Abnormal labor

Question 1

what are the abnormal labor patterns in the 1st stage?

Answer 1

• protraction

- arrest

Question 2

what are the abnormal labor patterns in the active phase of stage 1 labor?

Answer 2

• protraction
• secondary arrest
• combined disorder

Question 3

what is most diminished in a protracted disorder?

Answer 3

rate of cervical change

Question 4

protracted disorders carry what risks?

Answer 4

• secondary arrest

- poor perinatal outcome

Question 5

primary dysfunctional labor is what type of disorder? what is the cause in nulliparous women? multiparous women? what can you do for each?

Answer 5

• protracted
• nulliparous: inadequate uterine activity (hypocontractile - manage with amniotomy and/or oxytocin augmentation)
• multiparous: cephalopelvic disproportion (mange by C-section)

Question 6

an arrest can be called at what cervical dilation size?

Answer 6

6 cm

Question 7

what needs to be excluded before calling a secondary arrest?

Answer 7

malpresentation

Question 8

what can be administered to augment labor when 1st stage protraction or arrest disorders are noted?

Answer 8

oxytocin

Question 9

what are the risks of IV oxytocin?

Answer 9

• uterine hyperstimulation
• water intoxication
• hypotension if bolused
• uterine rupture

Question 10

what is a combined disorder? how is it managed?

Answer 10

• arrest of dilation when pt has previously shown primary dysfunctional labor
• managed by C-section

Question 11

what are the abnormal labor patterns in the 2nd stage?

Answer 11

• protracted descent

- arrested descent

Question 12

what is the best management for protraction of descent during stage 2 of labor?

Answer 12

expectant management (if everything else is going okay with the fetus)

Question 13

what are the adverse maternal outcomes during arrest?

Answer 13

• hemorrhaage
• trauma
• chorioamnionitis

Question 14

definition: episiotomy

Answer 14

incision into the perineal body maade during second stage labor to facilitate delivery

Question 15

what are the indications for an episiotomy?

Answer 15

• arrest or protracted descent
• shoulder dystocia
• instrument (operative) delivery
• expedite delivery if abnormal fetal heart pattern

Question 16

what are the benefits of a midline episiotomy? risks?

Answer 16

BENEFITS:

• straight
• reduction of second stage
• reduction of trauma to pelvic floor muscles

RISKS:

• increased blood loss (if too early)
• potential fetal injury
• localized pain
• increased incidence of 3rd and 4th degree lacerations
• long term incontinence and pelvic prolapse

Question 17

what are the benefits of a mediolateral episiotomy? risks?

Answer 17

BENEFITS:

• less damage to anal sphincter
• better for IBD

RISKS:

• unsatisfactory cosmetic result
• inclusion cysts within scar
• greater blood loss

Question 18

what type of episiotomy is good for patients with IBD?

Answer 18

mediolateral

Question 19

3rd degree episiotomy laceration? 4th?

Answer 19

3rd - into anal sphincter

4th - into rectum

Question 20

what is the McRoberts maneuver? what is it used for?

Answer 20

• mother brings knees up to armpits

- used to aid in delivery of fetus with possible shoulder dystocia

Question 21

definition: operative vaginal delivery

Answer 21

any operative procedure designed to effect vaginal deliver (forceps, vacuum)

Question 22

what are the maternal indications for using forceps / operative delivery?

Answer 22

• maternal exhaustion
• inadequate expulsive efforts
• lack of expulsive efforts
• need to avoid maternal expulsive efforts

Question 23

what are the fetal indications for using forceps / operative delivery?

Answer 23

• nonreassuring fetal heart tracing

- prolonged second stage

Question 24

what are the necessary criteria for delivering a baby with forceps?

Answer 24

• head first
• known position
• engaged in pelvis
• station greater than or equal to 2
• attitude of vertex, presence of caput or moulding

Question 25

what are the maternal risks of forceps?

Answer 25

- perineal injury - vaginal and cervical lacerations - postpartum hemorrhage

Question 26

what are the fetala risks of forceps?

Answer 26

- intracranial hemorrhage - cephalic hematoma - facial / brachial palsy - injury to soft tissues of face and forehead - skull fracture

Question 27

what are the maternal indications for C-section?

Answer 27

- obstructive benign and malignant tumors - large vulvar condyloma - abdominal cervical cerclage (stitch in cervix) - prior vaginal colporrhaphy - prior classical cesarean delivery or full thickness myomectomy - prior uterine rupture

Question 28

what are the maternal-fetal indications for C-section?

Answer 28

- cephalopelvic disproportion - failure to progress or arrest - placental abruption - placenta previa - uterine dehiscence or prior classical uterine scar - maternal request (controversial) - large pelvic mass

Question 29

what are the fetal indications for C-section?

Answer 29

- nonreassuring fetal heart tracing - malpresentation - HSV - ITP - major congenital abnormalities - cord prolapse

Question 30

what are the risks of C-section?****

Answer 30

- blood loss - infection - injury - thrombotic events / PE - risk of future C-sections - maternal mortality about 10x greater than vaginal births