Dysfunctional Labor (Moulton)

Question 1

In the first stage of labor, the latent phase is characterized by cervical softening and effacement occur with minimal dilation which is defined as less than __1__ cm.

The active phase starts when the cervix is dilated to __1__ cm.

Answer 1

1) 6 cm

Question 2

For all phases of labor (except the latent phase) an abnormality may be defined as either protraction or arrest. What does each mean?

Answer 2

1) Protraction: Slower than normal rate

2) Arrest: Complete cessation of progress (no further dilation or descent)

Question 3

An arrested latent phase implies that?

Answer 3

Labor has not begun

Question 4

Normal limits of the latent phase in a nulliparous mother can reach up to __1__ hours.

In a multiparous mother it can reach up to __2__ hours.

Answer 4

1) 20 hours

2) 14 hours

Question 5

Latent phase that exceed the norms is considered prolonged but the outcome of prolonged latent phase has little effect on perinatal mortality. What are some causes of prolonged latent phase?

Answer 5

1) Excessive use of sedatives

2) Fetal malposition

Question 6

What normal daily function is recommended with prolonged latent phase as it can provide patient with relief and aid in distinction between true and false labor?

What drug can be given that will progress the patient to the active phase or will stop contractions due to the patient undergoing false labor?

Answer 6

1) Sleep

2) Morphine

Question 7

Normal limits of the active phase in nulliparous mothers for cervical dilation is __1__?

Normal limits of the active phase in multiparous mothers for cervical dilation is __2__?

Cervical dilation of less than the norms constitutes a __3__ disorder of dilation of the active phase.

If 2 or more hours elapsed with no cervical dilation an __4__ disorder of dilation has occurred.

Answer 7

1) 1.2 cm/hr
2) 1.5 cm/hr
3) Protraction
4) Arrest

Question 8

Normal limits of the active phase in nulliparous mothers for fetal descent is __1__?

Normal limits of the active phase in multiparous mothers for fetal descent is __2__?

Fetal descent of less than the norms constitutes a __3__ disorder of descent of the active phase.

If no change in descent/station has occurred within 1 hr an __4__ disorder of descent has occurred.

Answer 8

1) 1 cm/hr
2) 2 cm/hr
3) Protraction
4) Arrest

Question 9

Klumpke paralysis is a lower arm palsy caused by damage to?

Answer 9

C8 and 1st thoracic nerve

Question 10

____ is defined as a delivery that requires additional obstetric maneuvers following failure of gentle downward traction on the fetal head to effect delivery of the shoulders.

Answer 10

Shoulder dystocia

Question 11

Shoulder dystocia is caused by the impaction of the anterior fetal shoulder behind the maternal __1__ or the impaction of the posterior shoulder on the __2__.

__3__ can be seen which is retraction of the delivered fetal head against the maternal perineum.

Answer 11

1) Pubic symphysis
2) Sacral promontory
3) Turtle sign

Question 12

Which palsy is more common?

Which is more common with shoulder dystocia?

Answer 12

1) Erb’s palsy

2) Klumpke’s palsy

Question 13

In the management of shoulder dystocia, the McRoberts Maneuver induces what movements of the maternal hips?

Answer 13

1) Hyperflexion

2) Abduction

Question 14

In the management of shoulder dystocia, __1__ pressure may dislodge the impacted anterior shoulder.

However you do NOT want to apply __2__ pressure.

Answer 14

1) Suprapubic

2) Fundal

Question 15

In the management of shoulder dystocia, when using the Rubin maneuver you want to place pressure on an accessible shoulder to push it toward the ____ of the fetus to decrease the bisacromial diameter and free the impacted shoulder.

Answer 15

Anterior chest wall

Question 16

In the management of shoulder dystocia, when using the Wood’s corkscrew maneuver you want to apply pressure ____ in order to rotate the infant and dislodge the anterior shoulder.

Answer 16

Behind the posterior

Question 17

__1__ maneuver for shoulder dystocia is the last resort maneuver where the fetal head is manually returned to its prerestitution position and slowly replaced in the vagina by steady upward pressure.

Delivery is then done by?

Answer 17

1) Zavanelli

2) Emergent cesarean section

Question 18

Shoulder dystocia is an obstetric emergency, what teams should be called for help?

The initial maneuvers used are?

Answer 18

1) Anesthesiologist and NICU

2) McRoberts and suprpubic pressure