Gyn-Ics-15-Abnl Labor (Dystonia)

Front 1

prolonged latent phase

Back 1

[Latent phase refers to time period from onset of uterine contractions to beginning of active phase (3-4 cm dilation)]

>20 hrs in nulliparas,
>14 hrs in multiparas

Front 2

prolonged latent phase is associated with

Back 2

-excessive sedation
-premature administration of epidural
-unfavorable cervical status
-myometrial disfxn

*NOT predictive of other labor abnl
*not assoc w/higher rate of C-section
*not assoc w/risk of depression or newborn asphyxia
*not caused by cephalopelvic disproportion

Front 3

Tx prolonged latent phase

Back 3

2 approaches:
1. "Therapeutic Narcosis"
most pts wake up feeling refreshed and go into labor

2."Active Management of Labor"
-if not 1 cm dilated==>amniotomy (you rupture the membranes)
-if 2 hours after admission, cervix is not dilated at least 1 cm==>administer oxytocin

Front 4

protraction D/O:
def?
assoc?
Tx?

Back 4

d/t altered Active Phase of Labor;
-SLOWING of either cervical dilation or fetal descnet

1. protracted active phase dilation:
<1.2 cm/hr for nulliparas,
<1.5 for multi

2. protracted descent:
<1 cm/hr for nulliparas,
<2 cm/hr for multiparas

Assoc w/:
-cephalopelvic disproportion
-use of conduction anesthesia
-fetal malposition

Preferred Tx: expectant and support

Exceptional Tx: C-section if cephalopelvis disproportion

Front 5

EXAM: which of the following mandates cesarian delivery at term?

Back 5

cephalopelvic disproportion:
(protracted descent, failure of descent)

Front 6

arrest d/o

Back 6

cessation of dilation (2 hrs) or of descent (1 hr) in active phase of labor
-50% of these have cephalopelvic disporportion
==>do C-section
-those WITHOUT cephalopelvic disportoportion==>give oxytocin to induce vaginal delivery

Front 7

EXAM: Pt is fully dilated and pushing for 9 days. What is most appropriate course of action?

Back 7

Note: this is 2nd stage of labor (complete dilation==>delivery of baby)

*do C-section (do C-section if 2nd stage > 2 hrs in nulliparas, >1 in multiparas. Add 1 hr if epidural anesthesia used)

Front 8

second stage of labor

Back 8

complete dilation==>delivery of baby
-descent mostly occurs in 2nd stage
-cardinal mvmts occur in 2nd stage

Front 9

prolonged second stage of labor can cause...

Back 9

1. postpartum hemorrhage and infxn
2. infant mortality doubles

Front 10

falure of descent
-define
-Tx

Back 10

>1 hr null and multi

Tx: with cephalopelvic disproportion==>C-section

Front 11

et of abnl labor (Obj 2)

Back 11

"Passage, Passenger, Powers"
A. "Passage"
-cephalopelvic disproportion-
pelvis is so contracted s.t. it cannot accomodate nl-sized fetal head
-can be d/t Vit D resistant rickets, dwarfism
-also, condyloma acuminata can be so extensive that vaginal delivery is undeisrable d/t bleeding and infxn
==>must do C-section

B. "Passenger"
1. Breeched position
-footing breech (feet delivering first) or breeches weighing >3500-3800 g MANDATE C-section
-high mortality,morbidity
==>must do C-section

2. Transverse or shoulder presentation:
-shoulder can prolapse and arm come thru vagina, leaving the shoulder impacted
-mom and baby can die!
==>must do C-section

3. Occiput Posterior positon
(occiput=head)
-head faces anterior instead of posterior

4. baby too big
*d/t gestational diabetes (EXAM)-->dystocia (difficult childbirth) d/t arrest of head (large, less flexible) or shoulders

5. Abnl dev of fetus
a. hydrocephalus makes baby head too big
b. tumors of baby's ovary and enlargement of liver or kidneys


C. The Powers
-not strong enough contractions to push out baby
-Tx: oxytocin

Front 12

EXAM: what mandates C-section

Back 12

These mandate C-section b/c high perinatal mortality and morbility:
1. Footing breeches (feet delivering first)
2. Breeches weighing > 3500-3800 grams

Front 13

EXAM: protraction d/o

Back 13

Protraction d/o=during active phase of labor when cervical dilation & descent of fetal head occur at SLOWER than nl rate

Cervical dilation:
nulliparas: <1.2 cm/hr
multiparas: <1.5 cm/hr

Descent of fetal head:
nulliparas: <1 cm/hr
multiparas: <2 cm/hr

Front 14

EXAM: descent

<1 cm/hr for nulliparas,
<2 cm/hr for multiparas

labor pattern?

Back 14

protraction d/o

Front 15

arrest of descent
-define
-Tx?

labor pattern?

Back 15

>1 hr for nulliparas or multiparas

Tx: if cephalopelvic disproportion
==>C-section

Front 16

arrest d/o
-define
-how Tx?

Back 16

-Arrest D/O = during active phase of labor
-CESSATION of cervical dilation or fetal head descent

a) cervical dilation
(cessation>1 hr for nulliparas or multiparas)

or

b) baby descent
(cessation>2 hrs for
nulliparas or multiparas)

*Most arrest d/o have cephalopelvic disproportion.
==>C-section
*If they do NOT have cephalopelvic disproportion
==>give oxytocin to stimulate delivery.

[Recall that active phase of labor refers to when uterus goes quickly from 3-4 cm dilation to full dilation)

Front 17

failure of descent:

>1 hr nulliparas,
>1 hr multiparas

labor pattern?

Back 17

arrest d/o

Front 18

pt who presents with contractions. What phase/stage is she in?

Back 18

First stage