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obstetric - gynecol STEP 2 > abnormal labor > Flashcards

abnormal labor Flashcards

1
Q

macrosomia - definition

A

fetuses with an estimated birth weight over than 4500 g

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2
Q

macrosomia - RF?

A

A. maternal: advanced age, DM, multiparty, excessive weight gain during pregnancy or pre-existing obesity
B. fetal: African american or Hispanic, male, post-term

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3
Q

macrosomia - diagnostic test

A

physical exam: fundal height equal gestational age in weeks (ex if 28 wks, then the fundal height should be 28. But in macrosomia it is 3 cm higher than the weeks
IF IT IS or 3 HIGHER –> US

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4
Q

macrosomia - treatment

A
  1. induction of labor should be considered if the lungs are mature BEFORE the fetus is above 4500 g in weigh
  2. Cesarean delivery is indicated if fetus is above 4500
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5
Q

Long term and posterm pregnancy complications

A

fetal: oligohydramnios, meconium aspiration, stillbirth, macrosomia, convulsions
maternal: C sction, infection, postpartum hemorrhge, periaeal trauma

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6
Q

Should dystocia?

A

fetus’s head has been delivered but the ANTERIOR shoulder is stuck behind the pubic symphysis

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7
Q

Should dystocia - RF

A
  1. Maternal diabetes and obesity (cause fetal macrosomia)
  2. Posterm pregnancy (baby more time to grow)
  3. history of prior should dystocia
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8
Q

warning signs for shoulder dystocia

A
  1. protracted labor

2. retraction of fetal head intothe perineum after delivery (turtle sign)

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9
Q

Should dystocia - treatment (only names)

A

sequential steps:

  1. McRoberts maneuver
  2. Rubin maneuver
  3. Woods maneuver
  4. Delivery of posterior arm
  5. deliberate fracture of fetal clavicle
  6. Zavanelli manuever
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10
Q

McRoberts maneuver?

A

1st line treatment

maternal frexion of knees into abdomen with suprapubic pressure

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11
Q

shoulder dystocia –> what to do if McRoberts fail

A

call for help –> apply suprapubic pressure –> ENLARGE vaginal opening with epiostomy –> other maneuvers

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12
Q

Rubin maneuver

A

Rotation of the fetus’s shoulders by pushing the posterior shoulder the fetal head

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13
Q

Woods maneuver

A

Rotation of fetus’s shoulders by pushing the posterior shoulder the fetal back

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14
Q

Zavanelli manuever

A
  1. push fetal head back into the uterus and perform cesarean delivery
  2. high rate of both maternal and fetal mortality
  3. Last maneuver to try
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15
Q

disorders of active phase of labor - types

A
  1. protracted cervical dilation

2. arrest

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16
Q

disorders of active phase of labor - types and presentation

A
  1. protracted cervical dilation –> cervical changes slower than expected
  2. arrest –> no cervical changes for 4 or more h with adequate contraction, no cervical changes for 6 or more with inadequate contraction
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17
Q

disorder of active phase of labor - types and treatment

A
  1. protracted cervical dilation –> oxytocin

2. arrest –> C section

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18
Q

protracted cervical dilation - etiology

A

3 Ps

  • Power: strength and frequency of uterine contraction (weak or infrequent)
  • Passenger: size and position of fetus
  • Passage: if passenger is larger than pelvis (cephalopelvic disproportion)
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19
Q

arrest disorder - etiology

A
  1. cephalopelvic disproportion (50% of all arrest disorders)
  2. Malpresentation (older than 36 wks with the presenting part something other than the head - head is not downward)
  3. excessive sedation / anesthesia
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20
Q

Cephalopelvic disproportion?

A

baby’s head or body is too large to fit through the mother’s pelvis

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21
Q

2nd stage arrest of labor - definition

A

insuficient fetal descent after pushing for

  • 3 or more h in nulliparuous
  • 2 or more h in multiparous
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22
Q

2nd stage arrest - RF

A

maternal obesity
excessive pregnancy weight gain
DM

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23
Q

second stage arrest of labor - etiology

A
  • cephalopelvic disproportion
  • malposition (MC: eg. nonocciput anterior)
  • inadequate contractions
  • maternal exhaustion
24
Q

2nd stage arrest of labor - management

A
  • operative vaginal delivery

- cesarean

25
Q

operative vaginal delivery (vacuum.forceps) - indications

A
  1. protracted 2nd stage of labor
  2. fetal heart rate abnormalities
  3. maternal contraindications to pushing
26
Q

operative vaginal delivery (vacuum.forceps) - fetal complications

A
  1. laceration
  2. cephalohematoma
  3. facial nerve palsy
  4. intracranial hemorrhage
  5. shoulder dystocia
27
Q

operative vaginal delivery (vacuum.forceps) - maternal complications

A
  1. Genitourinary tract injury
  2. urinary retention
  3. hemorrhage
28
Q

prolonged latent stage - definition

A

the latent phase last longer than 20 h for primipara and longer than 14 h for multipara

29
Q

prolonged latent stage - etiology

A
  1. sedation
  2. unfavorable cervix
  3. uterine dysfunction with irregular or weak contraction
30
Q

prolonged latent stage - treatment

A

rest and hydration

most will convert to spontaneous delivery in 6 to 12 h

31
Q

uterine rupture - definition / when

A

a life threatening to both mother and the fetus and usually occurs during labor
(THERE IS HOLE IN THE UTERUS)

