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18 Cards in this Set

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prolonged latent phase
[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
prolonged latent phase is associated with
-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
Tx prolonged latent phase
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
protraction D/O:
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
EXAM: which of the following mandates cesarian delivery at term?
cephalopelvic disproportion:
(protracted descent, failure of descent)
arrest d/o
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
EXAM: Pt is fully dilated and pushing for 9 days. What is most appropriate course of action?
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)
second stage of labor
complete dilation==>delivery of baby
-descent mostly occurs in 2nd stage
-cardinal mvmts occur in 2nd stage
prolonged second stage of labor can cause...
1. postpartum hemorrhage and infxn
2. infant mortality doubles
falure of descent
>1 hr null and multi

Tx: with cephalopelvic disproportion==>C-section
et of abnl labor (Obj 2)
"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
-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
EXAM: what mandates C-section
These mandate C-section b/c high perinatal mortality and morbility:
1. Footing breeches (feet delivering first)
2. Breeches weighing > 3500-3800 grams
EXAM: protraction d/o
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
EXAM: descent

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

labor pattern?
protraction d/o
arrest of descent

labor pattern?
>1 hr for nulliparas or multiparas

Tx: if cephalopelvic disproportion
arrest d/o
-how Tx?
-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)


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

*Most arrest d/o have cephalopelvic disproportion.
*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)
failure of descent:

>1 hr nulliparas,
>1 hr multiparas

labor pattern?
arrest d/o
pt who presents with contractions. What phase/stage is she in?
First stage