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Flashcards in 6. Variations of Labor Deck (41):
1

Define "Labor Dystocia"

Long, difficult or abnormal labor

2

Define "Dysfunctional Labor"

Ineffective uterine contractions (POWERS)

3

Hypertonic Uterus Characteristics of Contractions

Uncoordinated, irregular

4

Hypotonic Uterus: Characteristics of contractions

Coordinated but weak
Become shorter, farther apart

5

Hypertonic uterus Uterine resting tone

Higher than normal
**Reduces blood flow

6

At what phase does Hypertonic Uterus occur?

LATENT

7

At what phase does Hypotonic uterus occur?

ACTIVE

8

Management of Hypertonic Uterus (4)

• Relaxation (warm shower)
• Rest
• Tocolytics
• Hydration

9

Management of Hypotonic uterus (4)

• Amniotomy
• Oxytocin
• Position changes
• C-section

10

Two passageway problems that can cause dysfunctional labor

• Pelvic dystocia – We cannot change this
• Soft tissue dystocia – We can change these somewhat

11

Soft tissue changes

• Anatomic abnormality
• Full bladder or rectum
• Cervical edema

12

Four passenger problems that can cause dysfunctional labor. Which is counter-indicated with vaginal delivery?

• Fetal anomalies
• Cephalopelvic disproportion (CPD)**
• Malpresentation
• Suboptimal fetal position


CPD is counterindicated with vaginal delivery

13

What does CPD stand for?

Cephalopelvid Disproportion

14

Four categories of malpresentation. Which is most common?

• Face
• Shoulder
• Complete
• Breech -- Most common (3-4%)

15

Types of breech (3)

- Frank Breech (butt first)
- Single footing breech
- complete breech (cannon ball)

16

Six risks of turning a breech

• Fetal distress
• Rupture of membranes
• Maternal-fetal hemorrhage
• Placental abruption
• Could stimulate preterm labor
• Fetal death

17

When is a breech baby turned?

Done between 36-37 weeks

18

Exercises to encourage spontaneous version

Pelvic lifts

19

What is Friedman's Classification?

A way of monitoring progress in terms of cervical dilation and fetal descent

20

What categories are represented on Friedman's curve? (5)

- Precipitous labor
- Multipara
- Nullipara
- Secondary Arrest
- Prolonged latent phase

21

What is precipitous labor?

Total labor process is complete in less than 3 hours

22

Precipitous labor is associated with...

- Increased risk of maternal and fetal complications
- Cocaine use

23

Complications of precipitous labor
- Mom (2)
- Fetus (1)

- Mom: Tearing, Hemorrhage
- Fetus: Intercranial bleeds

24

"Trial of Labor" : Def

Allowance of a "reasonable period" of spontaneous active labor to determine safety

25

Indications of Trial of Labor (3)

• Maternal pelvis is a questionable size/shape
• Vaginal birth after cesarean (VBAC)
• Abnormal presentation

26

Induction of Labor (def)

Contractions initiated before spontaneous onset

27

Two methods of induction of labor

• Pitocin
• Amniotomy

28

When is success of IOL greater?

If Cervix is "favorable"

29

Bischop Scoring Method (def)

(What does a higher score indicate?)

Evaluating the "favorability" of a cervix

(Likelihood that an induction of labor will result in a vaginal birth. Higher score = more likely to succeed)

30

What five components does the Bishop scale measure?

• Dilation
• Effacement
• Station
• Cervical consistency
• Cervical position

31

Name five components of a top-scoring bishop scale

• Dilation of 5-6
• Effacement of 80%
• +1 station
• Soft cervix
• Anterior position

32

Chemical agents applied to "ripen" cervix

• Prostaglandins (prepidil, Cervidil)
• Misoprostol (Cytotec)

33

Three results of chemical cervical ripening

• Higher success of induction
• Lower doses of pitocin
• Shorter induction times

34

Pitocin: Methods of administration

• Intravenous titration
• IM

**Antepartum pitocin must ALWAYS be a pump

35

What must you monitor with pitocin?

Monitor FHR and contraction patterns Q15

36

Indications of IOL (7)

Unsuitable environment:
• Suspected fetal jeopardy: Is the baby better out or in?
• Chorioamnionitis: Amniotic infection
• Maternal Medical Problems
• PIH: Pregnancy Induced Hypertension

Pre/Post term
• PROM
• Post-term: The uterus is a union worker

Death
• Fetal Demise (FD)

37

What does PIH stand for?

Pregnancy Induced Hypertension

38

Risks of IOL (5)

• Fetal distress
• Failed induction
• Uterine rupture
• Water intoxication
• Hyperstimulation with Pitocin

39

Hyperstimulation with pitocin (def)

Very frequent, intense contractions with non-assuring FHR

40

Hyperstimulation with pitocin:
• CTX
• Resting time
• Uterine resting tone

• CTX Q2m x >90 seconds
• Resting time less than 30 seconds
• Uterine resting tone >20mmHg

41

What is an augmentation of labor?
• Two methods

An intervention after labor begins spontaneously, but CTX stop or abnormal labor is diagnosed.

• Pitocin
• Amniotomy