Ricci chapter 21 UPDATED ACTUAL
Exam Questions and CORRECT Answers
Dystocia - CORRECT ANSWER - defined as abnormal or difficult labor, can be
influenced by a vast number of maternal and fetal factors. Dystocia is said to exist when the
progress of labor deviates from normal; it is characterized by a slow and abnormal progression of
labor. It occurs in approximately 8% to 11% of all labors and is the leading indicator for primary
cesarean birth in the United States (Joy, Lyon, & Scott, 2015).
dystocia usually becomes apparent phase of labor. - however cannot be predicted when it will
occur
Because dystocia cannot be predicted or diagnosed with certainty, the term "failure to progress"
is often used. This term includes lack of progressive cervical dilation, lack of descent of the fetal
head, or both. An adequate trial of labor is needed to declare with confidence that dystocia or
"failure to progress" exists.
. The most common indications for primary cesarean births include, in order of frequency, labor
dystocia, abnormal fetal heart rate tracing, fetal malpresentation, multiple gestations, and
suspected macrosomia
Labors today are often longer which may in part be due to higher body mass index (BMI), higher
rates of labor induction, and the significant increase in the use of epidural anesthesia (ACOG,
2014a).
Admitting women too early to the hospital while still in the early latent phase of labor may
increase the diagnosis of dystocia and increase the risk of augmentation of labor and epidural
analgesia. These two interventions may cascade into a surgical birth. Adequate hydration, rest,
emotional and physical support, and, if needed, pharmacologic sedation can be encouraged as
alternatives to early hospital admission. Patience should be the critical factor here.
Risks for dystocia - CORRECT ANSWER - * Epidural analgesia/excessive analgesia -
keeps patient from being able to push abnormally.
* Multiple gestation
* Hydramnios
, * Maternal exhaustion
* Ineffective maternal pushing technique
* Occiput posterior position
* Longer first stage of labor - makes a longer and difficult labor
* Nulliparity, short maternal stature
* Fetal birth weight over 8.8 lb
* Shoulder dystocia - where shoulder gets stuck under the pelvis.
* Abnormal fetal presentation or position-
* Fetal anomalies
* Maternal age over 35 years
* High caffeine intake
* Overweight
* Gestational age over 41 weeks
* Chorioamnionitis
* Ineffective uterine contractions
* High fetal station at complete cervical dilation - baby hasnt dropped down but fully dilated
when this happens a procedure called laboring down is done where contractions push the baby
down.
Dystocia causes (powers) - CORRECT ANSWER - * Problems with powers
* Hypertonic uterine dysfunction - pain on contractions but does not relax contractions are
painful and intense. Women in this situation experience a prolonged latent phase, stay at 2 to 3
cm, and do not dilate as they should. Placental perfusion becomes compromised, thereby
reducing oxygen to the fetus. These hypertonic contractions exhaust the mother, who is
experiencing frequent, intense, and painful contractions with little progression. This
dysfunctional pattern occurs in early labor and affects nulliparous women more than multiparous
women (Ricci 758)
* Hypotonic uterine dysfunction - poor uterine contractions that are not strong enough to dilate
the cervix occurs during active labor (dilation more than 5 to 6 cm) when contractions become
poor in quality and lack sufficient intensity to dilate and efface the cervix. Factors associated
with this abnormal labor pattern include overstretching of the uterus, a large fetus, multiple
Exam Questions and CORRECT Answers
Dystocia - CORRECT ANSWER - defined as abnormal or difficult labor, can be
influenced by a vast number of maternal and fetal factors. Dystocia is said to exist when the
progress of labor deviates from normal; it is characterized by a slow and abnormal progression of
labor. It occurs in approximately 8% to 11% of all labors and is the leading indicator for primary
cesarean birth in the United States (Joy, Lyon, & Scott, 2015).
dystocia usually becomes apparent phase of labor. - however cannot be predicted when it will
occur
Because dystocia cannot be predicted or diagnosed with certainty, the term "failure to progress"
is often used. This term includes lack of progressive cervical dilation, lack of descent of the fetal
head, or both. An adequate trial of labor is needed to declare with confidence that dystocia or
"failure to progress" exists.
. The most common indications for primary cesarean births include, in order of frequency, labor
dystocia, abnormal fetal heart rate tracing, fetal malpresentation, multiple gestations, and
suspected macrosomia
Labors today are often longer which may in part be due to higher body mass index (BMI), higher
rates of labor induction, and the significant increase in the use of epidural anesthesia (ACOG,
2014a).
Admitting women too early to the hospital while still in the early latent phase of labor may
increase the diagnosis of dystocia and increase the risk of augmentation of labor and epidural
analgesia. These two interventions may cascade into a surgical birth. Adequate hydration, rest,
emotional and physical support, and, if needed, pharmacologic sedation can be encouraged as
alternatives to early hospital admission. Patience should be the critical factor here.
Risks for dystocia - CORRECT ANSWER - * Epidural analgesia/excessive analgesia -
keeps patient from being able to push abnormally.
* Multiple gestation
* Hydramnios
, * Maternal exhaustion
* Ineffective maternal pushing technique
* Occiput posterior position
* Longer first stage of labor - makes a longer and difficult labor
* Nulliparity, short maternal stature
* Fetal birth weight over 8.8 lb
* Shoulder dystocia - where shoulder gets stuck under the pelvis.
* Abnormal fetal presentation or position-
* Fetal anomalies
* Maternal age over 35 years
* High caffeine intake
* Overweight
* Gestational age over 41 weeks
* Chorioamnionitis
* Ineffective uterine contractions
* High fetal station at complete cervical dilation - baby hasnt dropped down but fully dilated
when this happens a procedure called laboring down is done where contractions push the baby
down.
Dystocia causes (powers) - CORRECT ANSWER - * Problems with powers
* Hypertonic uterine dysfunction - pain on contractions but does not relax contractions are
painful and intense. Women in this situation experience a prolonged latent phase, stay at 2 to 3
cm, and do not dilate as they should. Placental perfusion becomes compromised, thereby
reducing oxygen to the fetus. These hypertonic contractions exhaust the mother, who is
experiencing frequent, intense, and painful contractions with little progression. This
dysfunctional pattern occurs in early labor and affects nulliparous women more than multiparous
women (Ricci 758)
* Hypotonic uterine dysfunction - poor uterine contractions that are not strong enough to dilate
the cervix occurs during active labor (dilation more than 5 to 6 cm) when contractions become
poor in quality and lack sufficient intensity to dilate and efface the cervix. Factors associated
with this abnormal labor pattern include overstretching of the uterus, a large fetus, multiple
