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OBGYN Abnormal Labor
KYCOM Block 13
60
Medical
Graduate
01/18/2014

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Term
define percipitate labor
Definition
progresses more rapidly than expected
often associated with frequent occuring contractions associated with oxytocin over stimulation, chorioamniontis, or placental abruption (not enough blood flow)
Term
define dystocia
Definition
laboring patients that progress slower than normal
difficult labor or childbirth
usually related to one of the 3 P's power passenger passage
Term
define protraction
Definition
labor progresses slow
Term
define arrest
Definition
cease to progress in labor
no cervical change
Term
define CPD
Definition
cephalopelvic disproportion
fetal size and maternal pelvic size not compatiable
type of arrest disorder
Term
what are the 3 abnormal labor patterns
Definition
prolonged latent phase
protraction disorders
arrest disorder
Term
define prolonged latent phase
Definition
>20h for nulligravidas
>14h for multiparas
Term
define protracton disorder
Definition
prolonged active phase or labor
Term
how to qualify protraction disorder
Definition
cervical dilation///
<1.2cm for nilligravidas
<1.5 cm for multiparas

descent of presenting part
<1cm for nulligravidas
<1.5cm for multiparas
Term
what are the two arrest disorders, define each
Definition
secondary arrest dilation: no cervical dilation for >2h in active phase

arrest/descent: no descent in presenting par in >1h in second stage of labor
Term
two types of fetal monitoring 3
Definition
tocodynamometer: records force of contraction and frequency
uttering doppler: gets : screw metal into babys head
Term
fetal problems resultting in dystocia 4
Definition
fetal weight
fetal head position and attidude
malpresentation
fetal anomalies
Term
what are the types of fetal head position and attitude 6
Definition
asynclitic
brow
face
persistent occiput posterior; facing up, ok for vaginal
mentum posterior: cannot vaginal
mentum anterior: can vaginal, but difficult
Term
3 types of fetal malpresentation
Definition
comoiund: baby is trying to bring limbs out with its head (push them in)
transverse lie
breech
Term
2 fetal anomalies that can cause dystocia
Definition
hydrocephalus
fetal tumors
Term
5 materal conditions causing dystocia
Definition
bony pelvis
distended bladder
colon masses
axnedial masses: mass on ovary
fibroids: tumors in uterine muscle, all benign
Term
4 types of pelvis and their prognosis for delivery
Definition
android: most common reason for arrest disorders

gynecoid: round, baby comes out good

antrhopoid: undetermined

platypelloid: thin, baby dosent fit, some babies can go sideways
Term
how is dystocia categorized
Definition
prolongation and arrest disorders
Term
defne nulliparous prolonged latent phase
Definition
>20h
Term
define multiparous prolonged latent phase
Definition
>14h
Term
define nulliparous prolonged active phase
Definition
>12h (1.2cm/h)
Term
define multiparous prolonged active phase
Definition
>6h (1.5cm/h)
Term
how can abnormal labor be managed
Definition
induction
augmentation
Term
define induction of labor
Definition
stimulation of labor before the onset of contractions via pitosin
Term
define augmentation of labor
Definition
stimulation of labor contractions that are infrequent or ineffective in intensity
Term
define MVU
Definition
monotevifro units
number of uterine contractionsin 10 min x ineensity
>200 is normal labor progression
Term
what does bishop score evaluate
Definition
cervical status
Term
what gets 0 points in a bishop score
Definition
dilation: closed
effacement: 0-30%
station: -3
consistency: firm
prosition: posterior
Term
what gets 1 point in bishop score
Definition
dilation: 1-2cm
effacement: 40-50%
station: -2, -1
consistency: medium
prosition: mid
Term
what gets 2 points in bishop score
Definition
dilation: 3-4cm
effacement: 60-70%
station: 0
consistency: soft
prosition: anterior
Term
what gets 3 points in bishop score
Definition
dilation: 5cm+
effacement: 80%+
station: 1,2
Term
what does a bishop score of 0-4 indicate, what tx can you do (4)
Definition
induction not successful
ropening of cervix prostiglandins E2 gel
cytotex: sea weed forces cervix top open in 1-2d
foley bulb: put baloon n cervix and force it open
lanubara: pill that goes in vag every 4h to ripen
Term
what does bishop score 9-13 mean
Definition
induction likley successful and will have vaginal delivery
Term
indications of labor 7
Definition
post-term pregnancy
maternal medical problems: DM, heart disease
fetal demise
suspected fetal compromise
pregnancy induced HTN (pre-eclampsia)
premature rupture of membranes
chorioamnionitics
Term
contractions to labor induction 7
Definition
placenta or vasa previa
cord presentation
abnormal/unstable fetallie
presenting part about inlet
prior classical uterine incision in active muscle
posterior uterine incision of unk type
active genital herpes
Term
how can you tell a contraction in false and true labor apart
Definition
pain meds take away false
Term
what is vasa previa
Definition
placenta is covering entire opening of cervix forcing baby
could cause bleed or vessel previa
vessels cross opening of cervix and baby could bleed out
Term
true labor contractions: intervals, duration, intensity, cervix, location of pain, tx
Definition
interval: regular
duration: gradually increasing
cervix: dilating
location: back and abd
tx: sedation does not relieve
Term
false labor contractions: intervals, duration, intensity, cervix, location of pain, tx
Definition
interval: irregular
duration: irregular
cervix: no dilation
location: lower abd
tx: sedation does relieve
Term
when is prolonged second stage (active stage) too long
Definition
two hour is normal, esp for atypical presentations
OP may be longer but not to exceede 3h

