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PATHO OB > Breech > Flashcards

Breech Flashcards

1
Q

when the buttocks or legs of the fetus enter the pelvis before the head

A

Breech presentation

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2
Q

true/false

In breech presentation, it is more common when remote from term

A

True

In breech presentation, it is more common when REMOTE from term

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3
Q

persists AT TERM in 3-5% of singleton pregnancies

A

Breech presentation

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4
Q

why would the fetus want to present as breech and not the normal cephalic position?

A

Breech or buttocks will be LARGER in diameter compared to the biparietal diameter of the head

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5
Q

3 categories of breech presentation

A
  1. frank breech
  2. complete breech
  3. incomplete breech
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6
Q

BUTTOCKS: present in the introitus

THIGHS: flexed towards the lower abdomen

LEGS: extended

FEET: close to the face

A

Frank breech

BUTTOCKS: present in the introitus

THIGHS: flexed towards the lower abdomen

LEGS: extended

FEET: close to the face

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7
Q

“Indian sit”

A

Complete breech

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8
Q

THIGHS: flexed towards the lower abdomen

LEGS: flexed towards the thighs

A

Complete breech

THIGHS: flexed towards the lower abdomen

LEGS: flexed towards the thighs

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9
Q

One or both THIGHS: flexed or extended

One FOOT: extended

A

Incomplete breech/ Footling breech

One or both THIGHS: flexed or extended

One FOOT: extended

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10
Q

Reference point of all types of breeches

A

Sacrum

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11
Q

Give 2 types of breech presentation where the sacrum is very easy to palpate

A

Frank and Complete

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12
Q

Different positions of the presenting part

A

Right or Left, Anterior Sacrum or Sacro-anterior

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13
Q

presenting part of both Frank and complete breeches

A

Sacrum

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14
Q

What is the station if the sacrum is palpated at the level of the ischial spine

A

Station= 0

  • incomplete breech
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15
Q

True/False

Even if the foot is palpated on IE, the point of reference would be still the sacrum

A

True

Even if the foot is palpated on IE, the point of reference would be still the sacrum

*the sacrum is high in incomplete breech presentation

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16
Q

4 Risk factors of Breech presentation

A
  1. GREATER intrauterine surface area
  2. Congenital Anomaly
  3. DECREASE surface surface area at the LOWER uterine segment
  4. Prior occurrences of Breech delivery and CS delivery
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17
Q

Conditions wherein there is a GREATER intrauterine surface area

A

GREATER intrauterine surface area:

  • Gestational age (premature)
  • Abnormal amniotic fluid volume
  • High parity with uterine relaxation

*There will be more room for the fetus to turn into cephalic-breech-transverse

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18
Q

Congenital anomalies of the head that would present as breech

A
  • Hydrocephaly
  • Anencephaly

*confers a larger podalic pole, seeks the more spacious fundal pole and therefore, would present as breech

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19
Q

Conditions with DECREASED surface area at the lower uterine segment

A
  • Multifetal gestation
  • Fundal placental implantation
  • Uterine/Mullerian anomalies
  • Pelvic tumors (block the LUS)
  • Placenta previa (block the LUS)
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20
Q

Examples of Uterine/ Mullerian anomalies

A

Bicornuate uterus and Uterine didelphus

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21
Q

Maneuver used for abdominal examination

A

Leopold’s maneuver

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22
Q

identifies fetal lie and which fetal pole occupies the fundus

A

L1 (fundal grip)

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23
Q

L1= large, ballotable, nodular mass

A

Breech presentation

L1= large, ballotable, nodular mass (head)

ballotable- when you tap in the head over abdomen, the head would bounce back.

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24
Q

L1= hard, round and more mobile

A

Cephalic presentation

L1= hard, round and more mobile

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25
Q

maneuver to determine fetal orientation

A

L2 (Lumbar grip)

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26
Q

determines fetal back (resistant part) and fetal extremities (numerous, small, mobile parts)

A

L2(Lumbar grip)

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27
Q

true/false

At L2, breech is the same w/ cephalic, the fetal back on one side of the abdomen and fetal small parts on the
other will be felt.

A

true

At L2, breech is the same w/ cephalic, the fetal back on one side of the abdomen and fetal small parts on the
other will be felt.

