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eor - women's health > Labor and Delivery Complications > Flashcards

Labor and Delivery Complications Flashcards

1
Q

labor and delivery complications to know

A

breech presentation
dystocia
fetal distress
premature rupture of membranes
preterm labor
prolapsed umbilical cord

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2
Q

breech birth happens when a baby is born

A

bottom first

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3
Q

prevalence of breech deliveries decreases with

A

increasing gestational age

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4
Q

25% of breech births occur with fetuses < _ weeks old

A

28

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5
Q

tx for breech fetus

A
  1. external cephalic version at/near term
  2. if version is successful: trial of vaginal delivery
  3. if version is unsuccessful: c section
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6
Q

20 yo G2P1 f w. GDM and pre pregnancy BMI 43 presents in labor - labor begins w.o complication but becomes stalled as pt attempts to push shoulders thru - head delivers and then suddenly retracts against pelvis and will not budge

A

shoulder dystocia
aka
obstructed labor

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7
Q

baby does not exit pelvis during childbirth due to being physically blocked despite normal uterine contractions

A

shoulder dystocia/obstructed labor

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8
Q

what does dystocia mean

A

abnormal labor progression

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9
Q

main complication of obstructed labor for baby

A

hypoxia

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10
Q

3 main complications of obstructed labor for mom

A

infxn
uterine rupture
post partum bleeding

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11
Q

3 rf for obstructed labor

A

large or abnormally positioned baby
small pelvis
problems w. birth canal

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12
Q

3 rf for small pelvis

A

malnutrition
vit D deficiency
adolescence

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13
Q

problems w. the birth canal include

A

narrow vagina
narrow perineum

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14
Q

2 causes of narrow vagina/perineum

A

female genital mutilation
tumors

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15
Q

3 categories of dystocia

A

power
passenger
passage

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16
Q

problem of power

A

uterine contractions

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17
Q

problems of passenger

A

presentation
size -> macrosomia
position of fetus -> dystocia

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18
Q

dx of shoulder dystocia

A

PE

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19
Q

what is turtle sign and what does it make you think of

A

retraction of delivered head against maternal perineum

obstructed labor

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20
Q

what might a dystocia’ed (not a real word) baby look like

A

red puffy face

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21
Q

increasingly long time in labor indicates a _ issue,
and makes you concerned about _

A

mechanical
obstructed labor

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22
Q

tx for obstructed labor

A
  1. first try to change maternal positioning
  2. if unsuccessful: c section or vacuum extraction
  3. surgical opening of symphysis pubis (symphysiotomy)… oooooooooowwwwwwie!
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23
Q

tx for shoulder dystocia specifically

A
  1. non manipulative maneuvers: suprapubic pressure, flexion of maternal hips
  2. manipulative maneuvers: rotation of fetal shoulders 180 degrees, delivery of posterior arm
  3. push head back in and do a c section
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24
Q

what is the mcroberts maneuver

A

flexion of maternal hips w. shoulder dystocia’ed baby

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25
Q

what is wood’s corkscrew

A

rotation of the fetal shoulders 180 degrees with shoulder dystocia’ed baby

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26
Q

what is the zavanelli maneuver

A

pushing head of shoulder dystocia’ed baby back up in there for c section

that zavanelli guy was one crazy mofo

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27
Q

fetal tachycardia is defined as:
fetal bradycardia is defined as:

A

tachycardia: > 160 bpm x 10 min
bradycardia: < 120 bpm x 10 min

28
Q

simple, noninvasive way of checking on baby’s health

A

nonstress testing (NST)

29
Q

NST records baby’s (3)

A

movements
heartbeat
contractions

30
Q

what is considered a good NST/fetal well being

A

reactive

2 accelerations in 20 min, indicated by:
increased fetal HR >/= 15 bpm from baseline lasting > 15 sec

31
Q

what is a bad NST

A

nonreactive

no fetal HR accelerations OR < 15 bpm lasting < 15 sec

32
Q

what should you do if you have a pt w. a NST

A

order a contraction test

33
Q

contraction stress test measures

A

fetal response to stress at times of uterus contraction

34
Q

management of NST

A

delivery asap

35
Q

definition of premature rupture of membranes (PROM)

