Dysfunctional Labor

Question 1

What physiological processes cause relaxation and contraction of the uterus?

Answer 1

Relaxation: Increase of cAMP
Contraction: Increased intracellular calcium

Question 2

What are the differences between latent and active phase in the first stage of labor?

Answer 2

Latent phase: Cervical softening/effacement occurs with minimal dilation ( increased rate of dilation, descent of fetus)
Active phase: Starts with cervix @4cm–> full dilation

Question 3

What are the normal limits of the latent phase for nulliparous and multiparous women?

Answer 3

Nulliparous- Up to 20 hours

Multiparous- Up to 14 hours

Question 4

Normal limits of the active phase for cervical dilation for nulliparous vs. multiparous women?

Answer 4

Nulliparous- Cervical dilation of 1.2cm/hour

Multiparous- Cervical dilation of 1.5 cm/hour

Question 5

What are the normal limits of fetal descent during the active phase for nulliparous vs. multiparous women?

Answer 5

Nulliparous- Descent of 1cm/hour

Multiparous- Descent of 2cm/hour

Question 6

What MVU is necessary for adequate labor and what is the minimal effective uterine activity (Power)?

Answer 6

> 200 MVU (peaks of contractions in a 10 minute period)

Minimal effective uterine activity: 3 contractions in a 10 minute period averaging 25mmHg above baseline

Question 7

Presentations other then what are considered abnormal (Passenger)?

Answer 7

Vertex occiput anterior (OA)

Question 8

At what weight should a prophylactic C section be performed for macrosomia?

Answer 8

Fetus weighing >5000g

If diabetic-> Fetus >4,500g

Question 9

What is the most common brachial plexus injury and how does it present?

Answer 9

Erb-Duschenne palsy

Injury to CN5 & 6 (upper arm palsy)

Question 10

What causes Klumpke’s palsy?

Answer 10

Damage to C8 and T1 (lower arm palsy)

Question 11

What is McRoberts maneuver for shoulder dystocia?

Answer 11

Hyperflexion and abduction of maternal hips

Can add suprapubic pressure (NOT fundal pressure)

Question 12

What is the last resort for management of shoulder dystocia?

Answer 12

Zavanelli maneuver

Delivery by emergent C section

Question 13

What is the difference between arrest and protraction of the active phase?

Answer 13

Protraction- Cervical dilation less then norm

Arrest- 2+ hours elapse with no cervical dilation