if mom is tolerating and fetal heart is reassuring then more time may be allowed
Term
risks of prolonged labor to mom
Definition
infection
maternal exaustion
lacerations
uterine atony
operative delivery: vaccum/forceps cause soft tissue injury and fetal trauma
Term
what is uterine atony
Definition
uterus does not contraction to constrict vessels after birth causing hemorrhage
Term
risks of prolonged labor to baby
Definition
asphyxia: not enough O2
trauma from difficult deliveries
infection
meconium aspiration: resp distress due to 2 mechanical obstruction and chemical pneumpnitis
Term
tx for mechnoium aspiration 3
Definition
aminofusion in utero
suction catheter at birth
ET suction
Term
frequency of breech presentation
Definition
2% of single pregnancies at term
more frequent in premature births
Term
causes of breech presentation 8
Definition
prematurity: more amniotic fluid, baby is smaller, flipping
multiple pregnancies
polyhydraminos
hydrocephaly
anecephaly: no brain/top of head
aneuploidy: cant move wekk
uterine anomalies
uterine tumor/fibrosis
Term
3 types of breech presentations
Definition
frank breech: hips flexed, knees extended, feet by head

complete breech: hips and knes flexed

incomplete breech: single foot hanging down
Term
what is external cephalic version, who can get it, what is the concern
Definition
turning baby manually

allowed in normal fetus, normal heart tracing, sdequate AFI, no uterine scars, presenting part not in the pelvis, after 37 wks (could break water, and begin delivery)

it is painful
Term
how to deliver a breech fetus <2000 GMS
Definition
C section 2 to risk of birth injury
pulling on baby can cause brain bleed
Term
how deliver a breech fetus >3800 GMS
Definition
c section 2 to risk of entrapment of larger fetal head when baby comes out feet first
Term
how to deliver a 2000-3800 GMS
Definition
vaginal or C section
Term
types of breech delivery
Definition
total breech extraction: entire body extreacted, youll pull it out yourself

partial breech extraction: let mom push baby all the way up to belly button, less trauma on her and baby

spon breech delivery: no traction or manipulation on the fetus, delivers spontaneously
Term
how to do a breech extraction
Definition
gentile traction on feet, ankles, thighs, pelvis

gentile traction and rotation as scapulae become visible sweeping the posterior then anterior arm free in process

mariceau maneuver: to deliver head
Term
conditions for forceps application
Definition
cervix: fully dilated, ripping cervix causes lots of bleeding
membranes; ruptured
positions and station of fetal head: known and engaged
anesthesia: adequate for maternal comfort
maternal pelvis: evaluated and found appropirate
Term
forceps calssifications
Definition
outlet
low
mid
Term
outlet forceps: when do use, how to use
Definition
fetal skull has reached perineal floor, scalp is visible between contractions, saggital suture is AP diameter or in right/left occiput ant/post position, no more than 45 deg from midline
Term
when to use low forceps
Definition
leading edge of skull is +2 station or more
Term
when to use mid forceps
Definition
head is engaged but leading edge of skull is above +2 station
Term
when can you do vaginal birth after C section
Definition
allowed to have up to 2 C sections before not allowed to do vaginal delivery
1% risk of uterine rupture which is 50% mortality to baby
Term
complications of uterine rupture
Definition
fetal bradycardia
loss of intrauterine pressure
pain: can be masked by epidural
increased bleeding
movement of persenting fetal part of pelvis
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