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Flashcards in Things going wrong in labour Deck (13):

What is shoulder dystocia?

Inability to deliver body of the fetus using gentle traction after the head has been delivered- usually impaction of the anterior shoulder on the pubic symphysis


Complications of shoulder dystocia?

Mum: postpartum haemorrhage and perineal tears
Bab: brachial plexus injury , hypoxia, death


Risk factors for shoulder dystocia?

fetal macrosomia, high maternal body mass index, diabetes mellitus and prolonged labour


Management of shoulder dystocia?

Call for help
Mcroberts-flex the hips (thighs to tummy)
(incr ap angle)
Episiotimy if need internal manoeurvres (screw, posterior shoulder delivery)
Las resort is symphysiotomy and zavanelli (push it back in and c section.
These are often too late


What is an amniotic fluid embolism?

•This is when fetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction . Rare


Presentation of amniotic fluid embolism?

•The majority of cases occur in labour , though they can also occur during caesarean section and after delivery in the immediate postpartum.
•Symptoms include: chills, shivering, sweating, anxiety and coughing.
•Signs include: cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction


How is amniotic fluid embolism managed?

Mainly supportive, critical care unit and MDT


What is chorioamnionitis?

usually the result of an ascending bacterial infection of the amniotic fluid / membranes / placenta. Emergency


Major risk factor for chorioamnionitis?



Treatment of chorioamnionitis?

Prompt delivery of the foetus (via cesarean section if necessary) and administration of intravenous antibiotics


What is cord prolapse?

the umbilical cord descending ahead of the presenting part of the fetus. Left untreated, this can lead to compression of the cord or cord spasm, which can cause fetal hypoxia and eventually irreversible damage or death.


RF for cord prolapse?

•twin pregnancy
•cephalopelvic disproportion
•abnormal presentations e.g. Breech, transverse lie
•placenta praevia
•long umbilical cord
•high fetal station


Management of a cord prolapse?

- presenting part of the fetus may be pushed back into the uterus to avoid compression
-Tocolytics may be used
-If the cord is past the level of the introitus, it should be kept warm and moist but should not be pushed back inside.
-The patient is asked to go on 'all fours' until preparations for an immediate caesarian section have been carried out