Keppler labor abnormalities

Question 1

Management of shoulder dystocia?

Answer 1

1. Swift identification
2. Assemble team: skilled nurses, obstetrician, anesthesia
3. Drilling and memorization of appropriate response sequence

Question 2

Management of Transverse back down?

Answer 2

1, External cephalic version

2. Cesarean

Question 3

What is a category II

Answer 3

everything that is not category I or II

Question 4

What is considered true labor?

Answer 4

regular contractions with cervical changes

Question 5

True or false with VBAC fetus is at risk, with cesarean mom is at risk?

Answer 5

True

Question 6

What is the time frame for a latent stage 1 labor?

Answer 6

up to 12-24 hours depending on parity

Question 7

What is considered late term? Post term?

Answer 7

Late term is 41-42 weeks

post term is 42+ weeks

Question 8

What would make someone a candidate for VBAC?

Answer 8

• 1 or 2 prior cesareans
• Known (or assumed) low transverse uterine scar, no other prior uterine surgery
• No contraindications to vaginal delivery
• Obstetrician and anesthesia in house

Question 9

What things are considered labor augmentation/induction

Answer 9

1. Oxytocin (pitocin) drip

2. AROM

Question 10

What is stage 2 of the labor curve more dependent on?

Answer 10

more dependent on parity and anesthesia

Question 11

Around what week of pregnancy is a good time to have a conversation or give the option of a C-section?

Answer 11

around 40 weeks

Question 12

What things can you do to try and increase power of contraction?

Answer 12

1. Can give pitocin
2. Can do AROM (artificial rupture of membrane)
3. can do nipple stimulation

Question 13

What are some other risks associated with VBAC?

Answer 13

Cesarean: risk of maternal morbidity

VBAC: fetus shoulders majority of risk

Cesarean: Woman shoulders majority of risk

Question 14

For face or brow if the mentum is facing posterior can the baby be delivered vaginally?

Answer 14

no in this position they cant not

If the mentum is anterior then the baby can possibly be delivered vaginally

Question 15

What is the definition of Shoulder dystocia?

Answer 15

Failure of passage of the anterior (presenting shoulder) under the maternal pubic symphysis

Question 16

What are some labor abnormalities?

Answer 16

1. Labor presentation or arrest
2. Fetal malpresentation (external cephalic version)
3. Post-term pregnancy
4. Fetal heart Rate abnormalities
5. Vaginal birth after cesarean
6. Shoulder dystocia

Question 17

Compound presentation management?

Answer 17

1. Wait

2. Cesarean

Question 18

What are the first two interventions to try for shoulder dystocia?

Answer 18

1. McRoberts and suprapubic pressure

Question 19

What are all the things you can try for shoulder dystocia?

Answer 19

1. McRoberts
2. Suprapubic pressure
3. posterior shoulder
4. Woods Screw
5. Episiotomy
6. Fracture clavicle
7. Symphasisotomy
8. Zavanelli

Question 20

By what week in the pregnancy do they recommend bringing mom in for induction of labor?

Answer 20

41 weeks

Question 21

What is the main risk associated with VBAC

Answer 21

uterine rupture

Question 22

What is considered the active phase?

Answer 22

approximately 1 cm/ hour change in dilation

Question 23

What are the two options for operative delivery?

Answer 23

1. Forceps

2. Vacuum

Question 24

What are the indications for external cephalic version?

Answer 24

1. Known position
2. Singleton
3. No contraindication to vaginal delivery
4. Membranes intact

Question 25

What are some risk factors for post term pregnancy?

Answer 25

1. Abnormal fetal tracing 2. macrosomia 3. oligohydramnios 4. protracted / arrested labor 5. cesarean delivery 6. IUFD (1.8, 2.9X at 42, 43 wks)

Question 26

What is considered a category III of the FHT?

Answer 26

absent variability with recurrent pathologic decelerations or bradycardia, or sinusoidal pattern

Question 27

What are the 3 p's?

Answer 27

Power, passenger, and pelvis

Question 28

What two things are part of the management for VBAC?

Answer 28

fetal surveillance and maternal anesthesia

Question 29

What are contraindications to external cephalic version ?

Answer 29

1. Non-reassuring fetal status 2. Fetal anomalies 3. Multiple gestations 4. Cesarean indicated

Question 30

Risk factors of shoulder dystocia?

Answer 30

1. Macrosomia 2. Post-term pregnancy 3. DM/GDM 4. if its happened before

Question 31

What is labor protraction/arrest?

Answer 31

This is when rate of dilation lags from expected or has stopped all together

Question 32

How long is the stage 2 of labor for a 1. Primigravida 2. Multipara

Answer 32

1. Primigravida 2-3 hours 2. Multipara 1-2 hours Hours represent 95%ile of normal

Question 33

baseline 110-160, moderate variability, no pathologic decelerations, +/- early decelerations or acceleration, is what category of the fetal HR three tiered system

Answer 33

this is a category 1

Question 34

What are the three different kinds of breech presentations?

Answer 34

1. Complete breech 2. Incomplete breech 3. Frank breech

Question 35

What can we do about the Passenger Part of the three P's?

Answer 35

Rotation, or wait to see if little baby fixes themselves

Question 36

What is the expected rate of dilation

Answer 36

1 cm per hour for cervical dilation change

Question 37

True or false: VBAC decreases maternal risks associated with having another cesarean

Answer 37

True

Question 38

True or false we can manage the "pelvis" part of the three P's?

Answer 38

False

Question 39

What are the different malpresentations for birth?

Answer 39

1. Breech 2. Transverse 3. Compound 4. Face or brow

Question 40

What percentage of face or brow presentations are delivered by cesarean?

Answer 40

>50%