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RNC-OB > Obstetric Complications > Flashcards

Obstetric Complications Flashcards

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1
Q

What should you do for latent phase arrest (prodromal labor)?

A

Expectant management if no indication to deliver

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2
Q

What is hypertonic dysfunction/ what do you do for it?

A

High frequency low amplitude contractions with significant maternal discomfort

Therapeutic rest (morphine sleep)

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3
Q

What are the two active phase disorders?

A

Protraction disorders

Arrest disorders

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4
Q

What is protraction of the active phase of labor in a nullipara and multipara?

A
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5
Q

What is arrest of active phase?

A

Cessation of previously normal active phase dilation for >2 hours

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6
Q

What can cause active phase disorders?

A

Inadequate ctx
Malpresentation
CPD

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7
Q

How many MVU’s are needed in a 10 minute period to be considered adequate ?

A

200-250

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8
Q

What is considered protraction of second stage for a nullipara/multipara?

A

Nullipara

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9
Q

How long can second stage take as long as the fetus is tolerating labor for a nullipara/multipara?

A

Nullipara- 2hrs without anesthesia, 3 with

Multipara- 1 hr without anesthesia, 2 with

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10
Q

How long does third stage normally last?

A

10 minutes

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11
Q

When is it considered a retained placenta?

A

If placenta not delivered by 30 minutes

*risk of hemorrhage inc proportionally to time

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12
Q

What is expectant management of third stage?

A

No early cord clamping, no cord traction, no oxytocin

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13
Q

What does dystocia mean/what three things can cause it?

A

Abnormal labor

Powers
Passenger
Passageway

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14
Q

What is active management of third stage?

A

Early cord clamping, controlled cord traction, oxytocin

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15
Q

What is considered precipitous labor?

A

Delivery

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16
Q

What can be associated with precipitous labor?

A

Tachysystole, cocaine use, abruption

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17
Q

A shoulder dystocia occurs when head to delivery time is > ___

A

One minute OR use of ancillary measures to deliver

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18
Q

What are risk factors for a shoulder dystocia?

A 
AMA
Inc gest age
DM
obesity
Prior shoulder dystocia
Prior infant >4500grams
Dystocia
Operative vaginal delivery
Large paternal birth weight 
Hispanic
Male fetus
Positive 50g screen with neg 3hr GTT
macrosomia (>4000grams, inc abdominal circumference)
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19
Q

What is a sign of shoulder dystocia?

A

Turtle sign

Failure to achieve external rotation

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20
Q

What are fetal complications of a shoulder dystocia?

A

Asphyxia and/or acidosis
Brachial plexus injuries (erbs/klumpkes palsy)
Fractured humerus or clavicle
Fetal death

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21
Q

What are maternal complications of a shoulder dystocia?

A 
Bladder injury
Cervical/vaginal/perineal lacs
Hematoma
Separation of symphysis 
Uterine rupture 
Pp hemorrhage
Infection
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22
Q

What is a normal amniotic fluid volume?

A

1000ml at 36wks, then slowly decreases

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23
Q

What is oligohydramnios?

A

AFI

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24
Q

What is polyhydramnios?

A

AFI >24cm at term

Associated with CNS or GI anomalies or maternal diabetes

Can cause preterm labor (uterine distention)

