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Flashcards in Abnormal Labor Deck (53)
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1
Q

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

A

Protracted

Arrest

2
Q

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

A

No

3
Q

What is arrest of labor in the latent phase?

A

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

4
Q

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

A

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

5
Q

Does a prolonged latent phase correlate with adverse perinatal outcomes?

A

No

6
Q

Is prolonged latent phase an indication for a cesarean section?

A

No

7
Q

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

A

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

Not an indication for a C-section

8
Q

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

A

Yes– for mother and baby

9
Q

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

A
  • Inadequate uterine activity (give oxytocin or amniotomy)

- Cephalopelvic disproportion (c-section)

10
Q

What is an amniotomy? Why is this done?

A

AROM to help induce contractions

11
Q

What is the definition of secondary arrest?

A

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

12
Q

How do you manage a secondary arrest?

A
  • Verify dilation, presentation, position, and station

- Exclude malpresentation

13
Q

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

A
  • q2-3 / min
  • last 60 -90 secs
  • 50-60 mmHg
14
Q

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

A

Fetal heart pattern and uterine contractions

15
Q

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

A
  • Uterine hyperstimulation
  • Water intoxication
  • Hypotension if bolus
  • Uterine rupture
16
Q

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

A

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

  • Associated with less favorable outcome
  • C-section
17
Q

What defines protraction of descent? (nulliparous and multiparous)

A

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
Q

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

A

True

19
Q

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

A

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

20
Q

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

A

True

21
Q

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

A
  • Hemorrhage
  • Cord avulsion
  • Uterine inversion
22
Q

What causes the placenta to separate?

A

Consequence of continued contractions following delivery of fetus

23
Q

What is uterine inversion?

A

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

24
Q

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

A
  • Average = 15 minutes
  • 30 minutes indicates need to intervene
  • Give IV oxytocin or manual extraction
25
Q

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

A

Second stage of labor

26
Q

When is an episiotomy indicated? (4)

A
  • Arrest or protracted descent
  • Shoulder dystocia
  • Instrument delivery
  • Expedite delivery if abnormal FHT
27
Q

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

A
  • Reduction of second stage

- Reduction in trauma to pelvic floor muscles

28
Q

What are the risks of a midline episiotomy?

A
  • Increased blood loss
  • Potential fetal injury
  • Localized pain
  • Increased incidence of deeper lacerations
29
Q

What is a mediolateral episiotomy?

A

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

30
Q

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

A

If mother has IBD (not necessarily needed however)

31
Q

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

A
  • Does not increase the incidence of 3rd and 4th degree lacs

- Less damage to anal sphincter and rectal mucosa

32
Q

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

A
  • Inclusion cysts

- Greater blood loss

33
Q

What are 3rd and 4th degree lacerations?

A

3rd degree into the anal sphincter

4th degree into the rectum itself

34
Q

What are the complications that arise from shoulder dystocia?

A

-Permanent neonatal trauma (brachial plexus injury)

35
Q

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

A

True

36
Q

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

A

McRoberts maneuver–flex hips to open pelvis outlet

37
Q

What is operative vaginal delivery?

A

Refers to any operation procedure designed to effect vaginal delivery

38
Q

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

A

False–it is

39
Q

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

A

Lithotomy

40
Q

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

A

At least +2

41
Q

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

A

No

42
Q

What is placenta previa?

A

Placenta is over the cervix

43
Q

What are the three absolute contraindications for forceps delivery?

A
  • Cervix not fully dilated
  • Unruptured membranes
  • Placenta previa
44
Q

What should you prepare for if you are using forceps?

A

emergency c-section

45
Q

When do you pull with the vacuum?

A

With maternal contraction

46
Q

What is outlet forceps?

A

Using forceps when the scalp is at introitus

47
Q

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

A

Placenta detaches before birth– c-section

48
Q

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

A

True

49
Q

Why is ITP an indication for c-section?

A

Risk for infant

50
Q

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

A

False–only active infections

51
Q

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

A

10x greater than vaginal births

52
Q

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

A

Risk injury to baby with the delivery

53
Q

How many dr should be present with twin births?

A

2