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28
Q

confirms fetal presentation

A

L3 (Pawlick’s Grip)

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29
Q

thumb and fingers of one hand grasp the lower part of the abdomen above the symphysis pubis

A

L3(Pawlick’s Grip)

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30
Q

L3= hard, round, and more mobile part

A

Breech presentation

L3= hard, round, and more mobile part

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31
Q

L3= Large, ballotable, nodular mass (Head)

A

Cephalic presentation

L3= Large, ballotable, nodular mass (Head)

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32
Q

true/false

At L3, The breech is NOT MOVABLE above the pelvic inlet if engagement has NOT occurred

A

False

L3: The breech is MOVABLE above the pelvic inlet if engagement has NOT occurred. The intertrochanteric diameter of the fetal pelvis has NOT passed through the pelvic inlet

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33
Q

degree of descent

A

L4 (Pelvic Grip)

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34
Q

examiner facing the feet of the mother, places the fingertips of both hand on the presenting part

A

L4 (Pelvic Grip)

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35
Q

True/False

At L4, after engagement, the firm breech is beneath
the symphysis.

A

True

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36
Q

Fetal heart sounds is heard loudest SLIGHTLY ABOVE THE UMBILICUS (upper segment).

A

Breech

It is because the head is up with the upper torso.

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37
Q

Fetal heart sounds is heard loudest at the LUS

A

Cephalic

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38
Q

The ischial tuberosities, sacrum and anus usually are palpable

A

Frank Breech

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39
Q

After further descent, the external genitalia may be distinguished

A

Frank Breech

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40
Q

The ANUS may be mistaken for the mouth, and the ISCHIAL TUBEROSITIES for the molar eminences.

A

Frank Breech

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41
Q

The finger encounters muscular resistance with the anus, and upon removal from the anus, it is sometimes stained with meconium.

A

Frank Breech

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42
Q

Triangular shape is seen in what presentation?

A

cephalic presentation

Triangular shape- formed by the mouth and malar prominence

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43
Q

Straight line is seen in what presentation?

A

Frank Breech

Straight line- formed by the ischial tuberosities and Anus

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44
Q

Most accurate information that establishes the diagnosis of position and variety in frank breech

A

Location of the sacrum and its spinous processes

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45
Q

feet may be felt alongside the buttocks

A

Complete breech

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46
Q

Indian sit

A

complete breech

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47
Q

If the IE finger is pushed a little bit more beyond the ischial tuberosities/sacrum/anus, then the foot/feet will be felt alongside it

A

Complete breech

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48
Q

one or both feet are inferior to the buttocks

A

incomplete breech

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49
Q

feet is the presenting part

A

incomplete breech

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50
Q

true/false

Vaginal examination of Incomplete breech: foot can be readily be identified as right or left on the basis of the relation to the great toe.

A

TRUE

Vaginal examination of Incomplete breech: foot can be readily be identified as right or left on the basis of the relation to the great toe.

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51
Q

What you look for during the Ultrasound

A
  • Gross fetal abormalities (hydrocephaly/anencepahly)
  • neck flexion/ extension
  • fetal weight
  • BPD estimation
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52
Q

Factors that aid the determination of the best delivery route for a mother-fetus pair

A
  1. fetal characteristics
  2. pelvic dimensions
  3. coexistent pregnancy complications
  4. operator experience
  5. patient preference
  6. hospital capabilities
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53
Q

Delivery route when the pelvis has not been tested or it’s been proved that there’s contracted pelvis

A

CS delivery

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54
Q

Delivery route when the pelvis has been tested from previous deliveries for fetal weight. The present baby lay less

A

Planned vaginal delivery

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55
Q

Patient has anatomic congenital anomalies present. What is the delivery route?

A

CS delivery

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56
Q

True/false

Conform to the patient’s decision when a patient would prefer a normal delivery even if it’s breech in presentation

A

True

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57
Q

Fetus is > 3800 g. What is the delivery route?

A

CS delivery

*baby is big, and lacerations will occur w/ vaginal delivery

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58
Q

Fetus is <2500 g. What is the delivery route

A

CS delivery

*baby’s body is smaller compared to the fetal head so the problem of entrapment of the aftercoming head would be present w/ vaginal delivery

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59
Q

preferred delivery route for frank breech

A

vaginal delivery

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60
Q

preferred delivery route for footling breech

A

CS delivery

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61
Q

Delivery route in cases of placenta previa or abruptio?

