Complications of Pregnancy and Delivery

Question 1

What are some maternal risk factors that affect pregnancy?

Answer 1

• Age over 35, or younger than 20,
• smoking/ consuming alcohol
• Pregnancy with twins or more
• miscarriage history
• obesity/ anorexia

Question 2

What are some health conditions that can complicate pregnancy?

Answer 2

• Diabetes
• Cancer
• Hypertension
• STI’s
• Kidney problems
• Epilepsy
• Anemia

Question 3

What is an ectopic Pregnancy?

Answer 3

Fertilized egg implants outside the uterus (90% fallopian tube; but also abdominal cavity low in cervix), Non viable, diagnosed before 12wks(6)

Question 4

What are the symptoms of Ectopic Pregnancy

Answer 4

Pain, amenorrhea (missed periods), vaginal bleeding. Ruptured - hypotension and shock

Question 5

How do you treat ectopic pregnancy pts?

Answer 5

Treat underlying presenting problem; abdo pain, sycope, hypotension, shock

Question 6

What is a miscarriage?

Answer 6

Loss of pregnancy, naturally before 20wks

Question 7

How do miscarriages present?

Answer 7

bleeding; with lots of clots and tissue, cramping.

Question 8

What is hyperemesis Gravidarum?

Answer 8

Severe nausea/vomiting (3xday) during pregnancy, can lead to dehydration, vertigo, weight loss, preterm labour

Question 9

What is Preeclampsia?

Answer 9

Hypertensive disorder that develops after 20wks, untreated may develop into eclampsia

Question 10

What are signs and symptoms of Preeclampsia?

Answer 10

BP > 140/90
severe headache, blurred vision
upper abdo pain
N/V
Proteinuria
edema

Question 11

What is eclampsia?

Answer 11

When a pre-eclamptic pt goes into seizure

Question 12

How do you treat a pre-eclamptic pt?

Answer 12

Bring to hospital quick, don’t make them walk, they will develop plan and provide medications

Question 13

How do you treat an eclamptic pt?

Answer 13

Treat them like a seizure pt

Question 14

Why are babies of pts with untreated gestational diabetes large?

Answer 14

Excess glucose is transferred to the fetus and stored as fat

Question 15

How is gestational diabetes different than other forms of diabetes?

Answer 15

It develops during pregnancy and usually resolves once baby is delivered

Question 16

S/S of Gestational diabetes

Answer 16

Increased thirst, frequent urination, fatigue, nausea, frequent bladder and skin infections, blurred vision, dry mouth, yeast infections

Question 17

What is placenta Previa?

Answer 17

When the placenta partially or fully covers the cervix.

Question 18

What is prevented by placenta previa?

Answer 18

Vaginal delivery is not possible

Question 19

What is a complication of placenta previa if delivery is attempted?

Answer 19

Can cause placenta to rupture, leading to massive blood loss

Question 20

How frequent is Abruptio Placenta?

Answer 20

Occurs in 1% of all pregnancies

Question 21

What is abruptio placenta?

Answer 21

The partial or full placental detachment at 20wks, when vascular structures are torn away from uterine lining.

Question 22

A patient presents with severe abdominal pain described as tearing. She is currently 22wks pregnant with twins, what is likely diagnoses?

Answer 22

Abruptio Placenta

Question 23

What are the risk factors of Abruptio Placenta?

Answer 23

Trauma, multiple fetus, short umbilical cord, previous c section, preeclampsia/eclampsia, age >35 years

Question 24

What does AFE stand for

Answer 24

Amniotic Fluid embolism

Question 25

What is an amniotic fluid embolism?

Answer 25

Amniotic fluid, fetal cells, hair or debris enters into maternal pulmonary circulation, causing cardiovascular collapse

Question 26

S/S of AFE

Answer 26

dyspnea, hypoxia, hypotension, possible cardiac arrest

Question 27

Why must all trauma pts be transported, even with only minor injuries presenting?

Answer 27

60-70% of fetal loss is reported from "minor injuries"

Question 28

Is violence a cause of trauma in pregnant pts?

Answer 28

yes, 20% women experience violence during pregnancy

Question 29

What modification must be done for CPR on pregnant (>20wks) pts?

Answer 29

Manually displace abdomen to the left to relieve pressure on the pts vena cava preventing full blood flow

Question 30

What is supine Hypotension Syndrome?

Answer 30

Compression of the vena cava by the uterus creates hypotension (some cases syncope) when the pregnant woman is supine

Question 31

Why should pts >20 weeks be laying left lateral whenever possible?

Answer 31

To minimize pressure on vena cava

Question 32

What are some common respiratory issues pregnant women have?

