Dysfunctional Labor - Moulton

Question 1

• *Minimal rate of baby descent:
  
  • Nulliparous
  • Multiparous

Answer 1

1 cm/hr

2 cm/hr

Question 2

For all phases of labor, except the latent phase, a “disorder of labor” can either be ___ or ___

Answer 2

• Protraction (slower than normal)

- Arrest (complete cessation of progress) - for 2+ hours

Question 3

• *Normal upper limit of latent phase:
  
  • Nulliparous
  • Multiparous

Answer 3

20 hours

14 hours

Question 4

Causes for prolonged latent phase (3)

Treatment?

Answer 4

• No cervical change
• Excessive sedatives or analgesics
• Fetal malposition

Therapeutic rest (Morphine) - will eventually move to active phase (85%)

Question 5

Causes of active phase problems (4)

**How to remember?

Answer 5

• Poor uterine activity
• Cephalopelvic disproportion
• Fetal malposition
• Anesthesia

3 Ps - Power, Passenger, Passage (pelvic bones)

Question 6

Treating active phase issue - if what?

How?

Answer 6

Augmentation (if less than 3 contractions per 10 minutes and/or intensity is under 25)

Oxytocin

Question 7

Can oxytocin be given during an early abortion to help stop bleeding?

Answer 7

NO - not responsive to it until 20-40 weeks

Question 8

*****Relationship between oxytocin and ADH

Answer 8

If dehydrated, ADH binds to oxytocin receptors and causes premature contractions

If given too much oxytocin, will bind ADH receptors and cause fluid overload

Question 9

Transverse arrest of descent - define

Answer 9

Persistent OT position w/ arrest of descent for 1+ hrs

Question 10

How to treat persistent OT position, IF pelvis is adequate and baby is normal (2)

IF pelvis is inadequate or baby is huge? (1)

Answer 10

Oxytocin
Manual rotation

C-section

Question 11

Giving labor in OP position is associated with what 2 things?

Management options? (3)

Answer 11

• Prolonged 2nd stage
• LOTS of back pain

Monitor, vacuum, forceps

Question 12

Definition of macrosomia

Answer 12

4500 grams

Question 13

• **NERVE ROOTS…
• Erb-Duschenne palsy
• Klumpke palsy
• Paralysis of entire arm

Answer 13

C5-C6 injury (waiter’s tip)
C8-T1 injury (claw hand)
ALL brachial plexus injured

Question 14

***A pregnant woman is progressing well, then stalls. Do what next?

Answer 14

Assess 3 P’s

Question 15

***Shoulder dystocia - define

***Sign that it may be occurring?

Answer 15

A delivery that requires additional obstetric maneuvers after failure to get shoulders out from pelvis

Turtle sign - baby’s delivered head retracts back toward shoulders

Question 16

***Managing a shoulder dystocia (5)

Answer 16

• ***McRobert’s maneuver (hyperflex, abduct mom’s hips)
• ***Suprapubic pressure - push shoulder from outside
• Rotational/deliver posterior arm/fracture baby clavicle
• Proctoepisiotomy
• Zavanelli maneuver (put head back into mom) - WORST

Question 17

Risk of artificially rupturing the membrane - as a mechanism of augmenting the labor, etc

Answer 17

Cord prolapse

Question 18

***4 qualifications for forceps or vacuum

Answer 18

• Epidural
• Bladder drained
• Know baby position
• Completely dilated