A

CS delivery

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62
Q

True/false

Any pregnancy complication that compromises the mother or the fetus, then you have to expedite delivery of the breech baby by doing VAGINAL delivery.

A

False

Any pregnancy complication that compromises the mother or the fetus, then you have to expedite delivery of the breech baby by doing CS section.

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63
Q

True/False

If there is no one skilled to do the maneuvers for vaginal breech deliveries, do not attempt to do vaginal breech deliveries. Go for
a cesarean section.

A

TRUE

If there is no one skilled to do the maneuvers for vaginal breech deliveries, do not attempt to do vaginal breech deliveries. Go for
a cesarean section.

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64
Q

True/false

preterm deliveries are common in breech babies

A

True

Preterm deliveries are common in breech babies. Expect respiratory distress and asphyxia. You need to have a good neonatal team for the compromised baby

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65
Q

Increased neonatal mortality and morbidity

A

Planned vaginal delivery

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66
Q

Causes of death in Planned Vaginal Delivery

A
  1. Head entrapment
  2. Cerebral injury and intracranial hgg.
  3. cord prolapse
  4. severe asphyxia
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67
Q

True/false

Planned CS delivery has improved perinatal outcomes compared with planned vaginal delivery

A

True

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68
Q

True/false

24-32 wks AOG: attempted Vaginal delivery has LOW maternal complication rates and HIGH neonatal mortality rates

A

True

24-32 wks AOG: attempted Vaginal delivery has LOW maternal complication rates and HIGH neonatal mortality rates

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69
Q

AOG where there is NO improved survival rate on the neonate with CS or vaginal (same poor outcome)

A

24-29 wks AOG

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70
Q

AOG where Fetal Weight rather than AOG is the most important

A

32-37 wks AOG

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71
Q

According to SOGC, if the EFW >2500g, what is the route of delivery?

EFW- estimated fetal weight

A

Vaginal delivery

> 2500g: head is SMALLER than buttocks

<2500 g: head is BIGGER than buttocks; CS delivery because head entrapment and other complications would be higher if with vaginal delivery

72
Q

Delivery complications

A
  • maternal morbidity

- perinatal morbidity and mortality

73
Q

TRUE/FALSE

Genital tract lacerations is associated with Vaginal delivery only

A

FALSE

Genital tract lacerations is associated with BOTH Vaginal and CS delivery

74
Q

causes of vaginal wall and cervical lacerations

A
  • thinned LUS
  • delivery of the aftercoming head through an incompletely dilated cervix
  • application of forceps
75
Q

True/False

With vaginal delivery, extension of an EPISIOTOMY can create deep perineal tears and increase infection rates

A

True

With vaginal delivery, extension of an episiotomy can create deep perineal tears and increase infection rates

76
Q

complication of anesthesia used for uterine relaxation during vaginal delivery

A

Uterine atony

77
Q

True/False

Maternal death is rare, but rates appear higher in those with planned CS delivery for breech presentation.

A

TRUE

78
Q

True/ False

With CS delivery, added to the stretching of the lower uterine segment by forceps or a poorly molded fetal head can extend HYSTERECTOMY incisions laterally and might hit blood vessels

A

TRUE

With CS delivery, added to the stretching of the lower uterine segment by forceps or a poorly molded fetal head can extend HYSTERECTOMY incisions laterally and might hit blood vessels

79
Q

Prognosis is worse for fetuses in breech

A
  • increased incidence of preterm delivery
  • congenital anomalies
  • birth trauma
80
Q

Common injuries (trauma/compression) during delivery

A
  • fractures (humerus, clavicle and femur)
  • upper extremity paralysis (Erb or Duchenne)
  • vertebral fracture leading to spinal injury
  • testicular injury (if compressed)
  • umbilical cord prolapse
  • hip dysplasia
81
Q

4 images technique

A
  1. UTZ
  2. 2 view radiography of abdomen
  3. CT scan (pelvimetry)
  4. MRI (pelvimetry)
82
Q

should be ASSESSED before vaginal delivery to avoid head entrapment

A

Pelvic dimensions

83
Q

should be IDENTIFIED before vaginal delivery to avoid head entrapment

A
  • Fetal size
  • type of breech
  • degree of neck flexion or extension
84
Q

True/false

the head of a breech presenting fetus does undergo appreciable molding during labor

A

False

the head of a breech presenting fetus does NOT undergo appreciable molding during labor

85
Q

True/False

a well-flexed head CANNOT be delivered vaginally

A

False

Well-flexed head can be delivered vaginally.

