9. Complications in Labor Flashcards
Types of instrumental Delivery (3)
o Forceps Assisted Birth
o Vacuum-Assisted Birth
o Caesarean Section
Indications of instrumental delivery (4)
- Maternal exhaustion
- Ineffective pushing efforts
- Expedite birth
- Cephalopelvic Disproportion (CPD)
Classification of forceps is based on the station of the fetal head when the forceps are applied (4)
- Outlet forceps: Fetal head on perineum
- Low forceps: +2 station
- Mid forcep: 0 to +2 station
- High forceps: Above 0 station (not really done anymore)
Advantages of forceps
Shortens second stage
Risks of forceps (4)
- Neonatal birth trauma (Facial palsy)
- Neonatal respiratory depression
- Postpartum hemorrhage
- Bladder injury
Vacuum-Assisted Birth: Def
• Suction with soft or flexible cup on vertex
Which is used more: Forceps or Vacuum?
Vacuum
Risks of Vacuum-assisted birth (4)
- Cephalohematomoa
- Scalp lacerations
- Subdural hematoma
- Perineal trauma
C-Section: Def
• Birth through transabdominal incision of uterus
Why is a C-Section done?
• Preserve life / health of mother and baby
Indications for a C-Section (9)
- Maternal or fetal distress
- CPD
• Malpresentation (Breech or transverse lie)
- Placental Previa or abruption
- Prolapsed umbilical cord
- Failed induction
- Multi-fetal pregnancies
- Pre-eclampsia / Eclampsia
- Active herpes (HSV) infection
Types of C-Sections (types of uterine incisions) (2)
Upper Uterine Segment:
o Classical
Lower Uterine Segment
o Low transverse
What types of c-sections enable VBACs later?
Classical - VBAC is contraindicated
Low Transverse - VBAC possible
Contraindications of C-Sections (3)
- Fetal death
- Fetus is not expected to survive
- Maternal coagulation defects
Maternal risks of C-sections (6)
- Infection, Hemorrhage, UTI, Thrombophlebitis, Atelectasis
* Anesthesia Complications (Pnemonia)
Neonatal risks of C-sections (3)
- Inadvertant Preterm birth
- Lacerations
- Bruising or other trauma
Major risk of VBAC
and prevalence
Uterine rupture (0.5% prevalence)
Uterine rupture: Incidence
1 in every 1500 to 2000 births
Causes of uterine rupture (6)
- Separation of the scar of a previous classic cesarean birth or uterine trauma
- Congenital uterine anomaly
- Intense spontaneous uterine contractions
- Uterine stimulation (eg oxytocin)
- An over-distended utuerus (eg multifetal gestation)
- Malpresentation
Classifications of uterine rupture (2)
- Incomplete uterine rupture:
* Complete uterine rupture:
Incomplete uterine rupture (def)
• Rupture extends through the endometrium, myometrium but the peritoneum surrounding the uterus remains intact
Complete uterine rupture (def)
• Extends through the entire uterine wall (endometrium, myometrium and peritonium) and uterine contents spill into the abdominal cavity
Retained placenta: Causes (3)
- Partial separation
- Abnormal adherence of placenta
- Mismanagement of the 3rd stage of labor
Management of retained placenta (3)
- IV sedation or anesthesia
- Manual removal of placenta
- Prophylactic abx therapy
Adherent placenta – 3 types / levels
- Acreta
- Increta
- Percreta
Placenta acreta
Slight penetration of myometrium (A-creta = A-little penetration)
Placenta increta
Deep penetration of myometrium (In-creta = In- deep)
Placenta percreta
Complete perforation of the uterus (Per-creta = Per-foration)
Retained placenta: Predisposing factors (3)
- Abnormal site of implantation (placenta grabs onto something abnormal)
- Malformation of the placenta (not as common)
- Scarring of the uterus
What would cause scarring of the uterus? (4)
- High parity (scarring of the uterus)
- Previous cesarean section (scarring)
- Previous myomectomy (from removal of fibroids)
- Hx of vigorous curettage / perforation (scraping the lining)
Cord Prolapse (def)
• What happens
• Two forms
o Cord lies below the presenting part of the fetus
o May be hidden (occult) or visible (frank)
Cord prolapse: Management (3)
- Keep pressure off cord
- Keep moist with saline if it’s that visible
- Birth by c- section
How would you keep pressure off of a prolapsed cord?
- Knee-chest position
* Hand in vagina
Shoulder dystocia: Def
o Anterior shoulder cannot pass under the pubic arch of the maternal pelvis
2 causes of shoulder dystocia
- Macrosomia
* Pelvic anomolies
Sxs of shoulder dystocia prior to birth (3)
- Slowing of the progress of labor
- Formation of caput that increases the size
- After birth of head: Turtle sign
Management of shoulder dystocia
(4 options)
- Change pelvic diameter
- Snap the clavicle
- Suprapubic Pressure
- McRobert’s Maneuver
What is McRobert’s Maneuver?
- Supine
* Knees to chest
Maternal complications involved with shoulder dystoica (3)
- Uterine atony / rupture: Increased blood loss
- Vaginal lacerations
- Uterine infection (endometritis)
Neonatal complications involved with shoulder dystocia (3)
- Clavicle fracture
- Asphyxia → Seizure
- Erb’s palsy: Brachial plexus damage
PPH (def)
• Amounts
Greater than average blood loss:
• >500mL of blood after vaginal birth
• >1000mL after c-section
Early versus late postpartum hemorrhage
o Early PPH: Occurs within 24 hours PP
o Late PPH: Occurs after 24 hours, but within 6 weeks
Most common cause of postpartum hemorrhage
Uterine atony
Other (less common) causes of postpartum hemorrhage (6)
- Retained placenta
- Uterine rupture or inversion
- Cervical or vaginal lacerations
- Hematomas
- Infection (endometritis)
- Coagulopathies
Definition of uterine atony
Marked hypotonia of the uterus (along with distention, overstimulation or trauma to the uterus)
Nursing management of uterine atony (4)
o Bimanual compression
o Pharmacologic interventions
o Uterine exploration
o Surgical interventions - historectomy
What pharmacological management is used for uterine atony?
- First line
- Second line
o FIRST LINE: Pitocin
o SECOND LINE: Methergine
Pitocin: Dose, routes
- 10-40 units in 100mL LR
* Can also be administered IM
Methergine: Dose, route,contraindicaitons
- 0.2 mg IM
* Contraindicated in HTN / PIH
Inversion of the uterus sxs (3)
- Hemorrhage
- Pain
- Shock
Postpartum infection: Def
Any infection that occurs within 28 days after miscarriage, ETOP and childbirth
Postpartum infection: Clinical manifestation / diagnosis
• Fever is > or = to 100.4*F on two successive days of the first 10p days
Common postpartum infections (5)
o Endometritis o Wound infection o Mastitis o UTI o URI
Most common organisms for postpartum infections (2)
Streptococcal and anaerobic organisms
