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Flashcards in abnormal labour Deck (27):
1

what can this be due to

faults in powers, passages or passengers

2

what features of the passenger can make it abnormal

presentation and size

3

what presentations of fetus require C section

transverse and brow

4

what can happen if the fetus presentation is face or OP

fail to progress

5

what can be due to passages

cephalopelvic disproportion- if diametes are unfavourable and/or head is big

6

where do contractions start

fundus

7

when is it a problem with the powers

uterine dysfunction- lack of cervical dilatation over 2h and weak contractions

8

what can the contractions be divided into

hypotonic- decr resting tone, low contraction peak. normotonic- but too infreq or may be coupled

9

if the membranes are intact what can you try

amniotomy

10

if cervical dilatation is

oxytocin

11

management prolonged latent

no treatment or rupture of membranes

12

management prolonged active

rupture membranes or oxytocin

13

what is shoulder dystocia

inability to deliver shoulders after head delivered- gentle downward traction fails

14

what can occur with shoulder dystocia

PPH, perineal tears, brachial plexus injury- Erbs palsy

15

what is the danger in shoulder dystocia

asphyxia, cord squashed

16

associations shoulder dystocia

large/postdate baby, induced/oxytocin, prolonged labour-1st or 2nd stage, assisted vaginal delivery, prev shoulder dystocia

17

management dystocia

McRoberts position, apply suprapubic pressure 30s, rotate by 180so post shoulder now lies ant, episiotomy, get mother into all fours position, maternal symphiosotomy, cleidotomy (cutting through clavicles)

18

what is prolapsed cord

descent of the cord through the cervix either alongside (occulta) or in front of (overt) the presenting part in presence of ruptured membranes

19

why is prolapsed cord an emergency

as cord compression causes asphyxia

20

risk factors cord prolapse

2nd twin, footling breech, shoulder presentation, polyhydramnios, unengaged head, transverse lie, male

21

management prolapse if cord presentation noted before rupture of membranes

c section

22

when could cord prolapse occur iatrogenically

rupture of membranes, external cephalic version

23

signs prolapse

obvious if at the inoitrus, if not- bradycardia and variable decels- needs to do vaginal exam

24

management prolapse

keep the cord in vagina, stop presenting part from occluding cord. displace presenting part by putting a hand in vagina and push up, place woman head down. catheter and saline into bladder. tocolytics.

25

what tocolytics can be used in cord prolapse

terbutaline 0.25 SC- decreases contractions and helps bradycardia

26

choice of delivery in prolapse

immediate C section. if cervix is fully dilated and presenting part is low in pelvis- forceps or breech extraction so that birth is

27

what does the paediatrician do once baby is born after prolapse

paired cord sampes for PH and base excess