Complications of Labor and Delivery Flashcards
Most common cause of perinatal morbidity and mortality in the US
preterm labor
Two biggest risk factors for preterm labor
multiple gestation and prior perterm birth
What do you used an ultrasound for to evaluate preterm labor?
amt of amniotic fluid and estimation of cervical length if <26 weeks
Not routinely used to evaluate preterm labor, but can determine presence of an intraamniotic infection
amniocentesis
given to enhance fetal lung maturity. reduces Fetal respiratory distress, intraventricular hemorrhage, necrotizing enterocolitis. Maximal benefit if given within 7 days of delivery with dosing over 48hrs.
corticosteroids
When is a mother screened for group B strep?
between 35-37 weeks
Management of a mother with positive group B strep results
Penicillin G 5 million U IV then 2.5-3 mil U q 4 hours until delivery. Best if given 4 hours prior to delivery
Alternative abx for group B strep if there’s an allergy
cefazolin (if no h/o anaphylaxis to PCN), clindamycin, vancomycin
lack of progressive cervical dilation or lack of descent of fetal head or both
dystocia
leading indication for c-section
dystocia
Term for a large baby with a mom who has a small pelvis.
cephalopelvic disproportion
Expected cervical dilations for normal labor
1 cm/hr nulliparous. 1.5 cm /hr multiparous
Normal rate of descent for baby
Less than 3 hr if regional anesthesia. Less than 2 hr if no anesthesia
Manual rupture of the membranes. Risks: fetal heart rate decelerations due to cord compression, increased incidence of chorioamnionitis
amniotomy
Increase uterine activity to stimulate cervical change and fetal descent but avoid more than 5 contractions in a 10 minute period
oxytocin
Three most common indications for c-section
failure to progress, nonreassuring fetal status, fetal malpresentation
Umbilical cord is palpable on vaginal exam. Pressure on the cord causes fetal bradycardia. Prompt delivery by c-section
umbilical cord prolapse
What do the following have in common: Examiner’s hand maintained in vagina to elevate the cord. Pt is placed in steep trendelenberg position. Filling the bladder w/ 500-700 ml of NS. Giving a tocolytic such as terbutaline to stop contractions
maneuvers to reduce cord pressure in umbilical cord prolapse
Obstetric emergency. need for additional obstetric maneuvers to effect delivery of the shoulders at the time of vaginal birth
shoulder dystocia
Fetal head retracts into the perineum after expulsion. Seen with shoulder dystocia
turtle sign
adduction of the fetal shoulder, displacing them from the anteroposterior position. done if McRoberts and suprapubic pressure fails
Rubin maneuver
directing pressure on the anterior shoulder downward away from the pubic bone, in conjunction w/ McRoberts maneuver
suprpubic pressure
Delivery of the posterior arm for shoulder dystocia.
Barnum maneuver
Head enters birth canal first. Face is backward toward’s mother’s spine, arms are crossed, chin and neck are bent forward, down toward chest
cephalic presentation
Turning the baby from a breech presentation to a vertex (normal) presentation by applying external pressure
external cephalic version
Defined as a placenta that has not been expelled 30-60 min after delivery of the baby. Major cause of postpartem hemorrhage
retained placenta
What are the pharmacologic interventsions for retained placenta?
IV nitroglycerin or Intraumbilical injection of a solution of oxytocin in saline
Uterine fundus collapses into the endometrial cavity
uterine inversion
Treatment for uterine inversion
large bore IVs, uterine relaxation, manual correction
excessive bleeding that results in signs and symptoms of hypovolemia (tachycardia, tachypnea, delayed capillary refill, orthostatic changes, narrowed pulse pressure)
post partum hemorrhage
Treatment of post partum hemorrhage
fundal massage
Most frequently used uterotonic drugs to help tighten uterus
oxytocin or hemabate
