Complications of Labor and Delivery

Question 1

Most common cause of perinatal morbidity and mortality in the US

Answer 1

preterm labor

Question 2

Two biggest risk factors for preterm labor

Answer 2

multiple gestation and prior perterm birth

Question 3

What do you used an ultrasound for to evaluate preterm labor?

Answer 3

amt of amniotic fluid and estimation of cervical length if <26 weeks

Question 4

Not routinely used to evaluate preterm labor, but can determine presence of an intraamniotic infection

Answer 4

amniocentesis

Question 5

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.

Answer 5

corticosteroids

Question 6

When is a mother screened for group B strep?

Answer 6

between 35-37 weeks

Question 7

Management of a mother with positive group B strep results

Answer 7

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

Question 8

Alternative abx for group B strep if there’s an allergy

Answer 8

cefazolin (if no h/o anaphylaxis to PCN), clindamycin, vancomycin

Question 9

lack of progressive cervical dilation or lack of descent of fetal head or both

Answer 9

dystocia

Question 10

leading indication for c-section

Answer 10

dystocia

Question 11

Term for a large baby with a mom who has a small pelvis.

Answer 11

cephalopelvic disproportion

Question 12

Expected cervical dilations for normal labor

Answer 12

1 cm/hr nulliparous. 1.5 cm /hr multiparous

Question 13

Normal rate of descent for baby

Answer 13

Less than 3 hr if regional anesthesia. Less than 2 hr if no anesthesia

Question 14

Manual rupture of the membranes. Risks: fetal heart rate decelerations due to cord compression, increased incidence of chorioamnionitis

Answer 14

amniotomy

Question 15

Increase uterine activity to stimulate cervical change and fetal descent but avoid more than 5 contractions in a 10 minute period

Answer 15

oxytocin

Question 16

Three most common indications for c-section

Answer 16

failure to progress, nonreassuring fetal status, fetal malpresentation

Question 17

Umbilical cord is palpable on vaginal exam. Pressure on the cord causes fetal bradycardia. Prompt delivery by c-section

Answer 17

umbilical cord prolapse

Question 18

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

Answer 18

maneuvers to reduce cord pressure in umbilical cord prolapse

Question 19

Obstetric emergency. need for additional obstetric maneuvers to effect delivery of the shoulders at the time of vaginal birth

Answer 19

shoulder dystocia

Question 20

Fetal head retracts into the perineum after expulsion. Seen with shoulder dystocia

Answer 20

turtle sign

Question 21

adduction of the fetal shoulder, displacing them from the anteroposterior position. done if McRoberts and suprapubic pressure fails

Answer 21

Rubin maneuver

Question 22

directing pressure on the anterior shoulder downward away from the pubic bone, in conjunction w/ McRoberts maneuver

Answer 22

suprpubic pressure

Question 23

Delivery of the posterior arm for shoulder dystocia.

Answer 23

Barnum maneuver

Question 24

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

Answer 24

cephalic presentation

Question 25

Turning the baby from a breech presentation to a vertex (normal) presentation by applying external pressure

Answer 25

external cephalic version

Question 26

Defined as a placenta that has not been expelled 30-60 min after delivery of the baby. Major cause of postpartem hemorrhage

Answer 26

retained placenta

Question 27

What are the pharmacologic interventsions for retained placenta?

Answer 27

IV nitroglycerin or Intraumbilical injection of a solution of oxytocin in saline

Question 28

Uterine fundus collapses into the endometrial cavity

Answer 28

uterine inversion

Question 29

Treatment for uterine inversion

Answer 29

large bore IVs, uterine relaxation, manual correction

Question 30

excessive bleeding that results in signs and symptoms of hypovolemia (tachycardia, tachypnea, delayed capillary refill, orthostatic changes, narrowed pulse pressure)

Answer 30

post partum hemorrhage

Question 31

Treatment of post partum hemorrhage

Answer 31

fundal massage

Question 32

Most frequently used uterotonic drugs to help tighten uterus

Answer 32

oxytocin or hemabate