Complications In Labor Flashcards
How is cephalopelvic disproportion diagnosed?
It must seem a reasonable suspicion based on foreknowledge of the baby’s size, position, and the mother’s pelvic dimensions.
What is inlet disproportion?
Signaled by arrest at 6cm dilation, lack of descent past -3 or -2 station, deflexion or asynclitism, and cervix not well applied to the head. (Cervix hanging like empty sleeve)
Also, cervix may reclose and weak, uncoordinated contractions result. Mother may complain of intense pain similar to sciatica pain.
What is midpelvic disproportion?
The head may have engaged without trouble, but second stage is prolonged and descent delayed. This is often due to deep transverse arrest, in which the head is wedged behind the ischial spines and cannot rotate to the OA(or OP) position.
What is outlet disproportion?
Also leads to prolonged second stage but more commonly affects the perineal phase, causing severe early decels or bradycardia, delayed delivery, and tears of the bulbocabernosus muscles or perineum.
What are sterile water blocks, or papules?
Four subcutaneous injections of 0.15cc sterile water(using a tuberculin syringe) in the sacral area at both dimples near the promontory, and an inch below on either side. Although this causes a very painful burning sensation for about 20 secs, pain relief then lasts from 45 mins-3 hours. This alone may prompt spontaneous rotation.
What pelvis type are posterior positions common with?
Anthropoid Pelvis
What herbal remedies can help stabilize or lower blood pressure in labor?
Tinctures of hops, hawthorn, skullcap, and passionflower.
Also, bathing with Epsom salts(magnesium sulfate).
What is vasa previa?
An exceedingly rare complication where placental or cord vessels present at the cervical os
This can occur with a velamentous cord insertion or if vessels extend beyond the edge of the placenta.
What happens if membranes rupture at the site of vasa previa?
The mother will hemorrhage and the baby could die.
What is the first sign of newborn infection according to an experienced pediatrician?
Failure to nurse.
What is the recommended dosage of vitamin C after ROM?
Up to 2 g per day, with 250 mg every three hours.
What is face presentation in childbirth?
A rare occurrence where the baby’s face is the presenting part, happening once in every 250 deliveries.
What is a common cause of face presentation during delivery?
Cord around the neck deflexing the head as the baby descends.
What position must the baby be born in with face presentation?
Occipito-posterior (OP) position.
What happens to the baby’s brow during face presentation?
It may impinge on the symphysis pubis, preventing descent.
What technique can be used when the face begins to show?
Apply counterpressure to the perineum to hold back the baby’s brow.
What is commonly required for a newborn with face presentation after birth?
Suction to clear fluids from the nose.
What complications may arise for the newborn during face presentation?
Bruising, swelling, and potential breathing difficulties due to tracheal edema. Arnica and vitamin K may be indicated.
What is a major risk associated with face presentation?
Increased likelihood of perineal tearing.
What should be prepared in case of complications during face presentation?
Resuscitation equipment.
What is a compound presentation?
When the hand/arm presents alongside the head.
What is the Gaskin Maneuver?
Having mother roll over to hands and knees.
What is the Rubin-Davis maneuver?
Reaching inside the perineum for the posterior shoulder, placing two fingers in front of it(at the juncture of the chest and armpit), and pushing the baby backward to the oblique diameter of the pelvis(about 30 degrees).
What is the McRoberts position?
A position where the mother is fully supine with her knees hyperflexed to her shoulders
This position lifts the pelvis off the bed or floor, increasing flexibility of the joints and available room to maneuver.
What is the purpose of the McRoberts position during childbirth?
To increase flexibility of the joints and available room to maneuver
This position facilitates easier rotation of the baby’s shoulders during delivery.
How do you rotate the posterior shoulder in the McRoberts position?
By lifting the baby’s head toward the pubic bone and placing two fingers behind the posterior shoulder
This maneuver helps to position the shoulders obliquely.
