Abnormal Labor/Delivery

Question 1

What are some main risk factors for a Shoulder Dystocia?

Answer 1

Obesity of mom/baby and Diabetes Mellitus
- Also prior shoulder dystocia

Question 2

How may a shoulder dystocia present during labor?

Answer 2

Prolonged 2nd stage of labor

Question 3

What may you see while delivering a baby that has a shoulder dystocia?

Answer 3

Recoil of the perineum = “turtle sign”

Question 4

What may you see following delivery of a baby that experienced a shoulder dystocia?

Answer 4

Lack of head alignment for the fetus

Question 5

What 2 things are at risk of injury during a shoulder dystocia?

Answer 5

Clavicular fractures
Brachial plexus injury

Question 6

If a fetus experiences a brachial plexus injury, what is the treatment?

Answer 6

Nothing, will likely resolve

Question 7

What is the first things that should be done during a shoulder dystocia?

Answer 7

Maternal hip flexion + applying suprapubic pressure

Question 8

If the McRoberts maneuver does not work with a shoulder dystocia, what else can you try?

Answer 8

Woods screw maneuver = enter vagina and attempt rotation

Question 9

Besides the McRoberts and Woods screw maneuvers, what else can you try for a shoulder dystocia?

Answer 9

Deliver 1 arm
Episiotomy

Question 10

What defines Failure to Progress during the 1st stage labor?

Answer 10

Failure to have progressive cervical change

Question 11

With failure to progress, how long must the latent phase of labor be with no cervical change to classify as such?

Answer 11

Latent phase > 14 or 20 hours depending on parity

Question 12

With failure to progress, what will be seen in the active phase of labor?

Answer 12

No change in dilation from 6 cm with either:
1. 4 hours with adequate contractions
2. 6 hours with inadequate contractions

Question 13

What defines Failure to Progress during the 2nd stage of labor?

Answer 13

Arrest of fetal descent

Question 14

With failure to progress in the 2nd stage of labor, arrest of fetal descent is seen. What length of time is required to classify as such?

Answer 14

> 1-2 hours depending on pariity
***** + 1 hour to that if patient received an epidural!!!

Question 15

Spontaneous ROM

Answer 15

With the onset of labor or soon after

Question 16

Premature ROM

Answer 16

Occurs > 1 hour before the onset of labor

Question 17

Preterm Premature ROM

Answer 17

Occurs BEFORE 37 weeks gestation

Question 18

Prolonged ROM

Answer 18

Occurs > 18 hours before delivery

Question 19

If a patient has ROM, what should you NOT do?

Answer 19

Digital vaginal exam = infection risk

Question 20

What should be performed if ROM is suspected? What will be seen?

Answer 20

Sterile speculum exam
= pooling of amniotic fluid in vaginal vault

Question 21

What color will the Nitrazine paper test turn if amniotic fluid is present, signifiying ROM?

Answer 21

Blue = (+)

Question 22

What pattern of cells can be seen under microscope when amniotic fluid is allowed to dry, signifying ROM?

Answer 22

Ferning – snowflakes

Question 23

What is usually the treatment for ROM?

Answer 23

Induce labor +/- antibiotics/corticosteroids

Question 24

What defines Preterm labor?

Answer 24

Onset of labor between 20 - 37 weeks

Question 25

There are many risk factors for Preterm Labor, but what is an anatomical one?

Answer 25

Short cervix seen on US in 2nd trimester

Question 26

If a patient has a short cervix and they are at risk for preterm labor, what should be given?

Answer 26

Progesterone

Question 27

What is the treatment for preterm labor if < 34 weeks?

Answer 27

Tocolytic therapy

Question 28

What can be added to the treatment for preterm labor if < 32 weeks and why?

Answer 28

Magnesium to prevent cerebral palsy

Question 29

With preterm labor, what can be given to accelerate fetal lung maturity and what may be needed if unsure of GBS status?

Answer 29

Steroids
–> may need antibiotics/penicillin for GBS prophylaxis

Question 30

What are 3 Beta Agonists used for Tocolytic therapy?

Answer 30

Terbutaline
Ritodrine
Hexoprenaline

Question 31

What is a side effect of Beta Agonists when used for Tocolytic therapy?

Answer 31

Pulmonary edema

Question 32

What 2 Calcium Channel Blockers can be used for Tocolytic therapy?

Answer 32

Nifedipine
Nicardipine

Question 33

What are some Prostaglandin Inhibitors that can be used for Tocolytic Therapy?

Answer 33

Indomethacin and other NSAIDs

Question 34

When should you use Prostaglandin Inhibitors for Tocolytic therapy and why?

Answer 34

BEFORE 32 weeks gestation because they will close the PDA

Question 35

Magnesium Sulfate can also be used for Tocolytic therapy. What are 4 signs of toxicity?

Answer 35

Flushing
Respiratory distress
Cardiac arrest
Loss of patellar DTRs

Question 36

What is the correct presentation of a fetus?

Answer 36

Vertex with head down
- chin to chest
- occiput anterior

Question 37

Describe complete, frank and footling breech positions

Answer 37

Complete = hips and knees flexed
Frank = hips flexed and knees extended
Footling = 1 or both legs fully extended

Question 38

What occurs with most breech presentations?

Answer 38

Will spontaneously resolve and flip

Question 39

What can you try, although dangerous, with a breech presentation?

Answer 39

External cephalic version

Question 40

What is the best delivery method for breech presentation?

Answer 40

C-section

Question 41

When is performing an External Cephalic Version contraindicated? (3)

Answer 41

• History of classical C-section or uterine myomectomy
• Current placenta previa

Question 42

When is performing an External Cephalic Version Contraindicated? (3)

Answer 42

• History of classical C-section or uterine myomectomy
• Current placenta previa