Hyperextended head cannot be delivered vaginally

86
Q

the BEST imaging technique because it is always available, does not entail a big machine, and is cost effective

A

UTZ

87
Q

used to confirm a clinically suspected breech presentation and to identify fetal anomalies

A

UTZ

88
Q

used to help ensure that CS is not performed under emergency conditions for an anomalous fetus with no chance of survival

A

UTZ

89
Q

used to identify orientation of the head

A

UTZ

90
Q

used to identify fetuses not suitable for vaginal delivery

A

UTZ

91
Q

used to identify head flexion/extension

A

UTZ

92
Q

imaging modality used as exclusion criteria for vaginal delivery

A

UTZ

exclusion criteria for vaginal delivery:

EFW <2500 and >3800
evidence of FGR
BPD >90-100mm

93
Q

imaging modality to determine head inclination

A

Two view radiography of abdomen

94
Q

imaging modality that is accurate and widely available

A

CT scan

95
Q

imaging modality that can provide pelvic measurements and configuration at lower doses of radiation than standard radiography

A

CT scan

96
Q

imaging modality that suggest specific measurements to permit a planned vaginal delivery

A

CT scan

although variable, some specific measurements to permit a planned vaginal delivery:

  • Inlet anteroposterior diameter ≥10.5 cm
    − Inlet transverse diameter ≥12.0 cm
    − Midpelvic interspinous distance ≥10.0 cm
97
Q

Inlet AP diameter to permit planned vaginal delivery

A

≥10.5 cm

98
Q

Inlet transverse diameter to permit planned vaginal delivery

A

≥12.0 cm

99
Q

Midpelvic interspinous distance to permit planned vaginal delivery

A

≥10.0 cm

100
Q

imaging modality for maternal-fetal biometry correlation

A

CT scan

101
Q

imaging modality that provides reliable information about pelvic capacity and architecture WITHOUT ionizing radiation

A

MRI

  • pelvic capacity and architecture
  • No ionizing radiation
  • not always readily available.
102
Q

Favorable outcome with an breech delivery

A
  • adequate birth canal

- cervix must be fully dilated

103
Q

Factors favoring CS delivery of a breech fetus

A
  • lack of operator experience in vaginal breech
  • patient request for CS; prior CS
  • Large fetus >3800-4000g
  • apparently healthy and viable preterm fetus
  • severe FGR
  • prior perinatal death or neonatal birth trauma
  • incomplete/ footling breech presentation
  • hyperextended head
  • pelvic contraction
104
Q

3 general methods of breech delivery

A
  1. spontaneous breech deliver
  2. partial breech delivery
  3. total breech delivery
105
Q

the fetus is expelled entirely spontaneously without any traction or manipulation other than the support of the newborn

A

Spontaneous breech delivery

106
Q

the fetus is delivered spontaneously as far as the UMBILICUS, but the remainder of the body is extracted or delivered with operator traction and assisted maneuvers, with or without maternal expulsive efforts

A

Partial breech delivery

107
Q

the entire body of the infant is extracted by the obstetrician

A

Complete breech delivery

108
Q

done only in CS

A

Complete breech delivery

109
Q

controversial in women with breech presentation

A

Labor induction and augmentation

110
Q

True/False

Some protocols avoid augmentation. Others recommend it only for hypotonic contractions

A

TRUE

Some protocols avoid augmentation. Others recommend it ONLY for hypotonic contractions

111
Q

Labor management

A
  • Rapid assessment of status of the membranes, labor and fetal condition
  • close surveillance of FHR and uterine contractions
  • recruitment of necessary staff
  • IV catheter infusion
  • Planning for the route of delivery
112
Q

necessary staff for labor

A
  • OB skilled in art of breech extraction
  • associate to assist with the delivery
  • Anesthesia personnel
  • staff skilled in newborn resuscitation
113
Q

used in preparation for anesthesia induction/resuscitation following the possibility of hemorrhage

A

IV catheter infusion

114
Q

What will you assess for the planning for the route of delivery?

A
  • cervical dilatation & effacement
  • station
  • type of breech presentation
115
Q

True/false

obtain pelvimetry if labor is not too far advances.

A

True

116
Q

best indicator of pelvic adequacy

A

satisfactory progress in labor

117
Q

What will you assess using the sonography?

