Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
18 Cards in this Set
- Front
- Back
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:
def? assoc? Tx? |
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
-define -Tx |
>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 (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 |
|
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
-define -Tx? labor pattern? |
>1 hr for nulliparas or multiparas
Tx: if cephalopelvic disproportion ==>C-section |
|
arrest d/o
-define -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) 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) |
|
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
|