Labor and Delivery Complications Flashcards by Katie Keller

List some indications for a C-section

Dystocia
Protraction disorder or arrest disorder
Fetal malposition
Multiple intrauterine pregnancy
Fetal distress
Cord prolapse
Placenta previa
Placenta abruption
Previous intra-uterine fetal surgery
Previous myomectomy or uterine reconstruction
HIV
Active herpes
Medical or obstetrical complications precluding vaginal delivery
Suspected macrosomia by sonography estimated fetal weight

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What is the time frame to be considered nulliparous labor to be considered prolonged?

> 20 hours

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What is the time frame to be considered multiparous labor to be considered prolonged?

> 14 hours

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What is the definition of dystocia?

difficult or abnormal labor

Abnormal progression, “failure to progress”

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What are the 3 P’s pf labor?

Power (uterine contractions)
Passenger (baby)
Passage (maternal)

In dystocia, one or more of these is abnormal

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What are the risks of dystocia?

Infection – chorioamniotitis (consequence of prolonged labor)
Fetal infection and bacteremia
Pneumonia from aspirating infected amniotic fluid
Fetal trauma
Maternal soft tissue injury

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What is the optimal intrauterine pressure?

50-60 mmHg

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What is the optimal frequency of uterine contractions?

Minimum of 3 contractions in 10 minute interval

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What is the optimal contractile strength of uterine contractions?

MVU: normal labor is 200 or more MVU

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What are the abnormal fetal presentations?

Asynclistim
Extension
Brow
Face
compound

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What are the two categories of abnormal labor patterns?

Protraction disorders
Arrest disorders

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Stage exceeds 3hrs with regional anesthesia, 2 hours no regional
anesthesia, or fetus descends less than 1cm/hr (no regional anesthesia)

Second stage protraction disorder

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No descent after 1 hour of pushing

Can use oxytocin to help, labor positions (squatting, sitting in birthing chair, knees to chest)

Second stage arrest disorder

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Delivery Help:

Used to apply traction when uterine contractions and maternal
pushing are inadequate

Need the scalp to be visible, skull has to have reached the pelvic floor

Forceps

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What are some risks with using forceps to help with delivery?

Peritoneal trauma
Hematoma
Pelvic floor injury

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Inability to deliver shoulders after head was delivered

Occurs when fetal anterior shoulder impacts against maternal
symphysis following delivery of head

Cannot be predicted or prevented

Shoulder Dystocia

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Delivery Help:

Only steady traction used in the line of the birth canal

Need the scalp to be visible, skull has to have reached the pelvic floor

Vacuum extraction

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What are some risks with using vacuum extraction to help with delivery?

Intracranial hemorrhage
Hematoma
Scalp lacerations
Hyperbilirubin
Retinal hemorrhage

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What are some risk factors that may result in shoulder dystocia?

Macrosomic birth (>4500g at most risk)

Small pelvis

Post term gestation

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Head retracts back into maternal peritoneum - this is a sign of shoulder dystocia

Turtle sign

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What are some maternal complications of shoulder dystocia?

Post partum hemorrhage

Fourth degree lacerations

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What are some fetal complications of shoulder dystocia?

Brachial plexus injury, but fewer than 10% result in a persistent brachial plexus injury

Fracture of clavicle

Fetal death

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Shoulder Dystocia: Which maneuver is described below?

Hyperflexion of mother’s legs tight into abdomen

McRobert’s maneuver

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Shoulder Dystocia: Which maneuver is described below?

Fetal head is flexed and reinserted into vagina to reinstate blood flow
and to perform C section

Zavanelli manuever

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When assessing fetal distress, this is used to determine if the fetus is well oxygenated, assessment done to see if intervention is needed so it can be done in a timely manner

Fetal heart rate

What is the most common cause of fetal tachycardia?

chorioamniotitis

What are some tests/techniques to know when a fetus is in “distress”?

