Term
| Abnormal labor is aka __ __ literally meaning difficult labor or childbirth. |
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Definition
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Term
| Labor is aka ___. This is the process by which __ __ cause __ and __ of the cervix. This results in the expulsion of the fetus from the uterus (delivery/parturition). Neither __ nor __ __ alone meet the definition. |
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Definition
- Parturition
- uterine contractions
- effacement and dilation of the cervix
- neither contractions nor cervical changes meet the definition alone |
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Term
| Abnormal labor, dystocia, and failure to progress are imprecise terms that have been used to describe a difficult labor pattern that deviates from that observed in the majority of women who have spontaneous vaginal deliveries. |
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Definition
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Term
| Protraction disorders mean that labor is __ to ___. |
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Definition
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Term
| Arrest disorders are complete __ of progress. |
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Definition
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Term
About 20 percent of labors involve either protraction or arrest disorders
A labor abnormality is the most common indication for primary cesarean birth |
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Definition
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Term
| 2 ways to classify labor abnormalities: |
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Definition
- protraction disorders
- arrest disorders |
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Term
First stage: time from the onset of labor until complete cervical dilatation (latent and active).
Second stage: time from complete cervical dilatation to expulsion of the fetus.
Third stage: time from expulsion of the fetus to expulsion of the placenta. |
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Definition
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Term
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Definition
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Term
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Definition
| uterine contractions or maternal expuslive efforts |
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Term
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Definition
| position, size of presentation of fetus |
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Term
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Definition
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Term
external tocodynamometry,
internal uterine pressure catheters.
External and intrauterine monitoring devices appear to perform equally well, although the latter may work better in obese women.
three to five contractions per 10 minutes.
Montevideo units (i.e., the peak strength of contractions in mmHg measured by an internal monitor multiplied by their frequency per 10 minutes) are most often employed. |
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Definition
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Term
| Montevideo units are the peak __ of contraction in mmHg times the ___ per 10 minutes. Requires internal monitor. |
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Definition
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Term
| __ montevideo units (MVU) is necessary for adequate labor during the ___ phase. |
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Definition
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Term
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Definition
Hypocontractile uterine activity
Neuraxaial anesthesia
Cephalopelvic disproportion (CPD)
Bandl's ring- An hourglass constriction ring of the uterus
Occiput posterior position |
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Term
| ___ __ is normal position. |
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Definition
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Term
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Definition
| can't diagnose dystocia with certainty |
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Term
| 3 measurements of pelvimetry: |
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Definition
- Diagonal conjugate: 12.5-13 cm
- Bi-ischial diameter: 10 cm
- Angle of supra-pubic arch: 90 degrees |
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Term
| Station is 0 when the fetal ___ is at the __ ___. This is when the head is said to be ___. |
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Definition
vertex
ischial spines
engaged |
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Term
| Above the ischial spines, station has __ numbers. Below the ischial spines, station has __ numbers. |
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Definition
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Term
| The pelvic inlet is made up of what two things? |
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Definition
| - sacral promontory + symphysis pubis |
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Term
| Management options for poor progression in the first stage: |
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Definition
- oxytocin
- intrauterine pressure catheter
- prostaglandins
- amniotomy
- Ambulation, support
(OIPA) |
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Term
| Risk factors for poor progression in the second stage: |
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Definition
- nulliparity
- Diabetes
- macrosomnia
- neuraxial anesthesia
- chorioamnionitis (infection of the membranes) |
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Term
| Once second stage arrest disorder is diagnosed, the obstetrician has 4 options: |
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Definition
- continued observation
- attempt at operative vaginal delivery
- Cesearean delivery
- perform amniotomy if the membranes are still intact |
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Term
| __ __ does NOT shorten the second stage of labor. |
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Definition
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Term
| Initial interventions to try and get labor to progress: |
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Definition
- consider lessening neuraxial blockade
- change maternal position (upright posture, lateral, or hands and knees position)
- delay pushing if head high in pelvis and woman has no urge to
- fundal pressure should be avoided b/c studies suggest that it is not for hastening delivery in this setting |
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Term
| Cardinal movements of labor: |
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Definition
1. Engagement: 0
2. Flexion: +4
3. Descent
4. Internal Rotation
5. Extension
6. External rotation/restitution
7. Expulsion |
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Term
| 4 reasons for Leopold maneuvers: |
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Definition
determination of what
is in the fundus.
2) evaluation of the fetal
back and extremities.
3) palpation of the presenting
part above the symphysis.
4) determination of the direction
and degree of flexion of the head. |
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Term
| Maneuver done to alleviate shoulder dystocia: |
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Definition
| McRoberts maneuver and suprapubic pressure |
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Term
| The McRoberts Maneuver is performed by ___ and ___ of the hips which causes __ __of the __ __ and flattening of the __ __ that frees the impacted shoulder. |
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Definition
- hyperflexing and abducting the hips
- causes cephalid rotation of the symphysis pubis and flattening of the lumbar lordosis |
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Term
| Shoulder dystocia occurs when the __ shoulder gets wedged behind the __ ___. When this occurs you have __ minutes to get the baby out, or neurological defects can results. |
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Definition
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Term
Abnormal labor can result from one or more abnormalities of the cervix, uterus, maternal pelvis, or fetus (i.e., power, passenger, or pelvis).
approach to labor management:
Monitor progress in active labor with cervical examinations at one- to two-hour intervals. |
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Definition
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Term
| How long is normal for placenta delivery? |
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Definition
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Term
| For patients in active labor who fail to make adequate progress over ___ hours, administer ___, titrate the ___ dose to achieve uterine contractions greater than __ Montevideo units and monitor labor progress for __ to __ more hours as long as clinical assessment of fetal and maternal size is favorable and the fetal heart rate is reassuring. |
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Definition
- two hours
- administer oxytocin
- oxytocin
- 200
- two to four more hours |
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Term
The decision to perform an operative vaginal delivery (e.g., extraction or rotation) in the second stage versus continued observation or cesarean birth is based upon clinical assessment of mother and fetus and the skill and training of the obstetrician.
There is no evidence to support the use of radiographic pelvimetry in women with cephalic presentations. |
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Definition
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Term
| 4 hours after oxytocin administered, if no labor progression> |
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Definition
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Term
| During active labor, cephalopelvic disproption is diagnosed when there are __ __ __ and the __ __ __ in __ hours. |
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Definition
| - adequate uterine contractions and the cervix has not change in 4 hours |
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Term
| Dimensions of the pelvis that best predict successful vaginal delivery: |
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Definition
- diagonal conjugate greater than or equal to 12.5 cm
- interspinous diamter greater than or equal to 10 cm
- bituberous diameter greater than or equal to 8 cm |
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Term
| One reason the android pelvis is least favorable is: |
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Definition
| The sub pubic arch is > 90 degrees. Which may hinder internal rotation of the fetal head, and may lead to deep transverse arrest. |
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Term
| Android pelvis prevents the baby from rotating internally, so the baby gets stuck in the transverse position. |
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Definition
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Term
| Before starting the McRoberts Maneuver, you should tell the patient to __ __. |
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Definition
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Term
The best indicator of maternal pelvic capacity is the fetus.
As stated by Pinard (1844- 1934) “ The fetal head is the best plevimeter “ |
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Definition
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