A
  • fetal biometry
  • head flexion
  • fetal anatomy
118
Q

done during the 1st stage of labor

A

monitor FHR every 15 mins or continuously

119
Q

true/false

with ROM, the cord prolapse risk in INCREASED when the fetus is small or NOT in frank breech

A

TRUE

with ROM, the cord prolapse risk in INCREASED when the fetus is small or NOT in frank breech

Once there’s ROM, do IE and assess if there’s cord
prolapse or none.
- If none: proceed with labor watching.
- If there’s cord prolapse: do not remove your hand in the vagina canal (to prevent further prolapse, and cause hypoxia or asphyxia), while preparing for CS.

120
Q

should be done following rupture

A
  • vaginal exam

- monitoring of FHR for 15 minutes

121
Q

usually takes place with the BITROCHANTERIC DIAMETER in one of the oblique pelvic diameters

A

engagement and descent

122
Q

In engagement and descent, ANTERIOR hip descents MORE rapidly than the posterior hip. True or False?

A

True

ANTERIOR hip descents MORE rapidly than the posterior hip

123
Q

when the resistance of pelvic floor is met, INTERNAL ROTATION to ___ degrees follows.

A

when the resistance of pelvic floor is met, INTERNAL ROTATION to 45 degrees follows.

-this is to bring the anterior hip toward the pubic arch . allowing the bitrochanteric diameter to occupy the AP diameter of the pelvic outlet

124
Q

If the posterior extremity is prolapsed, it rotates to the _______ rather than the anterior hip.

A

If the posterior extremity is prolapsed, it rotates to the SYMPHYSIS PUBIS rather than the anterior hip.

125
Q

What happens to the perineum and anterior hip after rotation and descent continues.

A

After rotation, descent continues:

Perineum: distended by the breech
Anterior hip: appears at the vulva

126
Q

True/False

Anesthesia for breech decomposition and extraction must provide sufficient relaxation to allow intrauterine manipulations

A

True

127
Q

may provide sufficient relaxation to allow intrauterine manipulations but increased uterine tone may render the operation difficult

A

Epidural anesthesia

128
Q

may be required to relax the uterus as well as to provide analgesia

A

General anesthesia

129
Q

used with caution because this will relax the uterus

A

General anesthesia

130
Q

Uterus can further relax causing uterine atony which leads to postpartum hgg

A

General anesthesia

131
Q

this anesthesia can also go to the baby causing the baby to be in distress

A

General anesthesia

132
Q

An episiotomy is made and is an important adjunct to the delivery

A

Partial breech delivery

133
Q

True/False
in partial breech delivery, a cardinal rule in successful breech extraction is to employ steady, gentle, downward traction until the lower halves of the scapulas are delivered

A

True

134
Q

True/false

in partial breech delivery, as the fetus continues to descend, the legs are sequentially delivered by SPLINTING the medial aspect of each femur with the operator’s fingers positioned parallel to each femur, and by exerting pressure laterally to SWEEP each leg away from the midline.

A

TRUE

135
Q

maneuver used in partial breech delivery wherein the obstetrician will hook his index finger into the popliteal fossa of the fetus–> leg will automatically flex–> hook the leg and be delivered out of the vagina

A

Pinard’s maneuver

136
Q

maneuver used for the delivery of the arms

A

Loveset maneuver

137
Q

maneuver used for the delivery of the aftercoming head

A

Mauriceau maneuver

138
Q

In mauriceau maneuver, the index and middle finger of the operator is placed where?

A

placed on the malar prominence

139
Q

Forceps applied electively when the Mauriceau maneuver cannot be accomplished easily

A

Piper forceps or

Laufe-piper forceps

140
Q

True/False

The blades of the forceps should not be applied to the
aftercoming head until it has been brought into the pelvis by gentle traction, combined with suprapubic pressure, and is engaged.

A

True

141
Q

side of the blade of the forceps applied to the aftercoming head

A

left blade

142
Q

side of the blade of the forceps applied with the body still elevated

A

right blade

143
Q

maneuver used if the back of the fetus fails to rotate anteriorly

A

Prague maneuver

144
Q

manuever consisting of two fingers of one hand grasping the shoulders of the back-down fetus from below while the other hand draws the feet up over the maternal abdomen.

