Abnormal Labor/Delivery Flashcards
What are some main risk factors for a Shoulder Dystocia?
Obesity of mom/baby and Diabetes Mellitus
- Also prior shoulder dystocia
How may a shoulder dystocia present during labor?
Prolonged 2nd stage of labor
What may you see while delivering a baby that has a shoulder dystocia?
Recoil of the perineum = “turtle sign”
What may you see following delivery of a baby that experienced a shoulder dystocia?
Lack of head alignment for the fetus
What 2 things are at risk of injury during a shoulder dystocia?
Clavicular fractures
Brachial plexus injury
If a fetus experiences a brachial plexus injury, what is the treatment?
Nothing, will likely resolve
What is the first things that should be done during a shoulder dystocia?
Maternal hip flexion + applying suprapubic pressure
If the McRoberts maneuver does not work with a shoulder dystocia, what else can you try?
Woods screw maneuver = enter vagina and attempt rotation
Besides the McRoberts and Woods screw maneuvers, what else can you try for a shoulder dystocia?
Deliver 1 arm
Episiotomy
What defines Failure to Progress during the 1st stage labor?
Failure to have progressive cervical change
With failure to progress, how long must the latent phase of labor be with no cervical change to classify as such?
Latent phase > 14 or 20 hours depending on parity
With failure to progress, what will be seen in the active phase of labor?
No change in dilation from 6 cm with either:
1. 4 hours with adequate contractions
2. 6 hours with inadequate contractions
What defines Failure to Progress during the 2nd stage of labor?
Arrest of fetal descent
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?
> 1-2 hours depending on pariity
***** + 1 hour to that if patient received an epidural!!!
Spontaneous ROM
With the onset of labor or soon after
Premature ROM
Occurs > 1 hour before the onset of labor
Preterm Premature ROM
Occurs BEFORE 37 weeks gestation
Prolonged ROM
Occurs > 18 hours before delivery
If a patient has ROM, what should you NOT do?
Digital vaginal exam = infection risk
What should be performed if ROM is suspected? What will be seen?
Sterile speculum exam
= pooling of amniotic fluid in vaginal vault
What color will the Nitrazine paper test turn if amniotic fluid is present, signifiying ROM?
Blue = (+)
What pattern of cells can be seen under microscope when amniotic fluid is allowed to dry, signifying ROM?
Ferning – snowflakes
What is usually the treatment for ROM?
Induce labor +/- antibiotics/corticosteroids
What defines Preterm labor?
Onset of labor between 20 - 37 weeks
There are many risk factors for Preterm Labor, but what is an anatomical one?
Short cervix seen on US in 2nd trimester
If a patient has a short cervix and they are at risk for preterm labor, what should be given?
Progesterone
What is the treatment for preterm labor if < 34 weeks?
Tocolytic therapy
What can be added to the treatment for preterm labor if < 32 weeks and why?
Magnesium to prevent cerebral palsy
With preterm labor, what can be given to accelerate fetal lung maturity and what may be needed if unsure of GBS status?
Steroids
–> may need antibiotics/penicillin for GBS prophylaxis
What are 3 Beta Agonists used for Tocolytic therapy?
Terbutaline
Ritodrine
Hexoprenaline
What is a side effect of Beta Agonists when used for Tocolytic therapy?
Pulmonary edema
What 2 Calcium Channel Blockers can be used for Tocolytic therapy?
Nifedipine
Nicardipine
What are some Prostaglandin Inhibitors that can be used for Tocolytic Therapy?
Indomethacin and other NSAIDs
When should you use Prostaglandin Inhibitors for Tocolytic therapy and why?
BEFORE 32 weeks gestation because they will close the PDA
Magnesium Sulfate can also be used for Tocolytic therapy. What are 4 signs of toxicity?
Flushing
Respiratory distress
Cardiac arrest
Loss of patellar DTRs
What is the correct presentation of a fetus?
Vertex with head down
- chin to chest
- occiput anterior
Describe complete, frank and footling breech positions
Complete = hips and knees flexed
Frank = hips flexed and knees extended
Footling = 1 or both legs fully extended
What occurs with most breech presentations?
Will spontaneously resolve and flip
What can you try, although dangerous, with a breech presentation?
External cephalic version
What is the best delivery method for breech presentation?
C-section
When is performing an External Cephalic Version contraindicated? (3)
- History of classical C-section or uterine myomectomy
- Current placenta previa
When is performing an External Cephalic Version Contraindicated? (3)
- History of classical C-section or uterine myomectomy
- Current placenta previa
