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Women's Health EOR > Labor and Delivery Complications > Flashcards

Labor and Delivery Complications Flashcards

1
Q

What are the characteristics of breech presentation?

A

a breech birth happens when a baby is born bottom first instead of head first

  • around 3-5% of pregnant women at term (37-40 weeks pregnant) will have breech baby
  • prevalence decreases with increasing gestational age:
  • 25 percent of fetuses under 28 weeks are breech
  • 7 to 16 percent are breech at 32 weeks
  • 3 to 4 percent are breech at term
  • breech presentation may be frank, complete, or incomplete
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2
Q

How is breech presentation dx?

A

the diagnosis of breech presentation is based on physical examination, with ultrasound confirmation if the diagnosis is uncertain

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3
Q

What is the tx of breech presentation?

A

external cephalic version at or near term, followed by a trial of a vaginal delivery if the version is successful and planned cesarean delivery if breech presentation persists

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4
Q

What is dystocia?

A

obstructed labor, also known as labor dystocia, is when the baby does not exit the pelvis during childbirth due to being physical blocked, despite the uterus contracting normally

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5
Q

How is dystocia defined as?

A

an abnormal labor progression

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6
Q

What is a compilation for the baby of dystocia?

A

not getting enough oxygen which may result in death

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7
Q

What does dystocia increase for the mother?

A

risk of the mother getting an infection, having uterine rupture, or having postpartum bleeding

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8
Q

What is the main cause of dystocia?

A

a large or abnormally positioned baby, a small pelvis and problems with the birth canal

  • abnormal positioning include shoulder dystocia where the anterior shoulder does not pass easily below the pubic bone
  • risk factors for a small pelvic include malnutrition and a lack of exposure to sunlight causing vitamin D deficiency, it is also more common in adolescence as the pelvis may not have finished growing by the time they give birth
  • problems with the birth canal include a narrow vagina and perineum which may be due to female genital mutilation or tumors
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9
Q

What are the tree categories of dystocia?

A
  • problems of power: uterine contraction
  • problems of passenger: presentation, size (macrosomina), or position of the fetus (shoulder dystocia)
  • problems of passage: uterus or soft tissue abnormalities
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10
Q

What is shoulder dystocia?

A

failure of the shoulders to deliver spontaneously after delivery of the fetal head

  • one or both shoulders lodged at pubic symphysis with delivery of the head
  • this is an obstetric emergency
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11
Q

What are the causes of dystocia?

A
  • small pelvis
  • poor contractions
  • macrosomia
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12
Q

How is dystocia dx?

A

obstructed labor is usually diagnosed based on physical examination

  • turtle sign - retraction of the delivered head against the maternal perineum
  • one characteristic of a minority of shoulder dystocia deliveries is the turtle sign, which involves the appearance and retraction of the baby’s head (analogous to a turtle withdrawing into its shell), and a red, puffy face, this occurs when the baby’s shoulder is obstructed by the maternal pelvis
  • ultrasound can be used to predict malpresentation of the fetus
  • in examination of the cervix once labor has begun, all examination are compared to regular cervical assessments
  • the comparison between the average cervical assessment and the current state of the mother allows for a diagnosis of obstructed labor
  • an increasingly long time in labor also indicates a mechanical issue that is preventing the fetus from exiting the womb
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13
Q

What is the tx of dystocia?

A

before considering surgical options, changing the posture of the mother during labor can help to progress labor

  • the treatment of obstructed labor may require a cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis (symphysiotomy)
  • csesarean section is an invasive method but is often the only method that will save the lives of both the mother and the infant
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14
Q

What are the maneuvers for shoulder dystocia?

A

Non-manipulative maneuvers (1st line treatment)
-suprapubic pressure
-flexion of maternal hips (McRoberts maneuver)
Manipulative maneuvers
-rotation of fetal shoulders 180 degrees (Wood’s corkscrew)
-delivery of posterior arm
Emergent cesarean section
-pushing the fetal head back into the vaginal canal with immediate transport to cesarean section (Zavanelli maneuver)

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15
Q

What is normal fetal heart rate?

A

between 120-160 bpm

  • > 160 for 10 minutes fetal tachycardia
  • <120 for 10 minutes fetal bradycardia
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16
Q

What are the characteristics of non stress testing?

A

the non stress test is a simple, noninvasive way of checking on the baby’s health

  • the test records movement, heartbeat, and contractions
  • it notes changes in heart rhythm when the baby goes from resting to moving, or during contractions if the mother is in labor
  • good - reactive NST - >2 accelerations in 20 minutes defined by increased fetal heart rate of at least 15 bpm from baseline lasting >15 seconds, indicates fetal well being
  • BAD - nonreactive NST - no fetal heart rate accelerations or <15 bpm increase lasting <15 seconds, if this is the case then get a contraction stress test
17
Q

What are the characteristics of a contraction stress test?