Can do amnioreduction

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25
How can hypoxia cause meconium stained fluid?
Hypoxia results in fetal vagal response
26
What is PROM? What is active vs expectant management with PROM?
SROM >1hr prior to start of labor Active- induction Expectant- can delay induction 96 hours
27
What is PPROM?
SROM prior to 37 wks | Antibiotics and glucocorticoid for 24-34 wks
28
What is anaphylactoid syndrome of pregnancy?
"Amniotic fluid embolism" Amniotic fluid/debris enter maternal circulation Massive anaphylactic response Two phases: Acute cardiorespiratory collapse Hemorrhagic phase/DIC mortality 80% Most pts die within one hour
29
What is placenta previa?
Placenta covers cervical os Marginal- edge of placenta within 2-3cm Bright red painless bleeding Cesarean delivery
30
What are the risk factors for a placenta previa?
``` AMA prior uterine surgery Fibroids or other uterine abnormalities Cigarette smoking Multiple gestational Multiparity ```
31
What is abruptio placentae?
Detachment of placenta from uterine wall Bleeding with pain Bleeding may be concealed Ultrasound may not be reliable Rigid, tender abdomen Risk of DIC fetal tachycardia, bradycardia, absent variability, late decels, sinusoidal
32
What is vasa previa?
Fetal vessels over cervical os Extremely dangerous ROM or dilation and rupture vessels
33
What happens if the decidua basalis fails to control trophoblast invasion beyond the endometrium?
Placenta accrete
34
What is placenta accreta vera?
Chorionic villi attach to myometrium but do not invade muscle tissue May be able to manually remove
35
What is placenta increta?
Chorionic villi invade INTO myometrium Cannot be removed
36
What is placenta percreta?
Chorionic Villi invade THROUGH myometrium and penetrate uterine serosa (perimetrium) May invade surrounding tissue/organs
37
What is the most significant risk factor for placenta accreta?
Prior cesarean section(s)
38
What are the risks after 40 wks gestation?
Oligo, macrosomia, meconium, IUFGR
39
What are the main causes of preterm delivery?
50% idiopathic- unknown 30% underlying infectious processes 20% iatrogenic- elective for complications
40
What do you need to know about fetal fibronectin? (fFN)
``` Glycoproteins found in plasma Done between 24-34wks Collected from posterior vaginal fornix High negative predictive value Poor positive predictive value Not valid within 24 hrs of intercourse/sve ```
41
What cervical length is associated with PTL?
42
What are the four classes of tocolytics?
Sympathimimetics: terbutaline Magnesium sulfate Calcium channel blockers: nifedipine NSAIDS: indomethacin
43
How do glucocorticoids work?
Stimulates the synthesis of fetal proteins and peptides Stimulated synthesis of surfactant Promotes maturation of germinal matrix which reduces occurrence of intraventricular hemorrhage
44
What are monozygotic twins?
Come from same egg Identical Can share placenta and/or amnion
45
What are dizygotic twins?
Come from two eggs Not identical Always have separate placentas and amnions
46
What is twin-to-twin transfusion syndrome?
Blood supply of monochrorionic twins become connected- they share a blood supply Donor twin- smaller, pale, anemic, dehydrated Recipient twin- larger, red, too much blood, inc blood pressure, may develop cardiac failure
47
What is a big concern with mono/mono twins?
Becomes easy for twins to become entangled in each other's cords Entanglement may cause one twin to become stuck in birth canal
48
What is active management of third stage?
Early cord clamping, controlled cord traction, oxytocin
49
What is considered precipitous labor?
Delivery
50
What can be associated with precipitous labor?
Tachysystole, cocaine use, abruption
51
A shoulder dystocia occurs when head to delivery time is > ___
One minute OR use of ancillary measures to deliver
52
What are risk factors for a shoulder dystocia?
``` AMA Inc gest age DM obesity Prior shoulder dystocia Prior infant >4500grams Dystocia Operative vaginal delivery Large paternal birth weight Hispanic Male fetus Positive 50g screen with neg 3hr GTT macrosomia (>4000grams, inc abdominal circumference) ```
53
What is a sign of shoulder dystocia?
Turtle sign | Failure to achieve external rotation
54
What are fetal complications of a shoulder dystocia?
Asphyxia and/or acidosis Brachial plexus injuries (erbs/klumpkes palsy) Fractured humerus or clavicle Fetal death
55
What are maternal complications of a shoulder dystocia?
``` Bladder injury Cervical/vaginal/perineal lacs Hematoma Separation of symphysis Uterine rupture Pp hemorrhage Infection ```
56
What is a normal amniotic fluid volume?
1000ml at 36wks, then slowly decreases
57
What is oligohydramnios?
AFI
58
What is polyhydramnios?
AFI >24cm at term Associated with CNS or GI anomalies or maternal diabetes Can cause preterm labor (uterine distention) Can do amnioreduction
59
How can hypoxia cause meconium stained fluid?
Hypoxia results in fetal vagal response
60
What is PROM? What is active vs expectant management with PROM?
SROM >1hr prior to start of labor Active- induction Expectant- can delay induction 96 hours
61
What is PPROM?
SROM prior to 37 wks | Antibiotics and glucocorticoid for 24-34 wks
62
What is anaphylactoid syndrome of pregnancy?
"Amniotic fluid embolism" Amniotic fluid/debris enter maternal circulation Massive anaphylactic response Two phases: Acute cardiorespiratory collapse Hemorrhagic phase/DIC mortality 80% Most pts die within one hour
63
What is placenta previa?
Placenta covers cervical os Marginal- edge of placenta within 2-3cm Bright red painless bleeding Cesarean delivery
64
What are the risk factors for a placenta previa?
``` AMA prior uterine surgery Fibroids or other uterine abnormalities Cigarette smoking Multiple gestational Multiparity ```
65
What is abruptio placentae?
Detachment of placenta from uterine wall Bleeding with pain Bleeding may be concealed Ultrasound may not be reliable Rigid, tender abdomen Risk of DIC fetal tachycardia, bradycardia, absent variability, late decels, sinusoidal
66
What is vasa previa?
Fetal vessels over cervical os Extremely dangerous ROM or dilation and rupture vessels
67
What happens if the decidua basalis fails to control trophoblast invasion beyond the endometrium?
Placenta accrete
68
What is placenta accreta vera?
Chorionic villi attach to myometrium but do not invade muscle tissue May be able to manually remove
69
What is placenta increta?
Chorionic villi invade INTO myometrium Cannot be removed
70
What is placenta percreta?
Chorionic Villi invade THROUGH myometrium and penetrate uterine serosa (perimetrium) May invade surrounding tissue/organs
71
What is the most significant risk factor for placenta accreta?
Prior cesarean section(s)
72
What are the risks after 40 wks gestation?
Oligo, macrosomia, meconium, IUFGR
73
What are the main causes of preterm delivery?
50% idiopathic- unknown 30% underlying infectious processes 20% iatrogenic- elective for complications
74
What do you need to know about fetal fibronectin? (fFN)
``` Glycoproteins found in plasma Done between 24-34wks Collected from posterior vaginal fornix High negative predictive value Poor positive predictive value Not valid within 24 hrs of intercourse/sve ```
75
What cervical length is associated with PTL?
76
What are the four classes of tocolytics?
Sympathimimetics: terbutaline Magnesium sulfate Calcium channel blockers: nifedipine NSAIDS: indomethacin
77
How do glucocorticoids work?
Stimulates the synthesis of fetal proteins and peptides Stimulated synthesis of surfactant Promotes maturation of germinal matrix which reduces occurrence of intraventricular hemorrhage
78
What are monozygotic twins?
Come from same egg Identical Can share placenta and/or amnion
79
What are dizygotic twins?
Come from two eggs Not identical Always have separate placentas and amnions
80
What is twin-to-twin transfusion syndrome?
Blood supply of monochrorionic twins become connected- they share a blood supply Donor twin- smaller, pale, anemic, dehydrated Recipient twin- larger, red, too much blood, inc blood pressure, may develop cardiac failure
81
What is a big concern with mono/mono twins?
Becomes easy for twins to become entangled in each other's cords Entanglement may cause one twin to become stuck in birth canal

RNC-OB (9 decks)

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