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22 Cards in this Set

  • Front
  • Back
What is a prolonged latent phase?
A latent phase prolonged beyond 20 hrs in primiparas or 14 hrs in multiparas.
What is prolongation of the latent phase associated with?
1. Excessive sedation
2. Prematurely administered epidural anesthesia
3. Unfavorable cervical status
4. Myometrial dysfunction
What are the therapies for prolonged latent phase?
1. Therapeutic Narcosis
2. Active Managment of Labor
What is the "Therapeutic Narcosis" therapy for prolonged latent phase?
It involves sedating the pt after 20 hrs in the latent phase. Most pts awake rested, refreshed, and in active labor. This is the preferred treatment.
Describe "active management of labor" as therapy for a prolonged latent phase.
It involves rupture of amniotic membranes after the first cervical examination if 1 cm dilation has not occurred. 2 hrs after admission, oxytocin augmentation of labor is begun if at least 1 cm or more of additional dilation has not occurred. This is the exceptional treatment.
What are protraction disorders?
These disorders occur in the active phase of labor when cervical dilation and descent of fetal head ocur at a slower than normal rate.
Disorders of which phase are the most common labor abnormality?
Active phase disorders.
What are protraction disorders frequently associated with?
1. Cephalopelvic disproportion
2. Use of conduction anesthesia
3. Fetal malposition
What is an arrest disorder?
It is defined as cessation of dilation or of descent in active phase of laor for more than 1 hr (descent) or 2 hrs (dilation).
Half of the time, an arrest disorder is associated with what?
Cephalopelvic disproportion.
If a woman has an arrest disorder, and there is no cephalopelvic disproportion, what is the most likely route of delivery?
They will deliver vaginally 80% of the time w/ oxytocin augmentation.
When is intervention (C-section) recommended in the 2nd stage of labor?
For a second stage that exceeds 2 hrs in nulliparous women and 1 hr in multiparas.
What problems are assoc w/ a prolonged 2nd stage of labor?
1. Postpartum hemorrhage & infection
2. Infant mortality doubles
3. Nulliparous women did NOT experience inc infant mortality w/ 2nd stage labor exceeding 2 hrs.
What are the causes of abnormal labor due to the "passage?"
1. Absolute Cephalopelvic Disproportion
2. Nutritional Causes
3. Pelvic facture
4. Dwarfism
5. Soft Tissue Abnormalities
6. Condyloma Acuminata
7. Pelvic Tumors (fibroid & ovarian)
What is absolute cephalopelvic disproportion?
It occurs when the pelvis is contracted to the point where a normal-sized fetual is unable to traverse the canal.
What are the causes of abnormal labor due to the "Passenger?"
1. Breech Position
2. Transverse or Shoulder Presentation
3. Occiput Posterior Position
4. Excessive Size of Fetus
5. Abnormal Development of Fetus
What is the most common abnormality of presentation?
Breech Position
What is occiput posterior position?
The fetus descents facing anterior instead of posterior.
What are the causes of abnormal labor due to the "Powers?"
1. Lengthening of 1st or 2nd labor stage.
2. Inadequate Contractions
3. Fetal Malposition & Pelvic Contractures
4. Unknown Causes
5. Decreased contractility & lack of sufficient bearing down
How can we increas the amplitude and frequency of contractions?
Administer oxytocin
What are Montevideo units?
They are a rough estimate of the area under the contraction curves of a 10 min period. They are calculated by subtracting baseling uterine pressure from peak contraction pressure for each contraction in a 10 min window and adding the pressures generated by each contraction.
What is "Adequate labor?"
It describes a wide range of uterine activities.