Abnormal Labor Flashcards Preview

OB/GYN > Abnormal Labor > Flashcards

Flashcards in Abnormal Labor Deck (53):
1

What are the two most common abnormalities of the first stage of labor?

Protracted
Arrest

2

Do contractions stop if there is protraction or arrest of the first stage of labor?

No

3

What is arrest of labor in the latent phase?

Labor has not really begun, so there is no true arrest of labor

4

What is the definition of prolonged labor in the latent phase? (nulliparous and multiparous women)

More than 20 hours in nulliparous, or more than 14 in multiparous

5

Does a prolonged latent phase correlate with adverse perinatal outcomes?

No

6

Is prolonged latent phase an indication for a cesarean section?

No

7

What defines a protracted 1st stage of labor? Is this an indication for a cesarean section?

Rate of the active phase of cervical dilation is less than the 5th percentile

Not an indication for a C-section

8

Is there a risk for poor perinatal outcome with arrest in the active phase of labor? In whom (mother or baby)?

Yes-- for mother and baby

9

What are the causes of protracted disorders (hypocontractile uterine activity) and how do you manage each? (2)

-Inadequate uterine activity (give oxytocin or amniotomy)
-Cephalopelvic disproportion (c-section)

10

What is an amniotomy? Why is this done?

AROM to help induce contractions

11

What is the definition of secondary arrest?

Cessation of a previously normal *active* phase--at least 6 cm for a period of 4 hours

12

How do you manage a secondary arrest?

-Verify dilation, presentation, position, and station
-Exclude malpresentation

13

When giving IV oxytocin for an arrested active phase, what is the goal amount of contractions in terms of frequency, duration, and pressure?

-q2-3 / min
-last 60 -90 secs
-50-60 mmHg

14

When you augment contractions by administering oxytocin, what should you monitor?

Fetal heart pattern and uterine contractions

15

What are the four major complications that can arise from too oxytocin administration?

-Uterine hyperstimulation
-Water intoxication
-Hypotension if bolus
-Uterine rupture

16

What is a combined disorder? What is the significance of this in terms of outcomes? How do you manage this?

Arrest of dilation occurring when pt has previously shown primary dysfunctional labor

-Associated with less favorable outcome

-C-section

17

What defines protraction of descent? (nulliparous and multiparous)

Descent of presenting part during the second stage is less than 1 cm per hour in nulliparous and less than 2 cm in multiparous

18

True or false: protraction of the descent stage of labor is a subjective assessment

True

19

What are outcomes like with protraction of descent phase of labor?

Increase perinatal/maternal morbidity if overly aggressive attempts to shorten 2nd stage

20

True or false: expectant management of the descent phase of labor is appropriate if FHT reassuring

True

21

What are the three major adverse outcomes of the third stage of labor (placental delivery stage)?

-Hemorrhage
-Cord avulsion
-Uterine inversion

22

What causes the placenta to separate?

Consequence of continued contractions following delivery of fetus

23

What is uterine inversion?

When you pull on the placental cord, and the uterus inverts---EMERGENCY d/t severe hemorrhage

24

What is the average duration of the third stage of labor? When is intervention indicated? What should be done?

-Average = 15 minutes
-30 minutes indicates need to intervene
-Give IV oxytocin or manual extraction

25

During what stage of labor is an episiotomy performed, if it is going to be performed?

Second stage of labor

26

When is an episiotomy indicated? (4)

-Arrest or protracted descent
-Shoulder dystocia
-Instrument delivery
-Expedite delivery if abnormal FHT

27

What are the benefits of a midline episiotomy? (2)

-Reduction of second stage
-Reduction in trauma to pelvic floor muscles

28

What are the risks of a midline episiotomy?

-Increased blood loss
-Potential fetal injury
-Localized pain
-Increased incidence of deeper lacerations

29

What is a mediolateral episiotomy?

Incision at a 45 degree angle from the inferior portion of the hymenal ring

30

When is a mediolateral episiotomy indicated, as opposed to a midline?

If mother has IBD (not necessarily needed however)

31

What are the benefits of a mediolateral episiotomy over a midline one? (2)

-Does not increase the incidence of 3rd and 4th degree lacs
-Less damage to anal sphincter and rectal mucosa

32

What are the downsides of a mediolateral episiotomy as compared to a midline one? (2)

-Inclusion cysts
-Greater blood loss

33

What are 3rd and 4th degree lacerations?

3rd degree into the anal sphincter
4th degree into the rectum itself

34

What are the complications that arise from shoulder dystocia?

-Permanent neonatal trauma (brachial plexus injury)

35

True or false: shoulder dystocia can be a cause of postpartum hemorrhage

True

36

What is the maneuver that is helpful to prevent shoulder dystocia?

McRoberts maneuver--flex hips to open pelvis outlet

37

What is operative vaginal delivery?

Refers to any operation procedure designed to effect vaginal delivery

38

True or false: maternal exhaustion is not an indicated for the use of forceps

False--it is

39

What is the position that the mother should be in when using forceps?

Lithotomy

40

What station level should the fetus be in when using forceps?

At least +2

41

Can you do forceps delivery if the cervix is not completely dilated?

No

42

What is placenta previa?

Placenta is over the cervix

43

What are the three absolute contraindications for forceps delivery?

-Cervix not fully dilated
-Unruptured membranes
-Placenta previa

44

What should you prepare for if you are using forceps?

emergency c-section

45

When do you pull with the vacuum?

With maternal contraction

46

What is outlet forceps?

Using forceps when the scalp is at introitus

47

What is placental abruption, and how do you manage this?

Placenta detaches before birth-- c-section

48

True or false: placenta previa is an indication for a c-section

True

49

Why is ITP an indication for c-section?

Risk for infant

50

True or false: latent HSV infection is an indication for a c-section

False--only active infections

51

What is the maternal mortality rate of c-sections than compared with vaginal deliveries?

10x greater than vaginal births

52

Why is breech presentation a relative indication for a C-section?

Risk injury to baby with the delivery

53

How many dr should be present with twin births?

2