A

measures fetal response to stress at times of uterus contraction

  • GOOD - Negative CST - no late decelerations in the presence of 2 contractions in 10 minutes, indicates fetal well being, repeat CST as needed
  • BAD - Positive CST - repetitive late decelerations in the presence of 2 contractions in 10 minutes, worrisome especially if nonreactive NST, prompt delivery
18
Q

What are the characteristics of APGAR?

A

Appearance, Pulse, Grimace, Activity, Respiration

  • score from 1-10 with >7 normal, 4-6 fairly low, 3 and under critically low
  • test done at 1 and 5 minutes after birth
19
Q

What is premature rupture of membranes?

A

clinical definition: the rupture of membranes at >37 weeks gestation prior to the start of uterine contractions

  • preterm premature rupture membranes (PPROM) describes PROM <37 weeks gestation
  • major risk = infection or cord prolapse
20
Q

What are the signs and symptoms of premature rupture of membranes?

A

sudden “gush” of clear or pale yellow fluid from the vagina that occurs after 37 weeks of gestation

21
Q

How is premature rupture of membranes dx?

A

need to confirm that this is truly amniotic fluid

  • speculum - fluid pooling in the posterior fornix
  • nitrazine test - blue (due to elevated pH) determine if this is amniotic fluid - pH >7.1 means it is positive
  • microscope examination - ferning - take a specimen of fluid put it on a slide and let it dry will see “fern pattern” crystallization of the amniotic fluid (crystallization of estrogen and amniotic fluid)
22
Q

What is the tx of premature rupture of membranes?

A

> 34 weeks - induce labor
32-34 weeks collect fluid and check for lung maturity - then induce
<32 weeks stop contractions and start 2 doses of steroid injection then delivery the baby - give antibiotics

23
Q

What is preterm birth?

A

defined as the birth of baby less than 37 weeks gestational age as opposed to the usual 40 weeks

24
Q

What are the symptoms of preterm labor?

A

uterine contractions which occur more often than every ten minutes or the leaking of fluid from the vagina

25
Q

What are the characteristics of preterm labor?

A
  • the earlier the baby is born, the greater the risk, variety, and severity of complications to the infant’s health, particularly to the respiratory system
  • the earliest gestations age at which a baby has at least 50% chance of survival is approximately 24 weeks
26
Q

What are the risk factors of preterm labor?

A

smoking, cocaine use, uterine malformations, cervical incompetence, infection (vaginal or UTI), low pregnancy weight

27
Q

What is the dx of preterm labor?

A

the most clinically useful test to differentiate women who are at high risk for impending preterm delivery from those who are not is fetal fibronectin in cervical or vaginal secretions

  • placental alpha microglobulin-1 (PAMG-1) has been subject of several investigations and has been reported to be the single best predictor of imminent spontaneous delivery within 7 days of a patient presenting with signs, symptoms, or complaints of preterm labor (commercially known as the PartoSure test)
  • obstetric ultrasound has become useful in the assessment of the cervix in women at risk for premature delivery
  • a short cervix preterm is undesirable: a cervical length of less than 25 mm at or before 24 weeks gestational age is the most common definition of cervical incompetence
28
Q

What is the tx of preterm labor?

A

tocolysis - a number of medications may be useful to delay delivery including non steroidal anti-inflammatory drugs, calcium channel blockers, beta mimetics, and atosiban

  • tocolytics relax the uterus and are used in the treatment of preterm labor
  • the goal is to delay the onset of labor until a course of corticosteroids has been administered to induce fetal lung maturity in the setting of prematurity <34 weeks gestation
  • tocolysis rarely delays delivery beyond 24-28 hours
  • calcium-channel blockers (nifedipine) and an oxytocin antagonist can delay delivery by 2-7 days and Beta2-agonist drugs delay delivery by 48 hours buy carry more side effects
  • magnesium sulfate does not appear to be useful to prevent preterm birth however, it’s use before delivery does appear to decrease the risk of cerebral palsy
  • in those at risk, the hormone progesterone, if taken during pregnancy, may prevent preterm birth
  • in women who might deliver between 24 and 37 weeks, corticosteroids improve outcomes
29
Q

When does umbilical cord prolapse?

A

occurs when the umbilical cord comes out of the uterus with or before the presenting part of the fetus

30
Q

What are the characteristics of prolapsed umbilical cord?

A
  • it is an obstetric emergency and depending on duration and intensity of compression, may lead to fetal hypoxia, brain damage, and death
  • malpresentation and rupture of membranes with the presenting part not applied firmly to the cervix are the most common risk factors for a prolapsed umbilical cord during labor
  • on fetal heart tracing, this would usually look like moderate to severe variable decelerations
31
Q

What is the first sign of umbilical cord prolapse?

A

usually a sudden and severe decrease in fetal heart rate that does not immediately resolve

32
Q

What is the tx of prolapsed umbilical cord?

A

immediate cesarean section is the management of choice for a prolapsed umbilical cord
-other interventions include manual elevation of presenting fetal part and repositioning of mother to knee-chest position

Women's Health EOR (10 decks)

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