Complications of pregnancy and delivery Week 2

Question 1

What are the maternal risk factors

Answer 1

1. Older than 35 and younger than 20
2. Smoking and drinking
3. Having several baby’s at once
4. History of miscarriages
5. Obesity
6. Anorexia

Question 2

Health conditions that can complicate pregnancy

Answer 2

1. Diabetes
2. Cancer
3. High BP (can keep the placenta from getting enough blood
4. STI’s
5. Kidney problems
6. Epilepsy
7. Anemia

Question 3

1st trimester complications

Answer 3

Ectopic pregnancy
Miscarriage
Hyperemesis gravidarum

Question 4

2nd and 3rd trimester complications

Answer 4

Gestational diabetes
Placenta previa
Preeclampsia
Abruptio placenta
Eclampsia
amniotic Fluid embolism

Question 5

What is a ectopic, pregnancy and symptoms?

Answer 5

Ectopic pregnancy is when there is a fertilized egg developed outside the uterus
S&S:
Abdo pain
Syncope
Hypotension

Question 6

Hyperemesis gravidarum what is it and S&S

Answer 6

Severe nausea during typical 1st trimester not morning sickness but severe vomiting thru the day
S&S
Vomiting 3+ times a day
Vertigo
Dehydration
Weight loss
Can lead to preterm labor

Question 7

What is preeclampsia and S&S

Answer 7

It is a hypertensive disorder that occurs after 20 weeks and can develop 10 weeks after delivery.
Which can lead to liver and kidney damage
S&S:
BP over 140/90
Severe headache
Blurred vision’
Upper abdo pain
Proteinuria (protein in urine)
Edema

Question 8

What is gestational diabetes and S&S

Answer 8

Definition: A form of diabetes that develops during pregnancy due to insulin resistance and increased blood sugar levels.
S&S:
Frequent urination
Excessive thirst
Fatigue
Bladder and yeast infections
Dry mouth

Question 9

What is abrupt is placenta and S&S

Answer 9

It is partial/full detachment of the placenta at 20 weeks. This occurs when the vascular structures of the placenta are torn away from the uterine wall. Causes 5-8% maternal deaths and 10% of fetal deaths.
S&S:
Vag bleeding
Contractions that do not relax
Abdo pain often described as tearing pain

Question 10

What is placenta previa and S&S

Answer 10

It is when the placenta partly or fully covers the cervix
S&S:
Asymptomatic
Bright red vag bleeding

Question 11

What is Amniotic fluid embolism (AFE) and S&S

Answer 11

It is one of the catastrophic complications of pregnancy and wish amniotic fluid, foetal cells, hair or other debris enters the maternal pulmonary circulation, causing cardiovascular collapse. This typically occurs in labour or 30 minutes after delivery.
S&S
1. Increase Work of breathing
2. Hypoxia
3. Hypotension
4. Possibly cardiac arrest
5. Severe anxiety
6. chills
7. vomiting

Question 12

Premature birth definition, and risks

Answer 12

Premature Birth Summary

•	Premature: < 37 weeks
•	Risks: Hypothermia, requires resuscitation
•	Lungs: Poor compliance, no surfactant
•	Surfactant production: ~26-28 weeks
•	Adequate by 35 weeks
•	Treatment: Surfactant substitutes, hormone therapy

Question 13

What to do when presented with nuchal cord is present:

Answer 13

Check for cord – remove if present – slip overhead or body – document if present. If the cord is tight, it will impede delivery. Clamp/cut cord and deliver infant quickly
Prepare to deliver to rest of baby/shoulders are the hardest to deliver – downward for anterior shoulder & upward flexion “bum to mom”

Question 14

What to do in Precipitous labour calls

Answer 14

Extremely rapid delivery:
1. Delivery of baby within 3 hours of regular contractions
2. More common with 2nd births “multips”
3. Rapid labour may increase the risk of perineal lacerations & postpartum hemorrhage due to uterine atony

Management:
1. Same as delivery
2. Reassure mom
3. Encourage “panting” vs “pushing” to slow it down
4. Place mom in a position where gravity isn’t working against you
5. Guard perineum
6. Control delivery of head – apply gentle “counter-pressure” to vertex when crowning occurs

Question 15

What to do, if presented with limb presentation in labor?

Answer 15

Do not push back in
Discourage pt. from “pushing” – tell pt. to “pant” Wrap the limb & keep warm
NOTE: Birth is not possible with this type of Limb Presentation

Question 16

What to do in feet first breach

Answer 16

Place pt. into gravity position – side of bed, upright, or supported squat position
Voiding may increase internal space for fetal descent
An assistant should apply gentle fundal pressure to keep the fetal head flexed.
Encourage pt. to push when presenting part visible – i.e. “hands off” to reduce stimulation to neonate to breath

Question 17

Shoulder dystocia management

Answer 17

Please patient supine on a hard surface and note the time when the head is delivered. You have eight minutes to deliver The baby after head is delivered.

Ask for help
Legs abducted (McRoberts maneuver)
Abduct Fetal shoulders by applying super pubic pressure
Roll over and apply upward lateral pressure
Manually release arm

Question 18

Breach birth management

Answer 18

1. Move mother to the edge of surface to allow gravity to birth baby.
2. Keep hands off until feet need swept out and note time
   3.You have 4 minutes to deliver after the umbilicus is delivered
3. Gently sweep hand down and out when visible.
4. Allow baby to descend with gravity and keep hands off. (Parter may apply super pubic pressure)
5. Once the neck hair line is visible or if baby hasn’t been delivered within 3 mins initiate Mauriceau-Smellie-Veit maneuver.

Question 19

Prolapse cord management

Answer 19

1. Assists pt into exaggerated Sims position.
2. Encourage patient to breathe through the contractions if the cord has not gone back into the patient.
3. Cradles cord in your hand and place it back into the vagina.
4. Put finger/hand into the vagina following the cord until you feel the presenting part and apply manual pressure lifting it off the cord

Question 20

Nuchal cord management

Answer 20

1. Once head is delivered look for nuchal cord
2. If the cord is loose, slip it over the babies head.
3. If the cord is not loose, cut it ASAP

Question 21

When to and how to do a external uterine massage

Answer 21

Do it when the placenta has been delivered and if the fundas is still soft, boggy, or continuous bleeding.

How to:
1. Put one hand on the lower abdomen at the synthesis pubis with a cupped hand.
2. Place another and at the top of the uterus (the uterus should be palpable between the hands)
3. Massage with upper hand in a circular motion. Do this till bleeding stops and encourage patient to pee

Question 22

Bimanual uterine compression steps

Answer 22

1. Place one hand on the synthesis pubis
2. What other hand on the top of the uterus. The whole uterus should be palpable in between hands.
3. Compress the uterus together until haemorrhage stops.