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PAR3031 - MATERNITY > Week 8 > Flashcards

Week 8 Flashcards

(41 cards)

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1
Q

what are some examples of Malpresentations of a baby in utero?

A 
Breech (we went through this last week)
Occipito-posterior position
Face presentation
Brow presentation
Transverse or oblique lie
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2
Q

What is the occipitoposterior position (OP)

A

Babies back to maternal back

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3
Q

What is the presentation of the occipitoposterior position (OP)

A
  • As per normal labour
  • May feel need to push earlier
  • Foetal head is only delivered once face is cleared of symphysis pubis
  • Can lead to extensive perineal tearing
  • Painful ++
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4
Q

What are the risk factors for the occipitoposterior position (OP)

A

mum sitting hip below knee

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5
Q

How do you manage the the occipitoposterior position (OP)

A

Spontaneous rotation occurs 90-95% of the time

- manage as per normal labour

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6
Q

What is Face Presentation?

A
  • Complete or hyperextension of the foetus’ neck

- Face is presenting part

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7
Q

What are the risk factors for Face Presentation?

A
  • Macrosomicfoetus
  • Contracted pelvis
  • Umbilical cord wrapped around the neck a few times
  • OP position
  • Large neck due to cystic hygroma
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8
Q

What is the presentation of Face Presentation of baby in utero?

A
  • Face in the introitus
  • Will be bruised and oedematous (prepare mum)
  • can be confused with a breech pattern
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9
Q

How do you manage a face presentation?

A

Mentoanterior:

  • deliver as per normal
  • Prepare for extensive perineal tearing and trauma
  • Prepare for haemorrhage
  • Prepare for resus of neonate

Mentoposterior:

  • Can’t be delivered vaginally
  • Needs c-section
  • Rapid transport
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10
Q

What is mentoanterior and mentoposterio in face presentation?

A

Mentoanterior - chin anterior

Mentoposterior - chin posterior

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11
Q

what is brow presentation of the baby during labour?

A

Less “extreme” extension of neck compared to face presentation

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12
Q

How do you manage a brow presentation?

A

May move to a face presentation (unlikely)
Cannot be delivered vaginally –needs a C-section
Management: Rapid transport (consult with PIPER)

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13
Q

What is Transverse or oblique lie (shoulder presentation)

A

Long axis of mum and foetus are at right angles

The baby is sideways

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14
Q

What are the risk factors for Transverse or oblique lie (shoulder presentation)

A
  • Lax uterine muscles
  • Placenta praevia
  • Preterm foetus
  • Twins +
  • Grand multiparity
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15
Q

How does Transverse or oblique lie (shoulder presentation) present?

A
  • shoulder

- cord prolapse

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16
Q

What are some possible complications of Transverse or oblique lie (shoulder presentation)

A

can lead to uterine rupture

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17
Q

What is a cord prolapse

Study These Flashcards
A
  • The cord lies ahead of the presenting part
  • Can be occultor overt
  • Can compromise foetalcirculation-hypoxia-brain injury-death
18
Q

What are the causes/risk factors of cord prolapse?

Study These Flashcards
A 
 Multiparity
 High head
 Prematurity
 Malpresentations
 Polyhydramnious
 Low birth weight
 Placenta praevia
 Pelvic tumours
 Foetalcongenital abnormalities
19
Q

How do you manage a cord prolapse on scene before transport (delivery not imminent)?

Study These Flashcards
A

If delivery not imminent:

  • Position in all fours with head to floor immediately
    - >Genu-pectoral position
  • When ready -walk patient to stretcher or put patient straight on stretcher avoid carry chair
  • Administer oxygen –time critical
20
Q

How do you transport a cord prolapse patient (delivery not imminent)?

Study These Flashcards
A

Exaggerated Sims position
–For transport
–Ensure patient is well secured

21
Q

What is the overall management plan for a cord prolapse patient (delivery not imminent)?

Study These Flashcards
A 
 Document time of cord prolapse
 Transport in exaggerated SIMs position
 Oxygen high flow
 PIPER and MICA
 Rapid transport with pre-alert
 Pain relief if required
 Cord Management:-Insert cord into vagina using fingers only & try not to touch further-Keep cord warm and moist
 If presenting part compressing cord
     – Insert fingers into vagina & hold/push presenting part off cord
 Mum will require urgent c-section
22
Q

What is the overall management plan for a cord prolapse patient (DELIVERY IMMINENT- OMGGGGG)?

