High-Risk Pregnancy Intrapartum Notes
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Questions and Answers

What condition is indicated by a prolonged deceleration phase in labor?

  • Cervical dilation accelerating beyond normal
  • Immediate delivery without complications
  • Protracted labor with minimal contractions
  • Secondary arrest of dilation (correct)

    • Which management option is typically used for prolonged descent during labor?

  • Administration of analgesics for pain relief
  • C-section as the primary intervention
  • Oxytocin and amniotomy to facilitate labor (correct)
  • Tocolytics to relax uterine muscles

    • In which scenario is a C-section considered necessary during labor?

  • Fetal malposition leading to arrest of descent (correct)
  • Data suggests rapid delivery with oxytocin
  • Effective contractions with gradual cervical dilation
  • Delivery achieved without complications

    • What characterizes precipitate labor?

    <p>Rapid and intense contractions leading to quick delivery (A)</p> Signup and view all the answers

    During active labor, a primi patient should expect to experience cervical dilation at what rate?

    <p>6 cm/hr for primi (A)</p> Signup and view all the answers

    What is the defining characteristic of dysfunctional labor?

    <p>Sluggishness of contraction (B)</p> Signup and view all the answers

    In which phase of labor does hypotonic uterine contraction typically manifest?

    <p>Active phase (D)</p> Signup and view all the answers

    Which medication is primarily administered for hypotonic contractions?

    <p>Oxytocin (C)</p> Signup and view all the answers

    What is a common side effect of oxytocin administration?

    <p>Hypotension (B)</p> Signup and view all the answers

    What distinguishes hypertonic contractions from hypotonic contractions?

    <p>Timing of occurrence (D)</p> Signup and view all the answers

    What should be monitored every 15 minutes when administering oxytocin?

    <p>Uterine contraction and fetal heart rate (B)</p> Signup and view all the answers

    Which management option may be necessary for a prolonged latent phase of labor?

    <p>Amniotomy (C)</p> Signup and view all the answers

    What cervical dilation rate indicates a protracted active phase of labor?

    <p>&lt; 1.2 cm/hr (A)</p> Signup and view all the answers

    Which management option is appropriate for treating uterine inversion?

    <p>Hysterectomy (B)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for uterine rupture?

    <p>Cervical lacerations (A)</p> Signup and view all the answers

    What clinical finding can indicate the presence of a pathologic retraction ring?

    <p>Fundus not palpable (A)</p> Signup and view all the answers

    What is a potential consequence of amniotic fluid embolism?

    <p>Cyanosis (D)</p> Signup and view all the answers

    Which of the following is a significant risk factor for amniotic fluid embolism?

    <p>Hydramnios (C)</p> Signup and view all the answers

    What is a common management strategy for a patient experiencing fetal heart tones absent during labor?

    <p>Emergency laparotomy/hysterectomy (A)</p> Signup and view all the answers

    What condition occurs when the uterus turns inside out during or after childbirth?

    <p>Uterine inversion (A)</p> Signup and view all the answers

    What is the most common management approach for patients with suspected amniotic fluid embolism?

    <p>ICU admission (C)</p> Signup and view all the answers

    Flashcards

    Protracted nullipara

    Labor duration exceeds 12 hours in nullipara (first-time mother).

    Fetal malposition

    Abnormal position of the fetus affecting labor progress.

    Dysfunctional Labor

    Labor characterized by inadequate contractions or timing, also known as inertia.

    Secondary Arrest of Dilatation

    No progress in cervical dilation for 2 hours in multipara; 3 hours in nullipara.

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    Hypotonic Uterine Contraction

    Weak, ineffective uterine contractions during labor.

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    Oxytocin Management

    Administered to enhance contractions; requires monitoring of FHR and contractions.

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    Prolonged Deceleration Phase

    Abnormal prolonged fetal heart rate deceleration during labor.

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    Precipitate Labor

    Rapid labor with delivery completed in less than 3 hours.

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    Hypertonic Contractions

    Painful contractions occurring in the latent phase, often leading to uterine dyssynchrony.

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    Prolonged Latent Phase

    Latent phase lasts more than 20 hours in nullipara or 14 hours in multipara.

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    Protracted Active Phase

    Cervical dilation rate of less than 1.2 cm/hr during active labor.

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    Management of Labor Dysfunction

    Includes amniotomy, oxytocin, tocolytics, and C-section if needed.

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    Uterine Dyssynchrony

    Uncoordinated contractions due to different uterine pacemakers causing ineffective labor.

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    Premature placental separation

    Early separation of the placenta from the uterus before delivery, which can cause complications.

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    Risk factors for uterine rupture

    Several potential causes that increase the likelihood of uterine rupture during labor, including prolonged labor and prior cesareans.

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    Cervical dilation stages

    Stages indicating the opening of the cervix during labor, from 0 (closed) to 10 centimeters (fully dilated).

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    Inversion of the uterus

    Condition where the uterus turns inside out, often following childbirth, causing risk of shock.

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    Oxytocin administration

    Use of the hormone oxytocin to induce or augment labor, may contribute to uterine contractions.

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    Amniotic fluid embolism

    Serious condition where amniotic fluid enters the maternal circulation, causing shock and respiratory issues.

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    Uterine rupture signs

    Symptoms indicating potential rupture of the uterus during labor, including symptoms of shock and absent fetal heart tones.

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    Management of uterine inversion

    Treatment procedures for uterine inversion, primarily hysterectomy and administration of oxytocin.

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    Study Notes

    High-Risk Pregnancy Intrapartum Powerpoint Notes

    • Dysfunctional Labor: Also known as "inertia," it denotes sluggish uterine contractions.

