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Flashcards in L&D complications Deck (28)
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1
Q

what is tocolysis

A

delay PTL for 48 hrs to allow for fetal lung maturity with bethamethasone

2
Q

What are the tocolytics?

A
nifedipine:  CCB (first line)
MgSO4: competes with Ca for Ca channels
Terbutaline: B2 agonist
Ritodrine: B2 agonist
Indomethacin: NSAID
3
Q

MC side effects of CCB, nifedipine

A

HA, flushing, dizzy

4
Q

MC side effects of B2 agonists, terbutaline and ritodrine

A

HA, tachycardiam anxiety

5
Q

how to determine if ROM has occured?

A
  1. visualise fluid pooling
  2. nitrazine test (alkaline pH turns nitrazine paper blue)
  3. fern test (see ferning under microscope)
  4. amnio dye/tampon test (inject dilute indigo-carmine dye into amniotic sac and look for leakage into tampon)
6
Q

What is PROM?

A

rupture of membranes > 1 hr before labor, inc risk of infx

7
Q

PROM management

A

≥34 wk: delivery
24-33 wk: expectant management, tocolytics + betamethasone
<24 wk: pt counseling, expectant management or induced labor

8
Q

What is prolonged PROM

A

rupture >18 hrs before labor, ↑↑risk of infx

9
Q

What is PPROM?

A

rupture >1 hr before labor, preterm

10
Q

What is cephalopelvic disproportion? Management?

A

fetal head is too big to pass through maternal pelvis; MCC active phase prolongation

suspected CPD → trial of labor anyways, if CPD confirmed by CT or U/S → C/S

11
Q

Complete breech vs frank breech vs incomplete/footing breech

A

Complete breech: thighs and legs FLEXED
Frank breech: thighs flexed, legs STRAIGHT
Incomplete (footling) breech: feet first

12
Q

How is breech presentation managed?

A

external version to vertex, C/S, or breech delivery (rare)

13
Q

What are the complications of a breech delivery

A

cord prolapse, head entrapment, neurologic injury

14
Q

What are malpresentations?

A

includes face, brow, compound, persistent OP and OT

Face presentation: face first
Brow presentation: orbital ridge first
Compound presentation: vertex/breech + limb, 
Persistent OP: facing anterior
Persistent OT: facing sideways
15
Q

what malpresentation has high risk for cord prolapse

A

compound presentation

16
Q

what malpresentation has high risk for deep transverse arrest with platylelloid pelvis type

A

persistent OT

17
Q

WHat is the management of malpresentations

A

vaginal delivery but needs close monitoring

18
Q

What are causes of fetal bradycardia

A

Preuterine causes: maternal hypotension or hypoxia (seizure, PE, AFE, MI, etc.)

Uteroplacental causes: placental abruption, infx, hemorrhage

Postplacental causes: cord prolapse, cord compression, fetal vx rupture

19
Q

How is fetal bradycardia managed?

A

place in Left lat decub/RLD → start 2L O2 NC → look for cause → Tx appropriately

20
Q

What is shoulder dystocia?

A

anterior shoulder gets caught behind pubic symphysis

21
Q

what are complications of shoulder dystocia?

A

fetal humerus/clavicle fx
brachial plexus injury
phrenic nerve palsy
hypoxia → brain injury → death

22
Q

RF for shoulder dystocia

A

previous dystocia, ↑fetal size (macrosomia, diabetes, maternal obesity, postterm delivery), prolonged stage 2

23
Q

if manuvers to correct shoulder dystocia fail, what is next step?

A

cut clavicle or pubic symphysis— if this fails then Zavanelli manuver ( push head back in + perform C/S)

24
Q

What are the manuvers to correct shoulder dystocia

A

Suprapubic pressure: add pressure to dislodge anterior shoulder

McRoberts maneuver: sharp flexion of maternal hips increases pelvic AP diameter

Rubin maneuver: apply pressure behind either shoulder to decrease fetal diameter

Wood corkscrew: apply pressure behind posterior shoulder to rotate infant

Posterior arm delivery: deliver posterior arm first, then rotate infant to for anterior shoulder

Zavanelli maneuver: push head back in + perform C/S

25
Q

Causes of maternal hypotension in labor

A
amniotic fluid embolus
regional anesthesia
vasovagal
anaphylaxis 
hemorrhage
26
Q

how to manage maternal hypotension

A

IVFs, ephedrine + treat cause

27
Q

How is amniotic fluid embolus diagnosed

A

fetal cells in pulm vasculature at autopsy

28
Q

how to distingush between syncope and seizure

A

seizure will have postictal confusion