9. Complications in Labor Flashcards Preview

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Flashcards in 9. Complications in Labor Deck (54):
1

Types of instrumental Delivery (3)

o Forceps Assisted Birth
o Vacuum-Assisted Birth
o Caesarean Section

2

Indications of instrumental delivery (4)

• Maternal exhaustion
• Ineffective pushing efforts
• Expedite birth
• Cephalopelvic Disproportion (CPD)

3

Classification of forceps is based on the station of the fetal head when the forceps are applied (4)

• Outlet forceps: Fetal head on perineum
• Low forceps: +2 station
• Mid forcep: 0 to +2 station
• High forceps: Above 0 station (not really done anymore)

4

Advantages of forceps

Shortens second stage

5

Risks of forceps (4)

• Neonatal birth trauma (Facial palsy)
• Neonatal respiratory depression
• Postpartum hemorrhage
• Bladder injury

6

Vacuum-Assisted Birth: Def

• Suction with soft or flexible cup on vertex

7

Which is used more: Forceps or Vacuum?

Vacuum

8

Risks of Vacuum-assisted birth (4)

• Cephalohematomoa
• Scalp lacerations
• Subdural hematoma
• Perineal trauma

9

C-Section: Def

• Birth through transabdominal incision of uterus

10

Why is a C-Section done?

• Preserve life / health of mother and baby

11

Indications for a C-Section (9)

• Maternal or fetal distress
• CPD

• Malpresentation (Breech or transverse lie)

• Placental Previa or abruption
• Prolapsed umbilical cord

• Failed induction
• Multi-fetal pregnancies

• Pre-eclampsia / Eclampsia
• Active herpes (HSV) infection

12

Types of C-Sections (types of uterine incisions) (2)

Upper Uterine Segment:
o Classical

Lower Uterine Segment
o Low transverse


13

What types of c-sections enable VBACs later?

Classical - VBAC is contraindicated

Low Transverse - VBAC possible

14

Contraindications of C-Sections (3)

• Fetal death
• Fetus is not expected to survive
• Maternal coagulation defects

15

Maternal risks of C-sections (6)

• Infection, Hemorrhage, UTI, Thrombophlebitis, Atelectasis
• Anesthesia Complications (Pnemonia)

16

Neonatal risks of C-sections (3)

• Inadvertant Preterm birth
• Lacerations
• Bruising or other trauma

17

Major risk of VBAC
(and prevalence)

Uterine rupture (0.5% prevalence)

18

Uterine rupture: Incidence

1 in every 1500 to 2000 births

19

Causes of uterine rupture (6)

• Separation of the scar of a previous classic cesarean birth or uterine trauma
• Congenital uterine anomaly
• Intense spontaneous uterine contractions
• Uterine stimulation (eg oxytocin)
• An over-distended utuerus (eg multifetal gestation)
• Malpresentation

20

Classifications of uterine rupture (2)

• Incomplete uterine rupture:
• Complete uterine rupture:

21

Incomplete uterine rupture (def)

• Rupture extends through the endometrium, myometrium but the peritoneum surrounding the uterus remains intact

22

Complete uterine rupture (def)

• Extends through the entire uterine wall (endometrium, myometrium and peritonium) and uterine contents spill into the abdominal cavity

23

Retained placenta: Causes (3)

• Partial separation
• Abnormal adherence of placenta
• Mismanagement of the 3rd stage of labor

24

Management of retained placenta (3)

• IV sedation or anesthesia
• Manual removal of placenta
• Prophylactic abx therapy

25

Adherent placenta -- 3 types / levels

• Acreta
• Increta
• Percreta

26

Placenta acreta

Slight penetration of myometrium (A-creta = A-little penetration)

27

Placenta increta

Deep penetration of myometrium (In-creta = In- deep)

28

Placenta percreta

Complete perforation of the uterus (Per-creta = Per-foration)

29

Retained placenta: Predisposing factors (3)

• Abnormal site of implantation (placenta grabs onto something abnormal)
• Malformation of the placenta (not as common)
• Scarring of the uterus

30

What would cause scarring of the uterus? (4)

• High parity (scarring of the uterus)
• Previous cesarean section (scarring)
• Previous myomectomy (from removal of fibroids)
• Hx of vigorous curettage / perforation (scraping the lining)

31

Cord Prolapse (def)
• What happens
• Two forms

o Cord lies below the presenting part of the fetus
o May be hidden (occult) or visible (frank)

32

Cord prolapse: Management (3)

• Keep pressure off cord
• Keep moist with saline if it’s that visible
• Birth by c- section

33

How would you keep pressure off of a prolapsed cord?

• Knee-chest position
• Hand in vagina

34

Shoulder dystocia: Def

o Anterior shoulder cannot pass under the pubic arch of the maternal pelvis

35

2 causes of shoulder dystocia

• Macrosomia
• Pelvic anomolies

36

Sxs of shoulder dystocia prior to birth (3)

• Slowing of the progress of labor
• Formation of caput that increases the size
• After birth of head: Turtle sign

37

Management of shoulder dystocia
(4 options)

• Change pelvic diameter
• Snap the clavicle
• Suprapubic Pressure
• McRobert’s Maneuver

38

What is McRobert's Maneuver?

• Supine
• Knees to chest

39

Maternal complications involved with shoulder dystoica (3)

• Uterine atony / rupture: Increased blood loss
• Vaginal lacerations
• Uterine infection (endometritis)

40

Neonatal complications involved with shoulder dystocia (3)

• Clavicle fracture
• Asphyxia → Seizure
• Erb’s palsy: Brachial plexus damage

41

PPH (def)
• Amounts

Greater than average blood loss:
• >500mL of blood after vaginal birth
• >1000mL after c-section

42

Early versus late postpartum hemorrhage

o Early PPH: Occurs within 24 hours PP
o Late PPH: Occurs after 24 hours, but within 6 weeks

43

Most common cause of postpartum hemorrhage

Uterine atony

44

Other (less common) causes of postpartum hemorrhage (6)

• Retained placenta
• Uterine rupture or inversion
• Cervical or vaginal lacerations
• Hematomas
• Infection (endometritis)
• Coagulopathies

45

Definition of uterine atony

Marked hypotonia of the uterus (along with distention, overstimulation or trauma to the uterus)

46

Nursing management of uterine atony (4)

o Bimanual compression
o Pharmacologic interventions
o Uterine exploration
o Surgical interventions - historectomy

47

What pharmacological management is used for uterine atony?
- First line
- Second line

o FIRST LINE: Pitocin

o SECOND LINE: Methergine

48

Pitocin: Dose, routes

• 10-40 units in 100mL LR
• Can also be administered IM

49

Methergine: Dose, route,contraindicaitons

• 0.2 mg IM
• Contraindicated in HTN / PIH

50

Inversion of the uterus sxs (3)

• Hemorrhage
• Pain
• Shock

51

Postpartum infection: Def

Any infection that occurs within 28 days after miscarriage, ETOP and childbirth

52

Postpartum infection: Clinical manifestation / diagnosis

• Fever is > or = to 100.4*F on two successive days of the first 10p days

53

Common postpartum infections (5)

o Endometritis
o Wound infection
o Mastitis
o UTI
o URI

54

Most common organisms for postpartum infections (2)

Streptococcal and anaerobic organisms