    • Classification: Primary (occurring at the onset of labor) or secondary (occurring later in labor).

    • Uterine Contractions:

      • Normal: Interval 2-2 1/2, Duration 30-90 seconds, Intensity 40-50 mmHg.
      • Hypertonic: Interval <2, Duration asynchronous, Intensity >50 mmHg.
      • Hypotonic: Interval >5, Duration synchronous, Intensity <30 mmHg.

    • Hypotonic Uterine Contractions (Etiology):

      • Contractions: Not more than 2 or 3 in a 10-minute period.
      • Resting Tone: Less than 10 mmHg.
      • Strength of contractions: does not rise above 25 mmHg.
      • Labor Phase: Active.
      • Symptom: Painless.

    • Hypotonic Contraction Management:

      • Oxytocin: Given as a piggyback.
      • Monitor uterine contractions and FHR every 15 minutes.
      • Keep Magnesium sulfate at bedside if uterine tetany occurs.
      • Side Effects: Hypotension, dizziness, nausea/vomiting, tachycardia, fetal tachycardia or bradycardia, hypertonic contractions, decreased urine output.

    • Hypertonic Contractions:

      • Resting Tone: More than 15 mmHg.
      • Frequent, prolonged contractions that are not productive.
      • Labor Phase: Latent.
      • Symptom: Painful.
      • Cause: Muscle fibers of the myometrium do not repolarize or relax after a contraction, preventing the acceptance of a new pacemaker stimulus.

    • Hypertonic Contraction Management:

      • Treatment with intact membranes.
      • Rest., Hydration, Sedatives.
      • Tocolytics.

    • Comparison of Hypertonic and Hypotonic Contractions:

      • Hypertonic: Latent phase, painful, unfavorable to oxytocin, helpful to sedation.
      • Hypotonic: Active phase, limited pain, favorable to oxytocin, little value to sedation.

    • Uterine Dyssynchrony: Uncoordinated contractions, acting independently of the pacemaker, can interfere with blood supply to the placenta.

    • Dysfunctional Labor (1st Stage):

      • Prolonged latent phase.
      • Protracted active phase.
      • Prolonged deceleration phase.
      • Secondary arrest of dilation.

    • Lengths of Labor Phases (Table): Provides average time frames for nulliparous and multiparous women for latent phase, active phase, second stage, and placenta stage.

    • Prolonged Latent Phase: Latent phase lasting >20 hours (nulliparous) or >14 hours (multiparous).

      • Causes: Unripe cervix, excessive analgesia, excessive tocolytics, pain relief.
      • Management: Supportive care, decrease stimulation, amniotomy, oxytocin, C-section.

    • Protracted Active Phase: Cervical dilation <1.2 cm/hr (nulliparous) or <1.5 cm/hr (multiparous) in duration >12 hours (primi) or 6 hrs(multi).

      • Causes: Fetal malposition, CPD, ineffective myometrial activity.
      • Management: C-section, oxytocin.

    • Prolonged Deceleration Phase: Descent exceeding 3 hrs (nulliparous) or 1 hr (multiparous).

      • Causes: Fetal head malposition.
      • Management: C-section.

    • Secondary Arrest of Dilation: No progress in cervical dilation >2 hours.

      • Management: C-section.

    • Complications with Power (graphs): Illustrates normal and abnormal patterns of labor progression showing cervical dilation and station over the time.

    • 2nd Stage Dysfunctional Labor (Prolonged Descent & Arrest of Descent):

      • Prolonged Descent: Descent <1 cm/hr (nullipara), <2 cm/hr (multipara).
      • Arrest of Descent: No descent for 2 hrs (nullipara); 1 hr (multipara).

    • Management: Oxytocin, amniotomy, positioning, C-section (trial labor).

    • Precipitate Labor: Strong, few, rapidly occurring uterine contractions, delivery completed in <3 hours, Cervical dilation 5 cm/hr (primi) or 10 cm/hr (multi).

      • Risks: Premature placental separation, cervical/perineal lacerations, fetal head injury.
      • Management: Tocolytics, sedatives, pain relief.

    • Induction and Augmentation: Procedures to initiate or accelerate labor.

    • Cervical Ripening: The process of preparing the cervix for dilation before labor. Includes information on dilation, effacement percentages, station, consistency, and position.

    • Oxytocin: A hormone used to induce or augment labor.

    • Uterine Rupture: Rare complication (5% maternal deaths), caused by contributing factors.

      • Contributing Factors: Pathologic retraction ring, S/Sx of shock, FHT absent.
      • Clinical Findings: Classic C-section, prolonged labor, multiple pregnancy, traumatic labor.
      • Management: Emergency laparotomy/Hysterectomy, fluid, blood transfusion.

    • Inversion of the Uterus: Uterus turning inside out.

      • Clinical Findings: Fundus may protrude from vagina, fundus not palpable, S/Sx of shock.
      • Management: Do not replace the uterus/placenta. If necessary, hysterectomy, oxytocin.

    • Amniotic Fluid Embolism: Amniotic fluid entering the maternal circulation, potentially fatal if not treated.

      • Causes: Meconium, fetal sheds, oxytocin administration, PROM, hydramnios, abruptio placentae.
      • Clinical Findings: Chest pain, dyspnea, cyanosis, pulmonary artery HTN, DIC.
      • Management: Intubation/MV, CPR, ICU admission.

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    High-Risk Pregnancy Intrapartum Powerpoint PDF

    Description

    Explore the critical aspects of high-risk pregnancy during the intrapartum period. This quiz delves into dysfunctional labor, classifications, and management strategies for hypotonic uterine contractions. It’s essential for those studying obstetrics and labor management.

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