A

rupture of membranes at >/= 37 weeks gestation PRIOR to the start of contractions

36
Q

definition of preterm PROM (PPROM)

A

rupture of membranes at < 37 weeks gestation PRIOR to start of contractions

37
Q

2 major risks of PROM/PPROM

A

infxn
cord prolapse

38
Q

sx of PROM/PPROM

A

sudden gush of clear/pale yellow fluid

39
Q

work up of PROM/PPROM

A

confirm that fluid is amniotic fluid:
-speculum: fluid pooling
-nitrazine test: pH > 7.1 = (+)
-microscopic exam: fern pattern

40
Q

what is “ferning”

A

crystallization of estrogenon microscopic exam of amniotic fluid

41
Q

tx for PROM/PPROM

A

> 34 weeks: induce labor

32-34 weeks: collect fluid, check lung maturity, induce

<32 weeks: stop contractions, 2 doses steroid injxn, deliver, give abx

42
Q

definition of preterm delivery

A

delivery of viable infant before 37 weeks gestation

43
Q

sx of preterm labor

A

-uterine contractions more often than q 10 min
-leaking of fluid from vagina

44
Q

the earlier a baby is born, the greater the risk/severity/variet of complications to infant - which system is esp at risk for complications

A

respiratory

45
Q

earliest age at which a baby has at least 50% chance of survival

A

24 weeks

46
Q

6 rf for preterm labor

A

-smoking
-cocaine
-uterin malformations
-cervical incompetence
-infxn
-low birth weight

47
Q

3 tests useful in preterm delivery

A

fetal fibronectin
placental alpha microglobulin (PAMG-1)
US

48
Q

gs test to differentiate women at high risk for impending preterm delivery

A

fetal fibronectin via cervical/vaginal secretions

49
Q

best predictor of imminent spontaneous delivery w.in 7 days of a pt presenting w. s/sx of preterm delivery

A

placental alpha microglobulin-1 (PAMG-1) aka
PartoSure test

50
Q

usefullness of US in preterm delivery

A

assessment of cervix to determine risk

51
Q

what length of cervix is unfavorable

A

< 25 mm at or before 24 weeks gestation = incompetent cervix

52
Q

tx for preterm labor

A

tocolysis (labor delay via meds):
NSAIDs
nifedipine
beta agonists
atosiban (oxytocin antagonist)

53
Q

moa for tocolytics

A

relax uterus

54
Q

goal of tocolytics

A

delay onset of labor until corticosteroids have been administered for fetal lung maturity < 34 weeks gestation

55
Q

tocolytics rarely delay delivery beyond _ hr

A

24-48

56
Q

what 2 tocolytics together can dely delivery by 2-7 days

A

atosiban (oxytocin antagonist)
PLUS
nifedipine

57
Q

what drug is not a tocolytic, but can reduce risk of cerebral palsy in preterm baby

A

Mg sulfate

58
Q

what drug can reduce risk for preterm delivery in at risk pt

A

progesterone

59
Q

what med when given btw 24-37 weeks gestation can improve fetal outcomes

A

corticosteroids

60
Q

umbilical cord comes out of uterus w. or before the presenting part of the fetus

A

umbilical cord prolapse

61
Q

3 complications of umbilical cord prolapse

A

hypoxia
brain damage
death

62
Q

2 mc rf for umbilical cord prolapse

A

malpresentation
rupture of membranes

63
Q

first sx of umbilical cord prolapse

A

sudden/severe decrease in fetal HR that does not immediately resolve

64
Q

fetal HR tracing would show _ with umbilical cord prolapse

A

mod-severe variable decelerations

65
Q

gs tx for umbilical cord prolapse

A

immediate c section

66
Q

alternate management of prolapsed uterine cord (2)

A

-manueal elevation of presenting fetal part
-repositioning of mother to knee-chest position

eor - women's health (15 decks)

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