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OB > 9. Complications in Labor > Flashcards

9. Complications in Labor Flashcards

(54 cards)

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1
Q

Types of instrumental Delivery (3)

A

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

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2
Q

Indications of instrumental delivery (4)

A
  • Maternal exhaustion
  • Ineffective pushing efforts
  • Expedite birth
  • Cephalopelvic Disproportion (CPD)
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3
Q

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

A
  • 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)
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4
Q

Advantages of forceps

A

Shortens second stage

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5
Q

Risks of forceps (4)

A
  • Neonatal birth trauma (Facial palsy)
  • Neonatal respiratory depression
  • Postpartum hemorrhage
  • Bladder injury
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6
Q

Vacuum-Assisted Birth: Def

A

• Suction with soft or flexible cup on vertex

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7
Q

Which is used more: Forceps or Vacuum?

A

Vacuum

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8
Q

Risks of Vacuum-assisted birth (4)

A
  • Cephalohematomoa
  • Scalp lacerations
  • Subdural hematoma
  • Perineal trauma
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9
Q

C-Section: Def

A

• Birth through transabdominal incision of uterus

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10
Q

Why is a C-Section done?

A

• Preserve life / health of mother and baby

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11
Q

Indications for a C-Section (9)

A
  • 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
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12
Q

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

A

Upper Uterine Segment:
o Classical

Lower Uterine Segment
o Low transverse

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13
Q

What types of c-sections enable VBACs later?

A

Classical - VBAC is contraindicated

Low Transverse - VBAC possible

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14
Q

Contraindications of C-Sections (3)

A
  • Fetal death
  • Fetus is not expected to survive
  • Maternal coagulation defects
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15
Q

Maternal risks of C-sections (6)

A
  • Infection, Hemorrhage, UTI, Thrombophlebitis, Atelectasis

* Anesthesia Complications (Pnemonia)

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16
Q

Neonatal risks of C-sections (3)

A
  • Inadvertant Preterm birth
  • Lacerations
  • Bruising or other trauma
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17
Q

Major risk of VBAC

and prevalence

A

Uterine rupture (0.5% prevalence)

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18
Q

Uterine rupture: Incidence

A

1 in every 1500 to 2000 births

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19
Q

Causes of uterine rupture (6)

A
  • 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
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20
Q

Classifications of uterine rupture (2)

A
  • Incomplete uterine rupture:

* Complete uterine rupture:

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21
Q

Incomplete uterine rupture (def)

A

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

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22
Q

Complete uterine rupture (def)

Study These Flashcards
A

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

23
Q

Retained placenta: Causes (3)

Study These Flashcards
A
  • Partial separation
  • Abnormal adherence of placenta
  • Mismanagement of the 3rd stage of labor
24
Q

Management of retained placenta (3)

Study These Flashcards
A
  • 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

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