OB: L&D Complications 8%

Question 1

(RoshReview)

what are RF for prolapsed umbilical cord?

Answer 1

FRANK BREECH PRESENTATION
PREMATURITY
LOW BIRTH WT

uterine malformation
multiparity
long umbilical cord
prolonged labor
engaged body part

Question 2

(RoshReview)

management of prolapsed umbilical cord

Answer 2

emergency delivery preparations begin - 
prepare pt for CESAREAN DELIVERY
~also~
INTRAUTERINE RESUSCITATION TECHNIQUES such as
MANUAL ELEVATION of presenting part compressing the cord (MC)
TRENDELENBURG positioning
RETROFILLING THE BLADDER
administer TOCOLYTIC

Question 3

(RoshReview)

why is umbilical cord prolapse a problem?

Answer 3

it increases cord pressure and leads to fetal anoxia

tx is emergency C-section

Question 4

(SmartyPance) BUZZWORDS

late decelerations

Answer 4

think placental insufficiency

Question 5

(RR)

define PROM

Answer 5

> 37 weeks

membranes rupture before labor begins

Question 6

(RR)

tx for PROM

Answer 6

medical induction with oxytocin and prompt delivery

risk of intrauterine infection increases with the duration of ruptured membranes

Question 7

(RR)

what’s wrong with expectant management for PROM?

Answer 7

increases chances of infection
increases risk of serious complications such as cord prolapse or abruption

(“Waiting for spontaneous labor to begin (i.e., expectant management) not only increases chances of infection, but also increases the risk of serious complications such as cord prolapse or abruption.”)

Question 8

(RR)

commonly used tocolytic drugs

Answer 8

nifedipine (1st line?)
TERBUTALINE
Mg sulfate
indomethacin

Question 9

(SmartyPance)

what is labor dystocia?

Answer 9

obstructed labor

baby does not exit the pelvis due to being physically blocked (despite the uterus contracting normally)

Question 10

(SmartyPance)

how do we treat labor dystocia in general (four things)?

Answer 10

changing posture of mother,
C-section,
vacuum extraction

possible surgical opening of symphysis pubis (symphysiotomy)

Question 11

((SmartyPance)

what is the “turtle sign” of delivery?

Answer 11

retraction of delivered head against maternal perineum

Question 12

(SmartyPance)

what is first line, non-manipulative maneuver for shoulder dystocia?

Answer 12

suprapubic pressure and flexion of maternal hips (McRoberts maneuver)

Question 13

(SmartyPance)

what are the two manipulative maneuvers for solving shoulder dystocia?

Answer 13

rotation of fetal shoulders 180 degrees (Wood’s corkscrew) and delivery of posterior arm

Question 14

(SmartyPance)

what is third line treatment for shoulder dystocia?

Answer 14

push fetal head back into vaginal canal with immediate transport to cesarean section (Zavanelli maneuver)