Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics and Gynecology Revalida > Dystocia > Flashcards

Dystocia Flashcards

1
Q

Give a definition of dystocia

A

Labor abnormalities that interfere with the progression of normal spontaneous labor.

Characterized by abnormally slow labor progress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 abnormalities associated with dystocia.

what are the 3Ps according to ACOG?

A
  1. Abnormalities in the pelvis
  2. abnormalities in the fetal position
  3. abnormalities in the expulsive forces (uterine dysfunction)
  4. Abnormalities in the maternal tissue

simplified to 3 P’s

Powers
Passenger
Passage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the common clinical findings in Dystocia? Name them and describe each one (3).

A
  1. Ineffective labor:
    - -cephalopelvic disproportion (CPD) = disparity between fetal head size and maternal pelvis
    - -failure to progress = lack of progressive cervical dilatation
  2. Inadequate cervical dilatation or fetal descent
    - -Protracted labor = SLOW PROGRESS
    - -Arrested labor = NO PROGRESS
  3. Fetopelvic Disproportion
    - -Fetal size is too big
    - -Pelvis is not adequate
    - -Position of the fetus is not appropriate for delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the status of the Uterus and Cervix at the end of pregnancy but before the second stage of labor?

A
  1. the lower uterine segment is THICK
  2. the Cervix is UNDILATED
  3. The fundal muscles are not yet powerful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

At the end of pregnancy and before the second stage of labor, what factors will influence the progression of labor?

A
  1. Uterine contraction (muscles)
  2. Uterine Resistance (undilated cervix and thick lower uterine segment)
  3. Forward pressure of leading fetal part
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At what stage of labor does cephalopelvic disproportion become more apparent? why?

A

2nd stage of labor

because this is when the fetus will begin descending through the pelvic cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are two causes of uterine muscle dysfunction?

A

Uterine overdistention

Obstructed labor (CPD, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Should you give oxytocin if there is ineffective labor? (cephalopelvic disproportion & inadequate cervical dilation)

A

NO, giving oxytocin might cause uterine rupture during ineffective labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you diagnose Arrest of labor at the FIRST and SECOND stage??

A

FIRSTT STAGE
Wait for adequate time to pass before diagnosing arrest of labor

Adequate labor: greater than 6cm dilation WITH 4 hours of adequate contractions
–wait 6 hours if there is no cervical or inadequate contraction before proceeding with diagnosis

SECOND STAGE labor arrest DIAGNOSIS
no progress for 4 hours in nulliparous women WITH epidural. 3 hours if WITHOUT epidural

NO CS should be done until these timings have passeed if he maternal and fetal heart rates are reassuring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What brings about cervical dilatation, propulsion and expulsion of the fetus?

A

Uterine contractions on the FIRST stage of labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the treatment for hypotonic uterine dysfunction?

A

dilute oxytocin (parang 1unit lang ata)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is CS delivery warranted?

A

When oxytocin fails or its use is inappropriate (hindi ung uterus ung cause but CPD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In the latent (early) phase of the first stage of labor, how many hours does it usually last? At what cervical dilatation does this phase last?

what type of contractions can be seen here? describe

A

20 hours.

6cm dilatation

Irregular (5-30 mins, lasting 30 sec) and Regular contractions (3-5 minutes, lasting 1+ minutes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When does the active phase of the first stage of labor begin? What type of contractions happen here?

what is the cervical effacement at the beginning of this stage?

A

6-10cm cervical dilatations

Intense contractions (0.5-2 minutes lasting 60-90 seconds)

80% cervical effacement at the beginning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the two types of uterine dysfunctions?

Give a couple of differences and their treatment

A 
Hypotonic vs Hypertonic
happens in active phase vs latent phase
Synchronous vs asynchronous
Problem is that it cant dilate the cervix vs Problem is due to asynchronous contractions.
Treatment: Oxytocin VS Sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are causes in Uterine dysfunction?

A

Epidural anesthesia

Chorioamnionitis

Maternal position in labor

17
Q

What are the THREE abnormal labor patterns? Give the “time limit” for each stage as well as treatment for both nullipara and multiparas

A
  1. Prolongation Disorders
    - -Prolonged LATENT PHASE -> >20hr VS >14hrs
    - –treatment is bed rest (if very prolonged, oxytocin administration)
  2. Protraction Disorders
    - -Protracted active phase dilatation = <1.2cm dilatation/hr VS <1.5cm/hr (MINIMUM OF 4 HOURS)
    - –treatment is Expectant and support, if persists, oxytocin and amniotomy
    - -Protracted Descent (Baby slowly moving) = <1cm/hr VS <2cm/hr
    - –treatment is Expectant and support
  3. Arrest Disorders
    - -Prolonged deceleration phase >3hr VS >1hr
    - -Secondary arrest of dilatation >2hr VS >2hr
    - -Arrest of descent >1hr vs >1hr
    - -Failure of descent = no decent in the deceleration phase or the second stage of labor (di gumalaw at all si baby)
    - –TREATMENT = Evaluate for CPD if yes, CS, if no (just uterine dysfunction) then oxytocin
18
Q

What are the cervical dilatation ranges in the acceleration phase, phase of maximum sloe, and deceleration phase?

A

3-5 in accel phase
5-9 in maximum slope
9-10 in deceleration phase

19
Q

When does fetal descent actually begin?

A

According to the descent curve already at the first stage of labor at the latent phase there is already fetal descent

20
Q

When does active descent begin in Friedman’s curve?

A

at the phase of maximum slope

21
Q

At what cervical dilatation can protracted descent be diagnosed?