What is the technique to extract the arm if the baby does not come out after shoulder rotation?
Jacquemier’s or Barnum’s maneuver
This involves splinting the upper arm and sweeping it across the chest.
Describe the steps of Jacquemier’s or Barnum’s maneuver.
- Splint the upper arm with two fingers
- Sweep it across the chest
- Grasp the hand and bring the arm out
This technique reduces the girth of the shoulders for easier delivery.
What is the role of suprapubic pressure during childbirth?
To help dislodge the anterior shoulder
This is done by pressing inward and at an angle to complement the shoulder rotation efforts.
What should be done if the baby does not come out after applying suprapubic pressure?
Continue with shoulder rotation or perform Jacquemier’s or Barnum’s maneuver
These methods are used to assist with delivering the baby.
What condition occurs when the placenta implants abnormally into the endometrium?
Placenta accreta
Placenta accreta can complicate delivery and may require surgical intervention.
What is the recommended action if prolonged labor leaves the uterus exhausted?
Offer tinctures of cohosh and angelica
These tinctures may help stimulate uterine contractions.
What procedure may be required for the removal of placenta accreta?
D&C or hysterotomy
A D&C may suffice, but hysterotomy may be necessary for severe cases.
What is the most severe form of placenta accreta, where the placenta invades adjacent tissues or organs?
Placenta percreta
Placenta percreta is associated with high maternal mortality rates.
True or False: Cord traction is always safe in cases of placenta accreta.
False
Cord traction should be avoided when placental separation is not clearly established.
Fill in the blank: If the mother is tired and the baby is not yet nursing, you may wish to administer _______.
Pitocin IM
Pitocin can help stimulate uterine contractions to aid in placental delivery.
What can sometimes stall placental delivery after birth?
Maternal inertia
This can occur even after a rapid birth process.
What should a midwife assisting a VBAC request to check for potential complications?
An ultrasound
This helps ensure the placenta is not imbedded at the cesarean scar site.
What may happen if the placenta remains attached for an extended period after delivery?
Inversion of the uterus
This is a serious complication that can occur if the placenta is not delivered.
Why is suturing minor abrasions on the labia considered unwise?
Stitches will not hold unless imbedded in the flesh
Suturing superficial abrasions is discouraged due to the lack of adequate tissue for proper stitching.
What occurs sometimes even when the perineum remains intact?
Minor internal split of the bulbo-cavernosus muscle
This can happen without visible external damage to the perineum.
What should be done if bleeding from a minor internal split can be controlled?
Do not suture
Applying pressure with sterile gauze is often sufficient to manage bleeding.
What is the maximum depth of a split in the bulbo-cavernosus muscle that can heal without suturing?
Halfway through the muscle
If the split is no deeper than halfway, the edges will naturally join together.
Do first-degree perineal tears require suturing?
No, they heal by themselves with good care
Proper care is essential to ensure healing without intervention.
What may make a mother more comfortable after a tear?
Suturing
If tear edges do not approximate well, suturing can provide relief and comfort.
What are the top priorities for stabilizing a baby that is born compromised?
Warmth
Airway
What is primary apnea?
A baby who has not been hypoxic for long, but has already made gasping/respiratory efforts while in utero in an attempt to compensate.
What helps primary apnea?
Stimulation and blow by oxygen(holding tube by the nose)
What is secondary apnea?
A baby who has suffered a greater degree of hypoxia and has made a second round of gasping/respiratory attempts.
How do you help a baby with secondary apnea?
It will not attempt to breath on its own again so waste no time with stimulation. This baby needs ppv via mouth to mouth or bag mask resuscitation, and possibly chest compressions.
How do you suppress lactation after a stillbirth?
Sage tea, and binding the breasts
What contraceptive method is least effective in the postpartum period?
The fertility awareness method because the course of lactation causes erratic fluctuations in basal body temperature and cervical mucus.
