Chapter 23

Question 1

Defined as the abnormal or difficult labor

Answer 1

Dystocia

Question 2

Dystocia or difficult of labor can arise from four components:

Answer 2

*power (uterine contractions)
*passenger (fetus)
*passageway (birth canal)
*psyche (perception of the pregnancy)

Question 3

Time-honored term to denote sluggishness of contractions

Answer 3

Inertia

Question 4

Common causes of dysfuntional labor:

Answer 4

*Primigravida status
*CPD
*failure of the uterine muscle to contract properly
*nonripe cervix
*patient exhausted from labor
*rectum or urinary bladder is full that impedes fetal descent

Question 5

Are the basic force that moves the fetus through the birth canal

Answer 5

Uterine contractions

Question 6

Contractions not more than two or three occuring within a 10-minute period

Answer 6

Hypotonic uterine contractions

Question 7

What is the resting tone and strength in hypotonic uterine contractions

Answer 7

*Resting tone remains less than 10 mmHg
*Strength of contraction does not rise above 25 mmHg

Question 8

Occur during active phase of labor and tend to occur after administration of analgesia

Answer 8

Hypotonic Uterine Contractions

Question 9

Are marked by an increase in resting tone to more than 15 mmHg

Answer 9

Hypertonic Contractions

Question 10

Occurs frequently and are most commonly seen in the latent phase of labor

Answer 10

Hypertonic Uterine Contractions

Question 11

Lack of relaxation between conteactions that prevent optimal uterine artery filling leading to

Answer 11

Anoxia

Question 12

During this contraction, lack of relaxation between contractions that prevent optimal uterine artery filling leading to anoxia

Answer 12

Hypertonic Uterine Contractions

Question 13

Administer ______ to soften cervix for cervical thinning

Answer 13

Hyoscine

Question 14

More than one pacemaker may be initiating contractions, or receptor points in the myometrium may be acting independently of the pacemaker.

Answer 14

Uncoordinated Contraction

Question 15

Can occur so closely together that they can interfer with the blood supply to the placenta.

Answer 15

Uncoordinated contractions

Question 16

_______ administration is helpful in uncoordinated labor to stimulate better pattern of conteactions

Answer 16

Oxytocin

Question 17

Dysfunction occurs with the first stage of labor involves a

Answer 17

*prolonged latent phase
*protracted active phase
*prolonged deceleration phase *secondary arrest of diltation

Question 18

In prolonged latent phase, how long does latent phase lasts

Answer 18

*longer than 20 hours in nullipara
*14 hours in multipara

Question 19

With a prolonged latent phase, the uterus tends to be in

Answer 19

Hypertonic State

Question 20

What is the management of a prolonged latent phase?

Answer 20

*helping uterus to rest
*provide adequate fluid for hydration
*administer pain relief drugs like morphine sulfate or epidural

Question 21

Is simple measures of management does not work for prolonged latent phase

Answer 21

Cesarean birth or amniotomy or oxytocin infusion to assist labor may be necessary

Question 22

This phase if prolonged if cervical dilatation does not occur at a rate of at least 1.2 cm per hour for nullipara or 1.5 cm for multipara

Answer 22

Protracted Active Phase

Question 23

If the active phase lasts longer than 12 hours in a primigravida or 6 hours in a multigravida

Answer 23

Protracted Active Phase

Question 24

Extends beyond 3 hours in a nullipara or 1 hour in a multipara

Answer 24

Prolonged Deceleration Phase

Question 25

Occured if there is no progress in cervical dilatation for longer than 2 hours (for nullipara) and 1 hour for multipara

Answer 25

Secondary Arrest of Dilatation

Question 26

A prolonged decelertion phase most often results from

Answer 26

Abnormal fetal head position

Question 27

Occurs if the rate of descent is less than 1 cm per hour for nullipara or 2 cm per hour in multipara

Answer 27

Prolonged Descent

Question 28

Results when no descent has occured for 2 hours in nullipara or 1 hour in multipara

Answer 28

Arrest of Descent

Question 29

When expected descent of the fetus does not begin or movement beyond 0 station does not occur.

