervical dilation, umbilical cord prolapse, placental abruption, uterine rupture.
What are the common causes of hypotension?
regional anasthesia (such as epidural) can cause low BP. We fix by administration of IV fluid bolus or vasopressor (ephedrine)
rapid cervical dilation
labor progression especially rapid descent
