Delivery complications Flashcards
how should you treat bleeding in the third trimester?
treat it as a life threatning emergency until proven otherwise
bleeding with abnormal vital signs is considered what CTAS?
CTAS 1
what are common risk factors for fetal death?
- maternal obesity
- uncontrolled diabetes
- smoking
- hypertension
what are signs of decomposition of a stillborn fetus?
- skin discoloration
- nuchal cord
- malformed or discoloured extremities
when should you not initiate resus of a fetus?
- signs of decomposition present
- fetus is clearly not viable ie. >20 weeks
what is the defined birth weight for macrosomia?
=>4000 grams
shoulder dystocia can lead to what type of injury?
bracial plexus injuries
what is group B Streptococcus? how does it pose a risk to the fetus?
GBS is a common bacteria found in the rectum and vagina.
it can be transmitted to infants during vaginal delivery
what are the potential infections GBS can cause the newborn?
- pneumonia
- sepsis
- meningitis
what are causes for DIC?
- amniotic fluid embolism
- placental abruption
- eclampsia/HELLP syndrome
- retained dead fetus
- sepsis
- trauma
- hepatic failure
- hypothermia
- transfusion reactions
clinical presentation of DIC
- hypotension/ shock
- respiratory distress
- bleeding from multiple sites
- petechiae
where does shoulder dystocia typically occur?
anterior shoulder at the symphysis pubis
while rare the posterior shoulders can get stuce where?
against the sacrum
what are the signs of turtle dystocia?
- turtle sign
- cyanosis of fetal head
- arrest of decent
- no head rotation
what potential complications does shoulder dystocia carry
- entrapment of umbilical cord
- ches compression which limits babies abbility to breath
- brachial plexus injuries
- brain damage or death
when does irreversible hypoxic brain injury occur if the baby with shoulder dystocia remains stuck?
8 minutes
what is ALARM
A systemic approach in managing shoulder dystocia
A: ask for help
L: lift the legs in mcroberts position
A: Apply suprapubic pressure
R : Roll over
M : deliver the posterior arm as a last resort
why does mcrobers position help deliver the baby?
- widens the pelvic outlet
- alings the pelvic angle and straigtens the sacrum to open the birth canal
why does applying suprapubic presure help deliver the baby?
it pushes the shoulder downward, allowing the shoulder to pass under the symphysis pubis
shoulder dystocia is best mannaged with three people, where are all three people placed?
1 ; managing the legs
2 ; applying suprapubic pressure
3 ; overseeing the delivery (ME)
you must record all key events during ALARM. what are you recording?
- time of head delivery
- time of each maneuver
- overall outcome
rolling over the mom to deliver the baby is known as?
gaskin maneuver
what does the gaskin maneuver help with?
increasing pelvic diameter
what position should the mother be in if you are delivering the posterior arm?
lithotomy position (lying down) (can be done during the gaskin maneuver
what is the definition of breech birth?
the baby is delivered feet or buttocks first
complete breech?
buttocks presents first
incomplete breech
one or both legs present first
frank breech
buttocks presents and legs are extended straight up
what are signs of imminent breech birth
- fresh dark meconium
- visible buttocks or legs
- progression of the buttocks and legs with each contraction
why is hands off preformed during breech births?
this avoids stimulating the baby and prevents premature respirations of amniotic fluid, meconium , or other substances
once the umbilicus is visble during a breech birth, how much time do you have to deliver the baby?
4 minutes
what timmings do you have to document during a breech birth?
- time the umbilicus is exposed
- time the hair line is exposed
- any time you provide manual assistance
what are the indications for the MSV maneuver?
- umbilicus has been exposed for 3 minutes without further progression
- hair line is visible
when assisting the legs to deliver, what part of the legs are you grabbing?
the popliteal fossa
what is limb presentation and what does it indicate?
when a single limb (arm or leg) presents through the birth canal which indicates transverse lie
what actions should you take with limb presentation
- do not attempt delivery
- encourage panting
- wrap the limb with a dry blanket
- position the mother in the exaggerated sims position
- use gravity to delay labour
what are steps for the exaturates sims position?
- place mother on left side
- elevate hips using cushions to raise pelvis ubove shoulders
- back ar is placed behind for stability
why are you choosing to place the mother on their left side during exaturated sims position?
it helps to maintain blood flow to the Inferior vena cava to support maternal and fetal circulation
what is a prolapsed umbilical cord?
when the umbilical cord emerges from the uterus ahead of the presenting part of the baby
what actions should be taken if there is cord prolapse?
- knee to chest position
- exaggerated sims positon
- gently replace cord back to the vagina
- apply digital pressure to lift parts off the cord
what does oxytocin administration do?
stimulates uterine contraction to reduce bleeding
what is a retained placenta defined as?
a placenta not delivered within 30 mins post birth
indications for uterine massage?
- after the placenta is delivered and the patient is unstable (shock or bleeding)
- the uterus is soft and lacks tone
what is the goal of uterine massage
- stimulate the uterus to contract
- reduce bleeding by promoting uterine tone
what are signs for placental seperation
- lengthening of the umbilical cord
- increased vaginal bleedng
when should you use bi manual compression? what does it help with?
for patients with PPH and an undelivered placenta. it helps to reduce bleeding while awaiting surgery
what does urination do post delivery?
- stimulates oxytocin releae
- encourages uterine contraction
- reduces the risk of hemorrhage
how much does the risk of PPH increase if the placenta is not delivered after 30 mins
risk increases 6 fold
why does the blood pressure have to be under 160 systolic when administering Oxytocin
because oxytocin can inclrease bloodpressure