A

only at 8-9cm cervical dilatation. Remember, protracted descent also means that during the phase of maximum slope (of the descent curve), the descent is still slow

that is protracted descent

22
Q

Differentiate Arrest of descent vs Failure of descent

A

Failure of descent is when the leading part of the fetus does not pass station 0 (which is the point of reference) while arrest of descent is when the fetus initially descends, but the arrests at a certain position below station 0

23
Q

What is the treatment for protracted cervical dilatation?

A

Oxytocin and amniotomy

24
Q

When should you do CS for active phase arrest?

A

Cervical dilatation at 6cm WITH ruptured membranes.

Fail to progress for 4 hours despite adequate contractions

OR

6 hours of adequate oxytocin administration with inadequate contractions or no cervical change

25
Q

How long will you wait until you conclude that latent phase or labor is prolonged?

how long will you wait until you assume there is arrest at the active phase of labor?

What about arrest of descent in the second stage of labor?

A

> 20hr in nulluparas >14hr in multiparas

at least 6cm dilatation with adequate contraction for at least 4 hours

OR

6 hours with inadequate uterine contraction or no cervical change even with oxytocin administration

26
Q

What are the four types of pelvic shapes and which one is the best for childbirth?

A

Gynecoid
Platypelloid
Anthropoid
Android

27
Q

Name the features of a contracted pelvic inlet (3). Why is there no cervical dilatation? which factors affect cervical dilatation?

A
  1. Shortest anteroposterior diameter is <10cm
  2. Greatest transverse diameter is <12cm
  3. Diagonal conjugate <11.5cm

There is no cervical dilatation because the presenting part and the hydrostatic pressure of the unruptured membranes do not exert direct pressure on the cervix.

there can be rupture of membranes and because the pelvis is contracted the head will not present to the cervix,

28
Q

There are increased risk for ______(2) in CPD inlet

A
  1. face to shoulder presentations (3x)

2. Cord prolapse (6x)

29
Q

What are the features of a contracted midpelvis?

A

Interspinous + Posterior sagittal <13.5cm (normal is 15.5)
Interspinous is <8cm (normal is 10 - 10.5cm)

Spines are prominent
Narrow Sacro sciatic notch

30
Q

What are the features of a contracted pelvic outlet?

A

Interischial tuberous diameter of <8cm
rare
Usually from trauma or fractures

31
Q

Briefly describe face presentation.

What are the causes?

Diagnosis?

Management?

A

Face is facing the inlet with the next extended and the occiput close to the fetal back.

fetal chin is the presenting part

  1. Preterm
  2. enlargement of coils around neck
  3. large fetus
  4. contracted pelvis
  5. multiparous women

Diagnosis via vaginal examination

Management
1, if with no contracted pelvis, vaginal delivery may follow. Delivery of the baby will be by flexion instead of extension.
2. CS IS INDICATED IF MENTUM POSTERIOR
3. DO NOT ATTEMPT TO ROTATE

32
Q

Describe the transverse lie

Diagnosis?

Management?

A

When the fetal back is the “presenting” part.

Diagnosis via Leopold’s or vaginal examination

Management: vaginal delivery is impossible with persistent transverse lie so…CS.

BUT! low transverse lie may be difficult cause the incision is above the body of the baby in the uterus. so a vertical incision must be done.

33
Q

What is the management for persistent occiput posterior?

Why should we manage persistent occiput delivery?

A
  1. Spontaneous delivery because the fetus is small and the pelvis is wide
  2. Forceps delivery
  3. Manual rotation to occiput anterior then delivery
  4. Forceps rotation then delivery

we should manage this becausee it might lead to:

  1. increased blood loss
  2. Higher order vaginal lacerations 3rd 4th degree
  3. birth trauma followed by Apgar scores <7
34
Q

Define shoulder dystocia

A

If the normal birth delivery time is 24 seconds, >60 seconds is shoulder dystocia.

also, this is usually because the anterior shoulder got stuck in the symphysis pubis and fails to deliver with the downward traction

35
Q

Why is shoulder dystocia an emergency?

A

Because the umbilical cord is trapped between the birth canal and the baby

36
Q

What is the shoulder to head and chest to head ratio in shoulder dystocia?

Greater or Lesser?

A

Greater

37
Q

Name consequences of shoulder dystocia on both the mother and the fetus

A

Maternal Postpartum hemorrhage and vaginal lacerations

Fetal morbidity due to entrapment of umbilical cord leading to acidosis and hypoxia
Brachial plexus injury
Clavicular fracture

38
Q

What is a major risk factor for shoulder dystocia (in terms of mother and baby)

A

For the mother: Obesity -> DM -> fetal macrosomia -> shoulder dystocia
–post term pregnancy -> fetal macrosomia

Fetal weigth >4000g

39
Q

Define ALARMER

Expound on the different maneuvers for shoulder dystocia.

A 
ALARMER
Ask for Help
Lift the buttocks or legs -> Mcroberts
Anterior disimpaction -> Mazzanti maneuver
Rotation - wood corkscrew
Manual removal of the posterior arm
Episiotomy
Roll Over
  1. MAZZANTI MANEUVER (Suprapubic pressure) - pressure applied with the heel of the hand on the anterior shoulder
  2. MCROBERTS MANEUVER - removing the legs from the stirrups and flexing them, causes straightening of the sacrum relative to the lumbar vertebrae
  3. WOOD CORKSCREW MANEUVER - Hand placed on the posterior shoulder of the baby so the anterior shoulder will be moved. There’s also reverse woodscrew
  4. RUBIN’s MANEUVER - fetal shoulders are rocked side by side by applying pressure to maternal abdomen

Obstetrics and Gynecology Revalida (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions