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Flashcards in L&D complications Deck (28)
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1

what is tocolysis

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

2

What are the tocolytics?

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

3

MC side effects of CCB, nifedipine

HA, flushing, dizzy

4

MC side effects of B2 agonists, terbutaline and ritodrine

HA, tachycardiam anxiety

5

how to determine if ROM has occured?

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

What is PROM?

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

7

PROM management

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

8

What is prolonged PROM

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

9

What is PPROM?

rupture >1 hr before labor, preterm

10

What is cephalopelvic disproportion? Management?

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

Complete breech vs frank breech vs incomplete/footing breech

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

12

How is breech presentation managed?

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

13

What are the complications of a breech delivery

cord prolapse, head entrapment, neurologic injury

14

What are malpresentations?

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

what malpresentation has high risk for cord prolapse

compound presentation

16

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

persistent OT

17

WHat is the management of malpresentations

vaginal delivery but needs close monitoring

18

What are causes of fetal bradycardia

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

How is fetal bradycardia managed?

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

20

What is shoulder dystocia?

anterior shoulder gets caught behind pubic symphysis

21

what are complications of shoulder dystocia?

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

22

RF for shoulder dystocia

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

23

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

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

24

What are the manuvers to correct shoulder dystocia

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

Causes of maternal hypotension in labor

amniotic fluid embolus
regional anesthesia
vasovagal
anaphylaxis
hemorrhage

26

how to manage maternal hypotension

IVFs, ephedrine + treat cause

27

How is amniotic fluid embolus diagnosed

fetal cells in pulm vasculature at autopsy

28

how to distingush between syncope and seizure

seizure will have postictal confusion