Answer 32

Stuffy, runny nose, epistaxis

Question 33

What is considered a pre-mature birth?

Answer 33

Delivery prior to 37 wks gestation

Question 34

What are some things to be aware about for pre-mature births?

Answer 34

hypothermia risk, usually require resus, poor lung compliance, underdeveloped alveoli(no surfactant prior to 28wks)

Question 35

What should you do if nuchal cord is wrapped around baby neck?

Answer 35

Document. If loose, slide over baby head, if it is tight, clamp and cut - deliver quickly

Question 36

What is a precipitous Labour? what complications may it cause?

Answer 36

Extremely rapid delivery, risk of tearing and postpartum hemorrhage

Question 37

What is a transverse lying position?

Answer 37

baby is positioned across the pelvis - can not be delivered in such position

Question 38

What are the different types of breech?

Answer 38

frank (bum), complete (feet/bum), and footling (feet first)

Question 39

What fetal positions will not deliver?

Answer 39

Transverse, oblique(diagonal),shoulder presentation(arm out)

Question 40

What is the approach to breech babies? Why?

Answer 40

Hands off use gravity to deliver, to avoid stimulation

Question 41

What is cord prolapse?

Answer 41

When umbilical cord presents prior to the neonate - problem as when baby tries to deliver it will cut off all circulation.

Question 42

What is the management procedure for prolapsed cord?

Answer 42

Knee to chest (attempt gravity to move back in), assess pulse, if has pulse - place back into vagina, if no pulse/weak - cradle gently, insert fingers to relieve pressure from presenting part. Once in position pulsations return, do not move.

Question 43

If delivery is imminent with prolapsed cord, what considerations should be made?

Answer 43

Try to deliver quickly(4mins) prepare to resuscitate

Question 44

What is shoulder dystocia?

Answer 44

Fetal shoulders, are stuck

Question 45

What are some risk factors for shoulder dystocia?

Answer 45

Previous shoulder dystocia, gestational diabetes, postdate deliveries, small mamas, high pregnancy weight(gain), abnormal pelvic anatomy

Question 46

What is turtling in shoulder dystocia?

Answer 46

During contraction, head is forced down, and out, when relaxation, head moves back

Question 47

How long do you have to deliver baby after head is delivered? What happens if not?

Answer 47

4 minutes, after that the baby is not getting adequate circulation, and may suffer hypoxic injury.

Question 48

What does ALARM stand for

Answer 48

Ask for help, Legs up (open pelvis), adduct shoulder(suprapubic pressure), roll over, Manually deliver arm if seen.

Question 49

How many times can ALARM be performed

Answer 49

Twice, one time by each partner.

Question 50

What are some maternal complications caused by Shoulder Dystocia?

Answer 50

Soft Tissue Injuries, Anal sphincter damage, cervical or vaginal tears, Uterine Rupture, Postpartum Hemorrhage

Question 51

What are some neonatal complications caused by Shoulder Dystocia?

Answer 51

Clavicle Fracture, Fetal Acidosis, Humeral Fracture, Brachial Plexus Palsy (transient/ permanent), Hypoxic Brain Injury, Death

Question 52

What is the McRoberts maneuver?

Answer 52

Hyperflex knees to chest, to open pelvis.

Question 53

What are the 4 T of postpartum hemorrhage?

Answer 53

Tone (exhausted uterus cannot contract), Tissue (parts of placenta retained), Trauma (uterine rupture/laceration), Thrombin (abnormal coagulation)

Question 54

Fundal massage can only be done after what?

Answer 54

placental delivery

Question 55

How is a fundal massage given?

Answer 55

One hand on lower abdomen, circular movement to massage uterus. Done for 10-15 minutes then reassessed

Question 56

If maternal bleeding occurs after fundal massage, what is the next step?

Answer 56

Bimanual compression

Question 57

How is bimanual compression given?

Answer 57

One hand above symphysis pubis & other on top of fundus. Squeeze together – for 5-10 minutes until bleeding stops. Apply same pressure as external wound

Question 58

How do you treat postpartum hemorrhage?

Answer 58

Assess, and treat for shock symptoms. Oxygen, fluids

Question 59

What circumstances allow for bimanual compression?

Answer 59

Pre-placental delivery hemorrhage, post placental delivery where fundal massage failed

Question 60

What is meconium

Answer 60

Baby's first bowel movement - thick, sticky, dark green, consisting of cells, protein, fats and intestinal secretions

Question 61

What can cause meconium in utero

Answer 61

Fetal distress.

Question 62

Why is meconium pre-delivery a problem?

Answer 62

Baby can aspirate- infections, severe illness, potential death