Answer 29

Arrest of descent

Question 30

Most likely cause for arrest of descent during the second stage is

Answer 30

CPD or Cephalopelvic Disproportion

Question 31

Cervical dilatation that occurs at a rate of 5 cm or more per hour in a primipara or 10 cm or more for multipara per hour.

Answer 31

Precipitate Labor

Question 32

Occurs when uterine contractions are so strong a parent gives birth with only a few, rapidly occuring contractions

Answer 32

Precipitate birth

Question 33

Often defined as a labor that is completed in fewer than 3 hours.

Answer 33

Precipitate Birth

Question 34

Contractions can be so forceful they lead to

Answer 34

Premature separation of the placenta or lacerations of the perineum

Question 35

Labor is started artificially

Answer 35

Induction of Labor

Question 36

Refers to assisting labor that has started spontaneously but is not effective.

Answer 36

Augmentation of Labor

Question 37

Induction of labor is not used unless the fetus is

Answer 37

At term (39 weeks)

Question 38

Even if the fetus is less than 39 weeks, induction can still be done if

Answer 38

Fetus was proven to have adequate lung surfactant by amniocentesis

Question 39

Before induction of labor is done, the following conditions should be present:

Answer 39

*fetus is in longitudinal lie *cervix is ripe *presenting part is engaged *no suspected CPD *fetus is estimated to be mature (over 39 weeks)

Question 40

Change in the cervical consistency from firm to soft.

Answer 40

Cervical Ripening

Question 41

Simplest method for ripening the cervix

Answer 41

Stripping (or sweeping) the membranes

Question 42

Most common method to promote cervical ripening

Answer 42

Insertion of prostaglandin like dinoprostone into the posterior fornix of the vagina

Question 43

A synthetic form of naturally occuring pituitary hormone

Answer 43

Oxytocin

Question 44

In case of hyperstimulation, a primary care provider may prescribe ______ to relax the uterus

Answer 44

Terbutaline

Question 45

If hyperstimulation occurs, these interventions are done

Answer 45

*Turn patient to their left side to improve blood flow to the uterus *administer IV fluid bolus to dilute level of oxytocin in bloostream *administer oxygen by mask at 8 to 10 L

Question 46

Fetus needs ___________ between contractions to receive adequate oxygenation from blood vessels in the placenta.

Answer 46

60 to 90 seconds

Question 47

Uterine rupture occurs most often in patients who have _________

Answer 47

Previous cesarean scar

Question 48

If uterus should rupture, patient experiencea

Answer 48

"Tearing sensation"

Question 49

If uterus should rupture, what will be visible on the patient's abdomen

Answer 49

Retracted Uterus and the extrauterine fetus

Question 50

With an incomplete rupture, a patient may experience

Answer 50

Only a localized tenderness and a persistent aching pain over the lower uterine segment

Question 51

Refers to the uterus turning inside out with either birth of the fetus or delivery of the placenta

Answer 51

Uterine Inversion

Question 52

In uterine inversion, a patient will likely be given

Answer 52

General anesthesia or possibly nitroglycerin or a tocolytic drug by IV to relax the uterus

Question 53

These may speed the descent

Answer 53

Semi-fowler position, squatting, kneeling, or more effective pushing.

Question 54

A loop of the umbilical cord slips down in front of the presenting fetal part

Answer 54

Umbilical Cord Prolapse

Question 55

Umbilical cord prolapse tends to occur most often with:

Answer 55

*premature rupture of membranes *fetal presentation other than cephalic *placenta previa *small fetus *CPD preventing firm engagement

Question 56

Management for cord prolapse

Answer 56

*elevating the fetal head off the cord *placing the patient in a knee-chest or Trendelenburg position