1. external cephalic version at/near term 2. if version is successful: trial of vaginal delivery 3. if version is unsuccessful: c section

Labor and Delivery Complications Flashcards by Alice Richards

labor and delivery complications to know

breech presentation
dystocia
fetal distress
premature rupture of membranes
preterm labor
prolapsed umbilical cord

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breech birth happens when a baby is born

bottom first

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prevalence of breech deliveries decreases with

increasing gestational age

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25% of breech births occur with fetuses < _ weeks old

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tx for breech fetus

external cephalic version at/near term
if version is successful: trial of vaginal delivery
if version is unsuccessful: c section

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20 yo G2P1 f w. GDM and pre pregnancy BMI 43 presents in labor - labor begins w.o complication but becomes stalled as pt attempts to push shoulders thru - head delivers and then suddenly retracts against pelvis and will not budge

shoulder dystocia
aka
obstructed labor

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baby does not exit pelvis during childbirth due to being physically blocked despite normal uterine contractions

shoulder dystocia/obstructed labor

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what does dystocia mean

abnormal labor progression

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main complication of obstructed labor for baby

hypoxia

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3 main complications of obstructed labor for mom

infxn
uterine rupture
post partum bleeding

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3 rf for obstructed labor

large or abnormally positioned baby
small pelvis
problems w. birth canal

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3 rf for small pelvis

malnutrition
vit D deficiency
adolescence

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problems w. the birth canal include

narrow vagina
narrow perineum

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2 causes of narrow vagina/perineum

female genital mutilation
tumors

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3 categories of dystocia

power
passenger
passage

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problem of power

uterine contractions

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problems of passenger

presentation
size -> macrosomia
position of fetus -> dystocia

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dx of shoulder dystocia

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what is turtle sign and what does it make you think of

retraction of delivered head against maternal perineum

obstructed labor

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what might a dystocia’ed (not a real word) baby look like

red puffy face

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increasingly long time in labor indicates a _ issue,
and makes you concerned about _

mechanical
obstructed labor

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tx for obstructed labor

first try to change maternal positioning
if unsuccessful: c section or vacuum extraction
surgical opening of symphysis pubis (symphysiotomy)… oooooooooowwwwwwie!

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tx for shoulder dystocia specifically

non manipulative maneuvers: suprapubic pressure, flexion of maternal hips
manipulative maneuvers: rotation of fetal shoulders 180 degrees, delivery of posterior arm
push head back in and do a c section

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what is the mcroberts maneuver

flexion of maternal hips w. shoulder dystocia’ed baby

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what is wood's corkscrew

rotation of the fetal shoulders 180 degrees with shoulder dystocia'ed baby

what is the zavanelli maneuver

pushing head of shoulder dystocia'ed baby back up in there for c section *that zavanelli guy was one crazy mofo*

fetal tachycardia is defined as: fetal bradycardia is defined as:

tachycardia: > 160 bpm x 10 min bradycardia: < 120 bpm x 10 min

simple, noninvasive way of checking on baby's health

nonstress testing (NST)

NST records baby's (3)

movements heartbeat contractions

what is considered a good NST/fetal well being

**reactive** 2 accelerations in 20 min, indicated by: increased fetal HR >/= 15 bpm from baseline lasting > 15 sec

what is a bad NST

**nonreactive** no fetal HR accelerations OR < 15 bpm lasting < 15 sec

what should you do if you have a pt w. a NST

order a contraction test

contraction stress test measures

fetal response to stress at times of uterus contraction

management of NST

delivery asap

definition of premature rupture of membranes (PROM)

rupture of membranes at >/= 37 weeks gestation PRIOR to the start of contractions

definition of preterm PROM (PPROM)

rupture of membranes at < 37 weeks gestation PRIOR to start of contractions

2 major risks of PROM/PPROM

infxn cord prolapse

sx of PROM/PPROM

sudden gush of clear/pale yellow fluid

work up of PROM/PPROM

confirm that fluid is amniotic fluid: -speculum: fluid pooling -nitrazine test: pH > 7.1 = (+) -microscopic exam: fern pattern

what is "ferning"

crystallization of estrogenon microscopic exam of amniotic fluid

tx for PROM/PPROM

>34 weeks: induce labor 32-34 weeks: collect fluid, check lung maturity, induce <32 weeks: stop contractions, 2 doses steroid injxn, deliver, give abx

definition of preterm delivery

delivery of viable infant before 37 weeks gestation

sx of preterm labor

-uterine contractions more often than q 10 min -leaking of fluid from vagina

the earlier a baby is born, the greater the risk/severity/variet of complications to infant - which system is esp at risk for complications

respiratory

earliest age at which a baby has at least 50% chance of survival

24 weeks

6 rf for preterm labor

-smoking -cocaine -uterin malformations -cervical incompetence -infxn -low birth weight

3 tests useful in preterm delivery

fetal fibronectin placental alpha microglobulin (PAMG-1) US

gs test to differentiate women at high risk for impending preterm delivery

fetal fibronectin via cervical/vaginal secretions

best predictor of imminent spontaneous delivery w.in 7 days of a pt presenting w. s/sx of preterm delivery

placental alpha microglobulin-1 (PAMG-1) aka PartoSure test

usefullness of US in preterm delivery

assessment of cervix to determine risk

what length of cervix is unfavorable

< 25 mm at or before 24 weeks gestation = incompetent cervix

tx for preterm labor

tocolysis (labor delay via meds): NSAIDs nifedipine beta agonists atosiban (oxytocin antagonist)

moa for tocolytics

relax uterus

goal of tocolytics

delay onset of labor until corticosteroids have been administered for fetal lung maturity < 34 weeks gestation

tocolytics rarely delay delivery beyond _ hr

24-48

what 2 tocolytics together can dely delivery by 2-7 days

atosiban (oxytocin antagonist) PLUS nifedipine

what drug is not a tocolytic, but can reduce risk of cerebral palsy in preterm baby

Mg sulfate

what drug can reduce risk for preterm delivery in at risk pt

progesterone

what med when given btw 24-37 weeks gestation can improve fetal outcomes

corticosteroids

umbilical cord comes out of uterus w. or before the presenting part of the fetus

umbilical cord prolapse

3 complications of umbilical cord prolapse

hypoxia brain damage death

2 mc rf for umbilical cord prolapse

malpresentation rupture of membranes

first sx of umbilical cord prolapse

sudden/severe decrease in fetal HR that does not immediately resolve

fetal HR tracing would show _ with umbilical cord prolapse

mod-severe variable decelerations

gs tx for umbilical cord prolapse

immediate c section

alternate management of prolapsed uterine cord (2)

-manueal elevation of presenting fetal part -repositioning of mother to knee-chest position

Labor and Delivery Complications Flashcards

(66 cards)