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Year 2 OBGYN > Abnormal labor > Flashcards

Flashcards in Abnormal labor Deck (30):
1

what are the abnormal labor patterns in the 1st stage?

- protraction
- arrest

2

what are the abnormal labor patterns in the active phase of stage 1 labor?

- protraction
- secondary arrest
- combined disorder

3

what is most diminished in a protracted disorder?

rate of cervical change

4

protracted disorders carry what risks?

- secondary arrest
- poor perinatal outcome

5

primary dysfunctional labor is what type of disorder? what is the cause in nulliparous women? multiparous women? what can you do for each?

- protracted

- nulliparous: inadequate uterine activity (hypocontractile - manage with amniotomy and/or oxytocin augmentation)

- multiparous: cephalopelvic disproportion (mange by C-section)

6

an arrest can be called at what cervical dilation size?

6 cm

7

what needs to be excluded before calling a secondary arrest?

malpresentation

8

what can be administered to augment labor when 1st stage protraction or arrest disorders are noted?

oxytocin

9

what are the risks of IV oxytocin?

- uterine hyperstimulation
- water intoxication
- hypotension if bolused
- uterine rupture

10

what is a combined disorder? how is it managed?

- arrest of dilation when pt has previously shown primary dysfunctional labor
- managed by C-section

11

what are the abnormal labor patterns in the 2nd stage?

- protracted descent
- arrested descent

12

what is the best management for protraction of descent during stage 2 of labor?

expectant management (if everything else is going okay with the fetus)

13

what are the adverse maternal outcomes during arrest?

- hemorrhaage
- trauma
- chorioamnionitis

14

definition: episiotomy

incision into the perineal body maade during second stage labor to facilitate delivery

15

what are the indications for an episiotomy?

- arrest or protracted descent
- shoulder dystocia
- instrument (operative) delivery
- expedite delivery if abnormal fetal heart pattern

16

what are the benefits of a midline episiotomy? risks?

BENEFITS:
- straight
- reduction of second stage
- reduction of trauma to pelvic floor muscles

RISKS:
- increased blood loss (if too early)
- potential fetal injury
- localized pain
- increased incidence of 3rd and 4th degree lacerations
- long term incontinence and pelvic prolapse

17

what are the benefits of a mediolateral episiotomy? risks?

BENEFITS:
- less damage to anal sphincter
- better for IBD

RISKS:
- unsatisfactory cosmetic result
- inclusion cysts within scar
- greater blood loss

18

what type of episiotomy is good for patients with IBD?

mediolateral

19

3rd degree episiotomy laceration? 4th?

3rd - into anal sphincter

4th - into rectum

20

what is the McRoberts maneuver? what is it used for?

- mother brings knees up to armpits
- used to aid in delivery of fetus with possible shoulder dystocia

21

definition: operative vaginal delivery

any operative procedure designed to effect vaginal deliver (forceps, vacuum)

22

what are the maternal indications for using forceps / operative delivery?

- maternal exhaustion
- inadequate expulsive efforts
- lack of expulsive efforts
- need to avoid maternal expulsive efforts

23

what are the fetal indications for using forceps / operative delivery?

- nonreassuring fetal heart tracing
- prolonged second stage

24

what are the necessary criteria for delivering a baby with forceps?

- head first
- known position
- engaged in pelvis
- station greater than or equal to 2
- attitude of vertex, presence of caput or moulding

25

what are the maternal risks of forceps?

- perineal injury
- vaginal and cervical lacerations
- postpartum hemorrhage

26

what are the fetala risks of forceps?

- intracranial hemorrhage
- cephalic hematoma
- facial / brachial palsy
- injury to soft tissues of face and forehead
- skull fracture

27

what are the maternal indications for C-section?

- obstructive benign and malignant tumors
- large vulvar condyloma
- abdominal cervical cerclage (stitch in cervix)
- prior vaginal colporrhaphy
- prior classical cesarean delivery or full thickness myomectomy
- prior uterine rupture

28

what are the maternal-fetal indications for C-section?

- cephalopelvic disproportion
- failure to progress or arrest
- placental abruption
- placenta previa
- uterine dehiscence or prior classical uterine scar
- maternal request (controversial)
- large pelvic mass

29

what are the fetal indications for C-section?

- nonreassuring fetal heart tracing
- malpresentation
- HSV
- ITP
- major congenital abnormalities
- cord prolapse

30

what are the risks of C-section?****

- blood loss
- infection
- injury
- thrombotic events / PE
- risk of future C-sections
- maternal mortality about 10x greater than vaginal births