32
Q

uterine rupture - RF

A
  1. previous cesarean deliveries (all types, but classical more)
  2. trauma
  3. placenta percreta
  4. uterine myomectomy (surgical removal of uterine leiomyomas)
  5. uterine overdistention (polyhydramnios, multiple gestations)
  6. prolonged labor
  7. induction of labor
  8. congenital uterine anomalies
  9. fetal macrosomia
33
Q

cesarean deliveries types

A
  1. low transverse incision (more recent use)
  2. low vertical incision
  3. classical incision (longitudinal along uterus)
34
Q

uterine rupture - presentation

A
  1. vaginal bleeding
  2. intraabdomonial bleeding (hypotension, tachycardia)
  3. fetal heart decelerations
  4. loss of fetal station
  5. PALPABLE FETAL PARTS on abdominal examiniation
  6. loss of intrauterine pressure
    recession of the presenting part during active labor
35
Q

uterine rupture presentation - regression of fetus (explanation)?

A

fetus was moving toward delivery, but is no longer in canal because it withdrew into the abdomen

36
Q

uterine rupture treatment

A
  • immediate laparotomy with fetus delivery
  • repair of uterus or hysterectomy will follow
  • if uterine repairing –> all subsequent pregnancies will be delivered via cesarian birth at 36 weeks
37
Q

uterine surgeries that are contraindications for labor

A
  1. classical C-section (vertical)

2. abdominal myomectomy with uterine cavty enttry

38
Q

C- section - contraindication for labor?

A

only the classical (vertical)

not the low transverse (horisontal)

39
Q

myomectomy - contraindication for labor

A

if there is uterine cavity entry

40
Q

MC obstetric complication with WVD

A

postpartum bleedin

41
Q

uterine inversion

A

uterine fundus that inverts and prolapses thorugh the cervix or vagina, resulting in a smooth, round mass protruding through the cervix or vagina, a uterine fundus that in nonpalpable transabdominally, severe pain and postpartum hemorrhage
- can result from excessive funda; pressure and traction on the umbilical cord before placental separation

42
Q

uterine inversion - management

A
  1. aggressive fluids
  2. mannual replacement of the uterus –> if fails –> lapartomy
  3. placental removal + uterotonic drugs after uterine –> replacement
43
Q

postpartum hemorrhage - etiology

A 
mnemonic 4Ts
Tone uterine atony (MC)
Trauma - lacerations, incisions, uterine rupture 
Thrombin - coagulopathy 
Tissue - retaind products of conception
44
Q

how is the uterus in atony

A

enlarged –> higher than the umbilicus

45
Q

postpartum hemorrhage - definition

A

more than 500 ml after vaginal delivery
more than 100 ml after ceserean delivery
in the first 24 hours

46
Q

postpartum hemorrhage - RF

A
  1. prolonged on induced labor
  2. choriomanionitis
  3. multiple gestation
  4. polyhydramnios
  5. grand multiparity
  6. operative delivery
47
Q

postpartum hemorrhage - treatment

A 
massage
oxytocin
IV fluids, oxygen 
uterotonics (methylergonovine, carboprost, misoprostol)intrauterine balloon tembnade
uterine artery embolization
hysteroctomy
48
Q

Malpresentation - presentation

A
  1. lower half of fetus (pelvis and legs) is presenting. presenting part is the colsest to vaginal canal and will be engaged when labor start
  2. can be felt on physical exam.
49
Q

Malpresentation - can be felt on physical exam

A
  1. Leopold maneuvers are a set of 4 maneuvers that estimate the fetal weigh and the presenting part of the fetus
  2. Vaginal exam: with malpresentation, you fell a soft mass instead of the normal hard surface of the skull
50
Q

Malpresentation - diagnostic evaluation

A

US to confirm

51
Q

types of breech presentation (malpresentation) (only names

A
  1. Frank breech
  2. Complete breech
  3. Footling breech (incomplete)
52
Q

Frank breech

A

fetus’s hips are flexed with extended knees bilaterally

53
Q

Complete breech

A

fetus’s hips and knees are flexed bilaterally

54
Q

footling breech (incomplete)

A

fetus’s feet are first: 1 leg (single footling) or both legs (double footling)

55
Q

Malpresentation - treatment

A

with external cephalic version, the caregiver manuevers the fetus into a cephalic presentation (head down through the abdominal wall. You should not perform this maneuver until afrer 37 wks gestation/ the fetus can maneuver itself into a cephalic presentation (head first) before 37 wks -> if fails –> C section at 39 weeks

56
Q

internal podaric vesrion

A

used for the breech extraction of a malpresenting 2nd twin. Breech delivery of a 2nd tween has a lower asphyxia than cesarean delivery and is not contraindicated

57
Q

contraidincations to external cephalic version

A
  1. indications for cesarean delivery regardless of fetal lie
  2. placental abnormalities (previa or abruption)
  3. oligohydramnios
  4. ruptured membranes
  5. hyperextended fetal head
  6. fetal or uterine anomaly
  7. multiple gestation

obstetric - gynecol STEP 2 (22 decks)

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