Labor and Delivery Complications Flashcards
(32 cards)
What are the characteristics of breech presentation?
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
How is breech presentation dx?
the diagnosis of breech presentation is based on physical examination, with ultrasound confirmation if the diagnosis is uncertain
What is the tx of breech presentation?
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
What is dystocia?
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
How is dystocia defined as?
an abnormal labor progression
What is a compilation for the baby of dystocia?
not getting enough oxygen which may result in death
What does dystocia increase for the mother?
risk of the mother getting an infection, having uterine rupture, or having postpartum bleeding
What is the main cause of dystocia?
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
What are the tree categories of dystocia?
- 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
What is shoulder dystocia?
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
What are the causes of dystocia?
- small pelvis
- poor contractions
- macrosomia
How is dystocia dx?
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
What is the tx of dystocia?
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
What are the maneuvers for shoulder dystocia?
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)
What is normal fetal heart rate?
between 120-160 bpm
- > 160 for 10 minutes fetal tachycardia
- <120 for 10 minutes fetal bradycardia
What are the characteristics of non stress testing?
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
What are the characteristics of a contraction stress test?
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
What are the characteristics of APGAR?
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
What is premature rupture of membranes?
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
What are the signs and symptoms of premature rupture of membranes?
sudden “gush” of clear or pale yellow fluid from the vagina that occurs after 37 weeks of gestation
How is premature rupture of membranes dx?
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)
What is the tx of premature rupture of membranes?
> 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
What is preterm birth?
defined as the birth of baby less than 37 weeks gestational age as opposed to the usual 40 weeks
What are the symptoms of preterm labor?
uterine contractions which occur more often than every ten minutes or the leaking of fluid from the vagina
