Chapter 23 & 24 - Complications Of Labor & Delivery

Question 1

What is a precipitous birth and labor?

Answer 1

Lasts less than 3 hours, from the 1st contraction to birth.

Question 2

What are maternal risks of precipitous birth?

Answer 2

Cervical, vaginal and rectal lacerations (doesn’t have time to stretch) as well as hemorrhage.

Question 3

What are fetal risk from precipitous birth?

Answer 3

Hypoxia
Injury during birth
Intracranial hemorrhage

Question 4

What is preterm labor?

Answer 4

Delivery that occur is between 20-38 weeks.

Question 5

What is prolonged pregnancy?

Answer 5

Pregnancy that reaches or goes beyond 42 weeks.

Question 6

Risk factors for fetus with a prolonged pregnancy:

Answer 6

Meconium aspiration
Growth restrictions 
Intrapartum  asphyxia (not enough 02)
Macrosomia (big baby)
Shoulder dystocia 
Brachial plexus injury (paralysis)
Still birth

Question 7

Risk factors for mom with a prolonged pregnancy:

Answer 7

Induction
C-section
Infection
Hemorrhage
Emotional trauma
Injury to pelvic floor

Question 8

What is dysfunctional labor?

Answer 8

Sluggishness of contractions or the force of labor.

Question 9

What are causes of a dysfunctional labor?

Answer 9

Large fetus

Hypotonic, hypertonic or uncoordinated contractions occur

Question 10

What are risks of a dysfunctional labor?

Answer 10

Maternal postpartum infection
Hemorrhage
Infant mortality

Question 11

What occurs in the 1st stage of dysfunctional labor?

Answer 11

Prolonged latent stage
Protracted active stage (4cm then stops)
Prolonged deceleration (HR below 120 for 2+mins)
Secondary arrest of dilation (nice progression then stops)

Question 12

What are reasons for induction of labor?

Answer 12

Placenta previa (placenta over cervix)
Pre-eclampsia (C-Section if L&D not tolerated)
Diabetic (baby is too big)
Premature ROM (needs to be born within 36h after rupture)
CVD (baby cannot fit)
Post-term

Question 13

What are methods of induction?

Answer 13

Cervical ripening- prostaglandins and laminaria

Amniotomy- AROM (artificially rupture)

Misoprostol/Cytotec- stimulates UC’s (pill on cervix- POTENT [rectally when hemorrhaging])

Pitocin/Oxytocin- increases intensity of UC’s and may prolong them [give epidural 1st]

Question 14

What are two substances that ripen the cervix using prostaglandins?

Answer 14

Sperm

Cervadil

Question 15

Types of malpositions malpresentations:

Answer 15

OP: sunny side up (hard to get out) 25% of term deliveries
OT: face down
Breech presentation
Shoulder presentation

Question 16

What is a forcep delivery?

Answer 16

Metal instrument used to help facilitate delivery - helps rotate fetal head.

Question 17

What are risks of a forcep delivery?

Answer 17

Bruising and edema to fetal face
Maternal lacerations
Episiotomy extension

Question 18

What is a vacuum extraction?

Answer 18

A suction cup applied to the fetal head to facilitate delivery.

Question 19

What is an external version?

Answer 19

Manually trying to turn the fetus

Administer trabutelene to relax smooth muscle

Question 20

What is fetal distress

Answer 20

Insufficient 02 supply to the fetus.

Question 21

What are signs and symptoms of fetal distress?

Answer 21

Meconium stained amniotic fluid (green)
Changes in fetal heart rate
Changes in FHT pattern (variability)