Dysfunctional Labor (Moulton) Flashcards
(41 cards)
Uterus is a large smooth muscle organ composed of billions of smooth muscle cells. Each of these cells becomes a contractile element when the intracellular ionic __1__ concentration increases to trigger an enzymatic process that results in the formation of the __2__ element.
Stimulation of __3__ receptors on the plasma membrane further activates the __2__ element.
Contractions occur in localized areas during gestation but during labor the entire uterus contracts in an organized fashion. These coordinated smooth muscle cells contractions are secondary to the __4__ that activate the movement of action potentials throughout the myometrium.
1) Calcium
2) Actin-myosin
3) Oxytocin
4) Gap junctions
Relaxation of the uterus is maintained by factors that increase levels of __1__.
Contraction of the uterus is from the increase intracellular __2__ stores which promotes interaction of __3__ and __3__ causing uterine contractions
1) Cyclic adenosine monophosphate (cAMP)
2) Calcium
3) Actin and myosin
1) During labor, what are the two distinct segments of the uterus are that are formed?
2) What happens to each?
1) Upper-contract/retract to release fetus
2) Lower-cervix thinner (and passive)
What does the cervix contain?
Collagen and smooth muscle
In labor the cervix changes from firm, intact sphincter to soft, pliable, dilatable structure.
These structural changes are the result of
1)
2)
3)
1) Collagenolysis
2) Increased Hyaluronic acid
3) Decreased Dermatan sulfate (which favors increased water content)
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.
1) 6 cm
For all phases of labor (except the latent phase) an abnormality may be defined as either protraction or arrest. What does each mean?
1) Protraction: Slower than normal rate
2) Arrest: Complete cessation of progress (no further dilation or descent)
An arrested latent phase implies that?
Labor has not begun
What are the Normal length of the latent phase in
1) Nulliparous mother
2) Multiparous mother
1) 20 hours
2) 14 hours
1) What is the effect of prolonged latent phase with perinatal mortality?
2) What are the causes of prolonged latent phase?
1) NONE
2) Excessive use of sedatives/analgesics
Fetal malposition
1) In management of prolonged latent phase, what can help distinguish true vs false labor?
2) 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?
1) Sleep
2) Morphine
ACTIVE PHASE-Cervical Dilation
1) What is Normal nulliparous cervical dilation?
2) What is Normal multiparous cervical dilation?
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.
1) 1.2 cm/hr
2) 1.5 cm/hr
3) Protraction
4) Arrest
FETAL DESCENT-Active Phase
1) What is Normal nulliparous descent?
2) What is Normal multiparous descent?
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.
1) 1 cm/hr
2) 2 cm/hr
3) Protraction
4) Arrest
1) ____ is defined “difficult labor” it can be used interchangeably with dysfunctional labor characterizing that labor is not progressing normally.
2) What are the three P categories?
1) Dystocia
2) Power- Is contraction strong?
Passenger- How big is baby?
Passage-Is the pelvic bone too small?
The diagnosis of dystocia should NOT be made before what has been tried?
An adequate trial of labor
__1__ refers to stimulation of uterine contraction when spontaneous contractions have failed to result in progressive cervical dilation or descent of the fetus.
This should be considered if
2) Contractions are less than what in 10 minute period?
3) and/or the intensity is less than what?
1) Augmentation
2) Three
3) 25 mm/Hg
What is recommended in protraction and arrest disorders after assessing
- Maternal pelvis
- Fetal position
- Station
- Maternal/fetal status
Oxytocin
The intrauterine pressure catheter (IUPC) is a soft plastic catheter placed transcervically that gives precise measurement of the __1__ of the uterine
contractions in mmHg.
2) What is required for this?
3) What can Intrauterine pressure catheter be used to assess?
1) Intensity
2) Ruptured membranes
3) Power
Minimal effective uterine activity is defined as?
3 contractions in a 10 minute period averaging 25 mmHg above baseline
1) What is the Benefit of Artificial Rupture of membranes
2) What are the risks?
1) Augment Labor
2) Cord prolapse and Chorioamnionitis
What is the only FDA approved medicine for labor stimulation due to inadequate uterine contractions?
Pitocin (oxytocin injection)
1) What is Cephalopelvic disproportion?
2) This causes a failure of what?
3) Who is most at risk?
4) Which P of the Active Phase does this assess?
1) Disparity between pelvis and fetal head
2) Failure of Descent
3) Nulliparous
4) Passage
Presentations other than vertex __1__ position are considered to be abnormal in the laboring patient.
Fetal head usually enters and engages the maternal pelvis in __2__ position but then rotates to __1__.
1) Occiput anterior
2) Occipitotransverse
What occurs when the head fails to rotate and flex into the OA position
And may be caused by
-Cephalopelvic disproportion
-Altered pelvic architecture (Android or platypelloid)
-relaxed pelvic floor (epidural)?
Persistent Occipitotransverse Position
