1
Q
Time-honored term to denote sluggishness of contractions
A
Inertia
2
Q
The force of labor is less than usual
A
Inertia
3
Q
Dysfunction can occur at any point in labor but it is generally classified as
A
Primary (occurring at the onset of labor)
Secondary (occurring later in labor)
4
Q
Having a prolonged labor are usually at risks of what conditions
A
- Postpartum infection
- Hemorrhage
- Infant mortality
5
Q
Factors that can lead to having a prolonged labor
A
- Fetus is large
- Contractions are hypotonic, hypertonic, or uncoordinated
6
Q
Components of Pregnancy
A
Power
Passenger
Passageway
Psyche
Placenta
7
Q
Force that propels the fetus
A
Power
8
Q
It refers to the fetus itself
A
Passenger
9
Q
It refers the birth canal
A
Passageway
10
Q
Perception of events both the birthing parent’s and the family
A
Psyche
11
Q
2 phases of Uterine Contraction
A
Contraction (systole)
Relaxation (diastole)
12
Q
Cervical dilatation during active phase
A
Nullipara - 1.2cm/hr
Multipara - 1.5cm/hr
13
Q
Denotes sluggishness of contractions or force of labor
Dysfunctional labor
A
Inertia
14
Q
Number of contractions is unusually low or infrequent
Resting tone remains less than 10mmHg
A
Hypotonic Contractions
15
Q
Signs of Hypotensive Shock
A
- Rapid, weak pulse
- Falling blood pressure
- Cold, clammy skin
- Dilatation of the nostrils from air starvation
16
Q
Strength does not rise above 25mmHg
May occur after administration of analgesia or if there is bladder distention
A
Hypotonic Contractions
17
Q
Hypotonic Contractions may occur at what conditions?
A
- May occur after administration of analgesia
- Bladder distention is present
18
Q
Occurs in the uterus which is overstretched, larger than usual single fetus, polyhydramnios, or lax uterus
A
Hypotonic Contractions
19
Q
Management of Hypotonic Contractions
A
- Palpate the uterine fundus
- Obtain the patient’s blood pressure
- Assess the amount of lochia every 15 minutes
20
Q
Increasing in resting tone to more than 15mmHg
A
Hypertonic Contractions
21
Q
Occurs frequently in the latent phase of labor
More painful, myometrium becomes tender because of lack of relaxation
A
Hypertonic Contractions
22
Q
Uterine pacemakers arise in other areas of the uterus
A
Hypertonic Contractions
23
Q
What are the possible dangers? (having problems in power of contractions)
A
- Could lead to fetal anoxia
- Contractions are strong but ineffective
24
Q
Management of Hypertonic Contractions
A
- Apply external uterine and fetal monitor
- Prepare for possible cesarean birth
25
More than one pacemaker may be initiating contractions or receptor points in the myometrium may be acting independently
Uncoordinated Contractions
26
Occur erratically, may be difficult for a woman to rest between contractions
Uncoordinated Contractions
27
Management for Uncoordinated Contractions
1. Apply uterine and fetal monitor
2. Administer oxytocin
28
Dysfunction at the First Stage of Labor
Give the 4 phases
1. Prolonged Latent Phase
2. Protracted Active Phase
3. Prolonged Deceleration Phase
4. Secondary Arrest of Dilatation
29
Dysfunction at the First Stage of Labor
Latent phase that is longer than 20hrs in a nullipara or 14hrs in multipara
Prolonged Latent Phase
30
Dysfunction at the First Stage of Labor
It may occur if the cervix is not "ripe" at the beginning
Prolonged Latent Phase
31
Management of Prolonged Latent Phase
1. Rest the uterus
2. Adequate hydration
3. Pain relief - morphine sulfate or epidurals
4. Providing comfort measures (decrease noise and stimulation, etc.)
5. Oxytocin administration
6. Amniotomy
7. Cesarean birth
32
Etiology of Prolonged Latent Phase
1. Longing to complete the pregnancy
2. Having difficulty managing the uncertainty
33
Dysfunction at the First Stage of Labor
Usually associated with cephalo-pelvic disproportion or fetal malposition
Protracted Active Phase
34
Protracted Active Phase is usually associated with what conditions?
1. Cephalo-Pelvic Disproportion (CPD)
2. Fetal malposition
35
Dysfunction at the First Stage of Labor
Prolonged if cervical dilatation does not occur at a rate of 1.2cm/hr in a nullipara or 1.5cm/hr in a multipara
Protracted Active Phase
36
Dysfunction at the First Stage of Labor
Active phase is longer than 6hrs in multigravida
Protracted Active Phase
37
Management of Protracted Active Phase
1. Cesarean birth
2. Augmentation of labor
38
Dysfunction at the First Stage of Labor
A deceleration phase has become prolonged when it extends beyond 3hrs in a nullipara and 1hr in multipara
Prolonged Deceleration Phase
39
Dysfunction at the First Stage of Labor
A prolonged deceleration phase most often results from abnormal fetal head position
Prolonged Deceleration Phase
40
Dysfunction at the First Stage of Labor
Cesarean births is frequently required during this phase
Prolonged Deceleration Phase
41
A prolonged deceleration phase is most often results from what condition?