Study These Flashcards
A

 PIPER
 MICA
 Ask mother to push through contractions –need to deliver foetusASAP
 Give pain relief
 Assist delivery as per normal keep an eye on cord and compression
 Neonate will most likely require resus –prepare
 Rest and reassure mum ++

23
Q

What are the risk factors of twins?

Study These Flashcards
A 
 In vitro fertilisation/assisted fertility
 Previous history of twins+
 Familial history
 Multiparity
 Maternal age >45
24
Q

What are some complications associated with twins?

Study These Flashcards
A 
Prematuriy
Foetal growth restriction (FGR)
Cerebral palsy
Still birth
Antepartum and postpartum haemorrhage
Thromboembolic disease
25
How to manage delivery of twins?
``` Transport if able-if not: Call for back up, MICA, PIPER Notify hospital Oxygen for 2ndtwin  ``` ``` If in imminent delivery - –deliver first twin as singleton –Identify neonate as first twin  Clamp cord in two places & cut cord Do not attempt to deliver placenta Do not allow the placental end to bleed –the second twin may be attached ``` ``` Transport to hospital if able –before second delivery Deliver 2ndbaby as singleton Cut cord & clamp Prepare to resuscitate Identify as second twin –Identify cord clamps Check for third foetus Check for PPH ```
26
What do you do after the delivery of both twins in the management of this patient?
``` Attempt to transport Allow 3rdstage to remain in-utero –Beware of risk of hemorrhage Check fundus is firm & remains so –Blood loss minimal ``` ``` Only if bleeding or “boggy fundus” –Deliver 3rdstage with cord traction –Give oxytocic if available •Syntocinonor Mysoprostyl Keep fundus firm & central ```
27
What is pre-term labour?
Labour prior to 37 weeks. | Very premmy = <28 weeks
28
How can preterm labour present?
Mother will complain of labour –regular contractions (may or may not have pain) –cramp like period pain or backache. •Manage as per labour
29
What are the causes of preterm labour?
- Infection - > Haematogenous - > Latrogenic - Stress - > Maternal - > foetal - Multiple pregnancy - Uterine distension - Placental abruption - Cervical weakness
30
What are the risk factors for pre-term labour?
``` Previous premature delivery Twins+ Smoker Low SES Previous cervical incompetence Known SROM in current pregnancy Environmental stress Alcohol and drug use Poor nutrition Interestingly…. Marital status ```
31
How to you manage a preterm labour in pre-hospital environment (delivery not imminent)?
``` Reassure mother PIPER & MICA Good obstetric history Pain relief Mother in lateral position if transporting ``` If >34 weeks (AV) –basic care If <34 weeks gestation (in AV) consult to give GTN via 50mg patch on abdomen Notify hospital -Transport ?NICU –Dependent on gestation
32
How to you manage a preterm labour in pre-hospital environment (DELIVERY IS imminent GAHHHH)?
``` Back up –second crew + MICA + PIPER Prepare for delivery Prepare for resuscitation Risk of cord prolapse Breech presentation common prior to 34 weeks Keep neonate warm –If very prem. place baby in baking bag –Wrap head Observe ABC’s refer neonatal resus lecture ```
33
What is PROM (premature rupture of membranes)
``` Occurs in approx. 2% of all pregnancies 50% will deliver within 1 week & 75% within 2 weeks May occur during the ante-natal period –Prior to the commencement of labour –At any gestation ``` History of gush of fluid –May be sudden → forewaters – May be slow → hindwater
34
What are some complications of PROM?
Can progress to delivery of prem. infant Infection risk Prolapsed cord
35
How do you manage PROM?
- PIPER - Not in labour –> R&R +++; Oxygen; pain relief is not usually required - Transport
36
What is an Episiotomy?
Episiotomy –surgical incision of perineum to aid vaginal birth
37
What is an instrumental delivery?
Forceps - Indicated when there is foetal or maternal distress or issues associated with the 5 P’s - C/I in patients whose cervix isn’t fully dilated-Large metal forceps are placed inside the vagina on either side of the foetus’ head - Traction is applied with each contraction to effectively pull the foetus out (normally within 3 pulls)
38
What are the risks of operative (instrument) delivery
- High risk of trauma to mum and foetus | - High risk of haemorrhage due to tearing (even in the presence of episiotomy)
39
What is a caesarean section?
Incision through mums abdo(laparotomy) and uterus (hysterotomy)
40
What are the indications for a C section
Indications - Previous c-section - Immediate life threat - Elective - Failure to progress in Labour - Malpresentation
41
What are some complications of c sections?
``` Haemorrhage Infection UTI Transient tachypnoea is neonate Organ damage (bowel/bladder) VTE Psychological ```

PAR3031 - MATERNITY (11 decks)

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