3.2.3 Labor and Delivery Flashcards
What are some risk factors associated with shoulder dystocia?
Fetal macrosomia
Maternal diabetes
Maternal obesity
Post term gestation
Prior history of either macrosomia or should dystocia
Operative vaginal delivery
What are the principle movements of labor?
Engagement
Descent
Flexion at the neck
Internal rotation at the neck
Extension at the neck
External rotation at the neck
Expulsion
What are you cutting in a mediolateral episiotomy?
Mediolateral – cut bulbocavernosus muscle
What are the 3 Ps of dystocia?
Power
Passenger
Passage
What are the risk factors associated with a cord prolapse?
Low birth weight <2.5kg
Preterm birth
Breech presentation
Multiple gestation
Malpresentation (transverse lie)
Hydramnios
Obstetrical interventions
What is the management for cord prolapse?
Recognize
Call for help
Relieve
Remove
Describe the rate of cervical dilation during the different phases of the cervical phase
What are some clinical findings that suggest possible shoulder dystocia?
What is used to correct inadequate power in dystocia?
Inadequate uterine contraction activity can usually be corrected by infusion of oxytocin to both strengthen and increase the contraction frequency
Birth canal = ?
The True pelvis
What is shoulder dystocia?
When, after delivery of the fetal head further expulsion of the infant is prevented by impaction of the fetal shoulders within the maternal pelvis
What are the neonatal complication associated with shoulder dystocia?
What are the different types of Umbilical cord prolapse?
What are the characteristics of the placental stage?
Begins with the delivery of the baby
Ends with the delivery of the placenta
Relies on involution of the uterus through continued contractions to affect separation of the placenta
If there is a cord prolapse, why should the handling of the cord be reduced to a minimum?
Reduce the risk of vasospasm
What are the characteristics of should dystocia?
What are some maneuvers to alleviate shoulder dystocia?
What is the Term in Pregnancy?
38-42 Weeks of Pregnancy
Weeks of pregnancy are dated from the first day of the patients last menstrual period
Normal pregnancy is 40wks
Normal labor and delivery accounts for over two thirds of pregnancies.
What is the prevalence of the different types of pelvis?
What are the characteristics of the cervical stage?
Begins with the onset of labor
Ends when the cervix is fully dilated
Follow a characteristics course in a normal labor
Gets shorter with subsequent pregnancies
What is an episiotomy?
Cut on the posterior side of the vagina - enlarges the vaginal outlet to facilitate delivery
What are the problems associated with an android pelvis?
Appears to narrow inferiorly
Baby can get stuck
What are the covered parts?
What is an umbilical cord prolapse?
When the umbilical cord descends in advance of the presenting fetal part
What are the advantages/disadvantages of midline episiotomy?
Midline – less pain, easy repair, could extend to anus
What are the problems associated with an platypelloid (flat) pelvis?
Almost no room in pelvis for any internal rotation to occur - head stuck in transverse position
Transverse arrest of the fetal head
Why can the passenger create problems in dystocia?
Estimated fetal weight (macrosomia) at the time of labor can provide clues to possible difficulties for the fetus making its way through the birth canal
Malpositioning can increase the diameter trying to negociate the pelvis
What position will you move the mother to if there is a cord prolapse?
Trendelenburg position - raise the foot of the bed
or
Knee-Chest position
What are the characteristics of the Expulson phase?
Begins at full cervical dilation
Ends with delivery of the baby
Aided by use of abdominal muscles in a valsalva-like maneuver to bring pressure to bear on the uterine fundus
Effective pushing can double the expulsive forve of the uterus
What are the problems associated with an anthropoid pelvis?
Wider at the bottom
occiput remains posterior, can’t curve around pubic bone (no hyperflexion)
What is dystocia?
Difficultly with delivery
What is the physician measuring in this image?
Diagonal conjugate