A

modified prague maneuver

145
Q

incision at 10 o’clock and 2 o’clock to relieve entrapped aftercoming head. Infrequently, an additional incision is required at 6 o’clock.

A

Duhrssen’s Incision

146
Q

Do not do the incision on the 3 o’clock or 6 o’clock position

true/false?

A

True

*cervical branch of the uterine artery is inserted at 3 and 6 o’clock position

147
Q

Replacement of the fetus higher into the vagina and uterus, followed by CS delivery, to rescue an entrapped breech fetus that cannot be delivered vaginally.

A

Zavanelli maneuver

148
Q

very discomforting and distressing maneuver

A

Zavanelli maneuver

149
Q

two fingers are inserted along one extremity to the knee, which is then pushed away from the midline after spontaneous flexion

A

Pinard maneuver

150
Q

used to deliver a foot into the vagina

A

Traction

151
Q

delivery of the fetus in breech position by extending the legs and trunk of the fetus over the pubic symphysis and abdomen of the mother

A

Bracht maneuver

152
Q

procedure in which the fetal presentation is altered by physical manipulation, either substituting one pole of a longitudinal presentation for the other or converting an oblique or transverse lie into a longitudinal

A

Version

153
Q

used only for the delivery of the 2nd twin

A

Internal podalic version

154
Q

for breech fetuses near term, manipulations are performed exclusively through the abdominal wall

A

External podalic version

155
Q

accomplished inside the uterine cavity

A

Internal podalic version

156
Q

first twin is delivered vaginally. 2nd twin is in cephalic position

A

Internal podalic version

157
Q

insertion of a hand into the uterine cavity to turn the fetus manually

A

Internal podalic version

158
Q

The operator seizes one or both feet and draws them through the fully dilated cervix while using the other hand to transabdominally push the upper portion of the fetal body in the opposite direction

A

Internal podalic version

159
Q

after the internal podalic version operation, it is followed by what extraction

A

breech extraction

We want a faster delivery. If there is another fetus and the placenta separates, that will compromise the blood supply. That’s why you deliver by breech extraction.

160
Q

stage of labor where the placenta would separate

A

3rd stage of labor

161
Q

indication of external podalic version

A

If breech presentation is recognized prior to labor in a woman who has reached 36 wks AOG

162
Q

Contraindications of external podalic version

A
  • vaginal delivery is not an option
  • ROM
  • uterine malformations
  • multifetal gestation
  • recent vaginal bleeding
163
Q

relative contraindication of external podalic version

A

-prior uterine incision

164
Q

factors associated with successful version

A
  • multiparity
  • abundant amniotic fluid
  • unengaged presenting part
  • fetal size 2500-3000g
  • posterior placenta
  • non-obese patient
165
Q

True/false

when the placenta is placed posteriorly, even if you manipulate the abdomen during the version, it will NOT cause irritability

A

True

166
Q

True/false

In an obese patient, the abdomen is floppy and can rotate back to its original breech position after manipulation of version.

A

True

167
Q

performed to confirm nonvertex presentation and adequacy of amnionic fluid volume, to rule out obvious fetal anomalies if not done previously, and to identify placental location

A

UTZ

168
Q

External monitoring is performed to assess ____

A

Fetal heart rate reactivity

169
Q

this test is repeated after version until a normal test result is obtained

A

Nonstress test

170
Q

each hand grasps one of the fetal poles, and the buttocks are elevated from the maternal pelvis and displaced laterally

A

Forward roll

171
Q

clockwise pressure is exerted against the fetal poles

A

forward roll

172
Q

if the forward roll is unsuccessful, this procedure us attempted

A

backward flip

173
Q

increase success with version when EPIDURAL analgesia is used

A

conduction analgesia

174
Q

True/False

the ACOG recommends conduction analgesia for routinely for external version

A

False

ACOG: NOT enough evidence to recommend conduction analgesia for routinely for external version

175
Q

used for uterine relaxation

A

tocolysis

  • betamimetics: terbutaline
  • calcium channel blocker: nifedipine
  • NO donor: nitroglycerine
176
Q

Recommended tocolytic agent by the ACOG before version attempt

A

250g Terbutaline SC

177
Q

complications of version

A
  • placental abruption
  • uterine rupture
  • AF embolism
  • fetomaternal hgg
  • alloimmunization
  • preterm labor
  • fetal distress
  • fetal demise

PATHO OB (2 decks)

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