Fetal movement assessment Non stress test Fetal biophysical profile Amniotic fluid index Contraction stress test

Which fetal monitoring technique is described below? Indication: Maternal perception of decreased or absence fetal movement Technique: Mother counts number of perceived “kicks” during a specified amount of time

Fetal movement assessment

Which fetal monitoring technique is described below? Measurement of the fetal heart rate with movement The heart rate of the infant that is not acidotic or neurologically depressed will temporarily accelerate with fetal movement Results: Reactive (normal) - Two or more fetal heart rate accelerations within a 20 minute period Nonreactive - No sufficient fetal heart rate accelerations over a 40-minute period

Non stress test

Which fetal monitoring technique is described below? Components: Non-stress test, Fetal breathing movements, Fetal movement, Fetal tone, Determination of the amniotic fluid index Scoring – each component is scored 2 to 0 Normal: 8-10 Equivocal: 6 Abnormal: 4 or less

Biophysical Profile

Which fetal monitoring technique is described below? Technique: summation of the largest cord-free vertical pockets in each of the four quadrants of an equally divided uterus

Amniotic Fluid Index (AFI)

If this condition is seen on a biophysical profile, it warrants further evaluation regardless of the composite score

oligohydramnios

On the amniotic fluid index, no ultrasonographically measured pocket of amniotic fluid >2cm, or an AFI of 5cm or less is diagnostic of what?

oligohydramnios

Oligohydramnios is indicative of what conditions that requires close maternal/fetal surveillance or delivery?

Anomalies Placental dysfunction

Polyhydramnios can be normal, but also can cause what?

Can cause premature rupture of the membranes Can cause malpresentation of the fetus

Which fetal monitoring technique is described below? Looking for the presence or absence of late fetal heart rate decelerations in response to uterine contractions

Contraction stress test

What is the definition of late decelerations?

Decelerations in the fetal heart rate that reach their nadir after the peak of the contraction and usually persist beyond the end of the contraction

Which type of deceleration is described below? Associated with uterine contractions, nadir occurs same time as peak of contraction “mirror image” Physiologic, not a cause for concern

Early Deceleration

Which type of deceleration is described below? Considered significantly non-reassuring, especially when repetitive and associated with decreased variability

Late Deceleration

Which type of deceleration is described below? Abrupt, visually apparent decreases in the FHr below the baseline FHr (mediated by the vagus nerve) Characteristic sharp decelerations Often correctable by maternal position to relieve pressure on umbilical cord

Variable Deceleration

Variable decelerations are often associated with what conditons?

umbilical cord compression and oligohydramnios

Which decelerations are the most common periodic FHr pattern?

Variable Decelerations

What is a technique that may fix a variable deceleration?

Sometimes correctable by maternal position to relieve pressure on umbilical cord

Thick, black tarry substance in the fetal GI tract Sign of fetal distress Detected during labor when the amniotic fluid is stained dark green or black

Meconium

A fetus that passes meconium in utero is a sign of what?

fetal distress

Which condition is described below? Inhalation by neonate can lead to significant issues Severe cases may cause pneumonitis, pneumothorax, pulmonary artery hypertension

Meconium Aspiration Syndrome

Rupture of membranes during pregnancy before 37 weeks gestation and before the onset of labor

Premature Rupture of the Membranes

Amniotic fluid produced continuously after how many weeks, dependent upon fetal urine production?

16 weeks

Amniotic fluid protects against what?

infection fetal trauma umbilical cord compression

Premature rupture of the membranes happens in what percentage of pregnancies?

3% of pregnancies

Premature rupture of the membranes is responsible for how many preterm deliveries?

1/3 of preterm deliveries

>37 weeks Rupture of the chorioamniotic membrane before the onset of labor, generally followed by the onset of labor

PROM

< 37 weeks Is a leading cause of neonatal morbidity and mortality and is associated with 30% of preterm deliveries

PPROM

What are some risk factors for developing premature rupture of the membranes?

Smoking Short cervical length Prior preterm delivery Multiple gestations Bleeding early in pregnancy (threatened abortion)

This risk factor doubles a woman's chances of premature rupture of the membranes

Smoking

Fluid passing through vagina must be presumed to be what until proven otherwise?

amniotic fluid

What are some tests used to diagnose premature rupture of the membranes?