Abnormal fetal head position
42
Dysfunction at the First Stage of Labor
Occurs if there is no progress in cervical dilatation for longer than 2hrs
Secondary Arrest of Dilatation
43
Dysfunction at the First Stage of Labor
Cesarean birth may be necessary during this phase
Secondary Arrest of Dilatation
44
Dysfunction at the Second Stage of Labor
Give the 2 phases
1. Prolonged Decent
2. Arrest of Decent
45
Dysfunction at the Second Stage of Labor
Contractions have been of good quality and proper duration
Prolonged Decent
46
Dysfunction at the Second Stage of Labor
Contractions become infrequent and poor quality
Prolonged Decent
47
Dysfunction at the Second Stage of Labor
Management for Prolonged Decent
1. Rest
2. Fluid intake
3. IV oxytocin
4. Artificial rupture of membranes
48
Dysfunction at the Second Stage of Labor
Results when no descent has occurred for 1hr in multipara and 2hrs in nullipara
Arrest of Decent
49
Dysfunction at the Second Stage of Labor
Expected descent or engagement does not occur
Arrest of Decent
50
Interferes with fetal descent
Pathologic Retraction Ring (Bandl's Ring)
51
Hard band forms across the uterus, at the junction of the upper and lower uterine segment
Pathologic Retraction Ring (Bandl's Ring)
52
Fetus is gripped and cannot advance beyond the point
Pathologic Retraction Ring (Bandl's Ring)
53
Dangers associated with Pathologic Retraction Ring
1. Uterine rupture
2. Neurologic damage to fetus
54
Management for Pathologic Retraction Ring (Bandl's Ring)
1. IV morphine sulfate
2. Tocolytic agents
3. Emergency CS
55
Occurs when the uterus undergoes more strain than it is capable of sustaining
Uterine Rupture
56
Contributing factors of Uterine Rupture
1. Prolonged labor
2. Abnormal presentation
3. Multiple gestation
4. Unwise use of oxytocin
5. Obstructed labor
6. Traumatic maneuvers of forceps or traction
57
Contraction stop two distinct swellings are visible
Complete rupture
58
Complete Uterine Rupture, contraction stops at two distinct locations
1. Extrauterine fetus
2. Retracted uterus
59
Localized replacement therapy
Persistent, aching pain at the lower uterine segment
Incomplete rupture
60
Incomplete Uterine Rupture can be confirmed by what diagnostic procedure?
Ultrasound
61
Management for Uterine rupture
1. Fluid replacement therapy
2. IV oxytocin - for contraction and to minimize bleeding
3. Possible laparotomy (hysterectomy or tubal ligation) - to control bleeding
62
Uterus turns inside out
Inversion of the Uterus
63
May occur if tractions is applied to the umbilical cord to remove the placenta
Inversion of the Uterus
64
Signs of Inverted Uterus
Sudden gush of blood
Fundus not palpable in the abdomen
Signs of blood loss
65
Management for Inverted Uterus
1. Never replace the inversion - handling of the uterus could increase the bleeding
2. Never attempt to remove the placenta if it is still attached - it creates a larger surface area for bleeding
3. Start an IV fluid line (large-gauge needle)
4. Administration of oxygen by mask
5. Assess vital signs
6. Tocolytic agents to relax the uterus
7. General anesthesia or possible nitroglycerin
8. Manual replacement
9. Administration of oxytocin
10. Antibiotic therapy - to prevent infection
66
Amniotic fluid is forced into an open maternal uterine blood sinus through defects in the membrane, rupture of the membrane, premature separation of the placenta
Amniotic Fluid Embolism
67
Women in strong labor sits up suddenly grasp her chest because of sharp pain and inability to breathe
Amniotic Fluid Embolism
68
Signs and Symptoms of Amniotic Fluid Embolism
Blood pressure may drop significantly with loss of diastolic measurement
Hypotension
69
Signs and Symptoms of Amniotic Fluid Embolism
Labored breathing and tachypnea may occur
Dyspnea
70
Signs and Symptoms of Amniotic Fluid Embolism
Tonic-clonic seizures are seen in 50% of patients
Seizure
71
Signs and Symptoms of Amniotic Fluid Embolism
Usually a manifestation of dyspnea
Cough
72
Signs and Symptoms of Amniotic Fluid Embolism
As hypoxia/hypoxemia progresses, circumoral and peripheral cyanosis and changes in mucous membranes may manifest
Cyanosis
73
Signs and Symptoms of Amniotic Fluid Embolism
In response to the hypoxic insult, FHR may drop to less than 110bpm
Fetal Bradycardia
74
Signs and Symptoms of Amniotic Fluid Embolism
This is usually identified on chest radiograph
Pulmonary edema
75
Signs and Symptoms of Amniotic Fluid Embolism
1. Hypotension
2. Dyspnea
3. Seizures
4. Cough
5. Cyanosis
6. Fetal Bradycardia
7. Pulmonary Edema
8. Cardiac Arrest
9. Uterine Atony
10. Coagulopathy or severe hemorrhage in absence of other explanation (DIC)
11. Altered mental status/confusion/agitation
76
Management of Amniotic Fluid Embolism
1. Oxygen administration
2. Flat or in a slight Trendelenburg position - to improve the venous blood return and perfusion of the CNS
3. Fluid therapy
4. Administration of pharmacological agents
5. Electrocardiographic monitoring to detect and treat arrhythmias
MCN 2 Lec (Midterms)
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