Flashcards in Abnormal Labor Deck (53):
What are the two most common abnormalities of the first stage of labor?
Do contractions stop if there is protraction or arrest of the first stage of labor?
What is arrest of labor in the latent phase?
Labor has not really begun, so there is no true arrest of labor
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
Does a prolonged latent phase correlate with adverse perinatal outcomes?
Is prolonged latent phase an indication for a cesarean section?
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
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
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)
What is an amniotomy? Why is this done?
AROM to help induce contractions
What is the definition of secondary arrest?
Cessation of a previously normal *active* phase--at least 6 cm for a period of 4 hours
How do you manage a secondary arrest?
-Verify dilation, presentation, position, and station
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
When you augment contractions by administering oxytocin, what should you monitor?
Fetal heart pattern and uterine contractions
What are the four major complications that can arise from too oxytocin administration?
-Hypotension if bolus
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
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
True or false: protraction of the descent stage of labor is a subjective assessment
What are outcomes like with protraction of descent phase of labor?
Increase perinatal/maternal morbidity if overly aggressive attempts to shorten 2nd stage
True or false: expectant management of the descent phase of labor is appropriate if FHT reassuring
What are the three major adverse outcomes of the third stage of labor (placental delivery stage)?
What causes the placenta to separate?
Consequence of continued contractions following delivery of fetus
What is uterine inversion?
When you pull on the placental cord, and the uterus inverts---EMERGENCY d/t severe hemorrhage
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
During what stage of labor is an episiotomy performed, if it is going to be performed?
Second stage of labor
When is an episiotomy indicated? (4)
-Arrest or protracted descent
-Expedite delivery if abnormal FHT
What are the benefits of a midline episiotomy? (2)
-Reduction of second stage
-Reduction in trauma to pelvic floor muscles
What are the risks of a midline episiotomy?
-Increased blood loss
-Potential fetal injury
-Increased incidence of deeper lacerations
What is a mediolateral episiotomy?
Incision at a 45 degree angle from the inferior portion of the hymenal ring
When is a mediolateral episiotomy indicated, as opposed to a midline?
If mother has IBD (not necessarily needed however)
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
What are the downsides of a mediolateral episiotomy as compared to a midline one? (2)
-Greater blood loss
What are 3rd and 4th degree lacerations?
3rd degree into the anal sphincter
4th degree into the rectum itself
What are the complications that arise from shoulder dystocia?
-Permanent neonatal trauma (brachial plexus injury)
True or false: shoulder dystocia can be a cause of postpartum hemorrhage
What is the maneuver that is helpful to prevent shoulder dystocia?
McRoberts maneuver--flex hips to open pelvis outlet
What is operative vaginal delivery?
Refers to any operation procedure designed to effect vaginal delivery
True or false: maternal exhaustion is not an indicated for the use of forceps
What is the position that the mother should be in when using forceps?
What station level should the fetus be in when using forceps?
At least +2
Can you do forceps delivery if the cervix is not completely dilated?
What is placenta previa?
Placenta is over the cervix
What are the three absolute contraindications for forceps delivery?
-Cervix not fully dilated
What should you prepare for if you are using forceps?
When do you pull with the vacuum?
With maternal contraction
What is outlet forceps?
Using forceps when the scalp is at introitus
What is placental abruption, and how do you manage this?
Placenta detaches before birth-- c-section
True or false: placenta previa is an indication for a c-section
Why is ITP an indication for c-section?
Risk for infant
True or false: latent HSV infection is an indication for a c-section
False--only active infections
What is the maternal mortality rate of c-sections than compared with vaginal deliveries?
10x greater than vaginal births
Why is breech presentation a relative indication for a C-section?
Risk injury to baby with the delivery