Nitrazine test Fern test Ultrasound

Which test used to detect amniotic fluid/PROM is described below? Amniotic fluid is alkaline (>7), vaginal and urine secretions are more acidic (<6) Fluid to paper: dark blood = alkaline

Nitrazine test

Which test used to detect amniotic fluid/PROM is described below? Fluid drying on a slide that resembles a fern is amniotic fluid Better than the nitrazine test

Fern test

Which test used to detect amniotic fluid/PROM is described below? If unclear, transabdominal instillation of indigo carmine dye, followed by observation for passage of blue fluid from vagina

Ultrasound

Using this treatment is associated with decreased risk of chorioamniotitis and endometritis

Oxytocin

After PROM, when is the induction of labor appropriate?

At any time after PROM

What is a MAJOR complication of PROM?

Intrauterine infection

This condition is a major threat to mother and fetus

Infection of the fetal membranes and amniotic fluid 🡪 Chorioamniotitis

Patients with Chorioamniotitis frequently encounter these complications?

Frequently enter spontaneous and often dysfunctional labor

What is the treatment for chorioamniotitis?

IV abx prompt delivery

List some signs and symptoms of chorioamniotitis?

significant fever (>101) tachycardia (fetal and maternal) uterine tenderness purulent cervical discharge - late finding

Patients with these infections are at higher risk for intrauterine infection if present?

gonorrhea BV group B strep

List some complications of PROM?

Intrauterine infection Chorioamniotitis Prolapsed umbilical cord Abruption placenta Pulmonary hypoplasia Respiratory distress syndrome Neonatal sepsis Fetal death

Complication that occurs prior to or during delivery of the baby Occurs in approximately every 300 births

Prolapsed Umbilical Cord

What are some causes of a prolapsed umbilical cord?

Premature rupture of the membranes (MC cause) Premature delivery Excessive amniotic fluid Delivering multiple babies (twins, triplets, etc) Breech delivery Umbilical cord that is longer than usual

What are some complications of a prolapsed umbilical cord?

Hypoxia stillbirth

What is the most common cause of a prolapsed umbilical cord?

Premature rupture of the membranes

What is the treatment for a prolapsed umbilical cord?

Move fetus away from the cord Emergency C-section

Preterm delivery is defined as delivery prior to how many weeks?

37 weeks

What is the most common cause of perinatal morbidity and mortality?

Preterm labor

What are the strongest risk factors for preterm labor?

multifetal gestation and prior preterm birth

Which organ system is the last to develop?

lungs

You cannot rule out preterm labor by absence of contractions on the fetal monitor – you need to check what?

check the cervix

What are the goals in preterm labor?

Stop contractions Prolong pregnancy at least 48 hours to administer corticosteroids

What is the maximal benefit when administering steroids in preterm labor?

Maximal benefit is 7 days prior to delivery (24-34 weeks)

List some tocolytics used to stop contractions in preterm labor?

Nifedipine Mg2+ sulfate (also neuroprotective effects for baby) B agonists (Terbutaline)

List some potential causes of breech pregnancies

Multiple pregnancies Polyhydramnios Hydrocephaly Anencephaly Aneuploidy Uterine anomalies Uterine tumors

In singleton deliveries, what percentage are breech presentation?

2% of singleton deliveries

What are the three types of breech presentations?

Frank Complete Incomplete

What are some methods to diagnose a breech presentation in pregnancy?

Leopold maneuvers Pelvic exam ultrasound

Why is intrapartum fetal surveillance done in breech presentations?

Done to recognize changes in fetal oxygenation that could result in serious complications

What are some complications with breech presentation?

Morbidity and mortality rates for mother and fetus, regardless of gestational age or mode of delivery Fetal anomalies Prematurity Umbilical cord prolapse Birth trauma

Most occur during labor and 90% associated with prior uterine scar

Uterine Rupture

What are some treatment/management methods for a breech presentation?

External Cephalic Version (turning fetus in mom's belly) Administer Rhogam to Rh- patients C-section

What is the criteria for the external cephalic version for treatment of a breech presentation?

Normal fetus Reassuring rates Adequate amniotic fluid Presenting part not in pelvis Adequate pelvis

What treatment method for a breech presentation works 50% of the time?

External Cephalic Version

What treatment method for a breech presentation do doctors use/prefer the most?

C-section

A sudden onset of intense abdominal pain +/- vaginal bleeding should have you considering what diagnosis?

Uterine Rupture

Labor and Delivery Complications Flashcards

(94 cards)