12.2g Obstetric Emergencies Flashcards
Meconium Stained Amniotic Fluid
- Fetus passed meconium before birth
- Amniotic fluid will look green. Consistency will be thin (light) or thick (heavy)
Reasons Why
- Normal with breech position
- Due to hypoxia-induced peristalsis and sphincter relaxation
- Can be caused by umbilical cord compression-induced vagal stimulation in mature fetuses
MAJOR RISK
- Meconium Aspiration Syndrome (MAS)
Care Management Before Birth
- Assess presence of meconium in amniotic fluid after ROM
- If there is meconium, gather supplies needed for resuscitation
- There should be someone able to preform an endotracheal intubation on the newborn present at birth
Care Management After Birth
- Assess Respiratory Effort, HR, and Muscle Tone
- Suction mouth and nose with bulb syringe OR large bore suction catheter IF
a. Baby has strong respiratory efforts
b. Good muscle tone
c. HR greater than 100 - Suction trachea with endotracheal tube connected to meconium aspiration device. Use assisted ventilation if
a. Baby has depressed respirations
b. Decreased muscle tone
c. Heart rate less than 100
Shoulder Dystocia
- Condition where head is born but shoulder cannot pass pubic arch
- Related to macrosomia or pelvic abnormalities
RISKS
- Maternal diabetes (risk of macrosomia)
- History of shoulder dystocia
- Prolonged second stage of labor
SIGNS
- Slow progression of 2nd stage of labor
- Caput succedaneum that increases in size
- TURTLE SIGN (retraction of fetal head after it emerged)
- External rotation does not occur
FETAL INJURIES
- Asphyxia
- Trauma (fractured humerus, clavicle, brachial plexus injuries)
Shoulder Dystocia Care Management
McRoberts Maneuver and Suprapubic Pressure (First Line of Defense)
McRoberts - Legs are hyperflexed on abdomen which straightens sacrum
Gaskin Maneuver - Hands and Knees Position
Newborn Assessment - Examination of fractured clavicle/humerus, brachial plexus injuries, asphyxia.
Maternal Assessment - Detection of hemorrhage, trauma to vagina, perineum and rectum.
Umbilical Cord Prolapse
- Cord lies below presenting part
- Can be Occult (hidden)
CARE MANAGEMENT
- Prompt recognition due to risk of fetal hypoxia. Occlusion of blood flow over 5 minutes results in CNS damage and Death of Fetus
- Pressure on cord can be relieved by using sterile gloves to push the babies head off the umbilical cord.
Positions for mom can be
- Modified Sims
- Trendelenburg
- Knee-Chest
Rupture of Uterus
- Separation of the layers of uterus or previous scar
- Most commonly occurs during TOL (Trial of Labor) for VBAC (Vaginal Birth After C-Section)
RISK FACTORS
- Prior uterine rupture
- Trauma
- Abortion
- Instrumental Injury
- Uterine perforation
- Grand multiparity
- Uterine overdistention
Uterine Dehiscence
- Incomplete uterine rupture (separation of previous scar)
Signs
- Abnormal FHR (Category 2 or 3)
- No fetal descent
- Sudden sharp ripping or tearing sensation in the abdomen
- Bright red vaginal bleeding
- Signs of hypovolemic shock from hemorrhage
- Fetal parts palpable through abdomen
CARE
- Start IV Fluids
- Transfusing blood products
- Administer O2
- Assist in preparations for immediate surgery
Amniotic Fluid Embolus (AFE)
- Anaphylactoid Syndrome of Pregnancy
- Sudden and acute hypotension, hypoxia, hemorrhage caused by coagulopathy
- Sudden Respiratory and Cardiovascular Collapse
RISKS
- Rapid labor
- Meconium stained amniotic fluid
- Tears into uterine or other large pelvic veins
- Older age
- Post-term Pregnancy
- Labor induction/augmentation
- Eclampsia
- C-section
- Forceps/Vacuum Assisted Birth
- Placental abruption/previa
- Hydramnios
CARE MANAGEMENT
- Immediate C-section and Resuscitation
ECV Contraindications (External Cephalic Version)
- Uterine Malformations
- Oligohydramnios (risk of cord compression)
- Ruptured Membranes
- Non-Reassuring FHR
- Previous Vertical Uterine Surgeries (high risk of rupture during fundal manipulation)
Ripening Of Cervix
- If a foley catheter is used as mechanical ripening of cervix, and it falls out, this is because her cervix was successfully ripened. Once 3-4 cm dilation the catheter will fallout and Pitocin induction can begin.
