Keppler labor abnormalities Flashcards
Management of shoulder dystocia?
- Swift identification
- Assemble team: skilled nurses, obstetrician, anesthesia
- Drilling and memorization of appropriate response sequence
Management of Transverse back down?
1, External cephalic version
2. Cesarean
What is a category II
everything that is not category I or II
What is considered true labor?
regular contractions with cervical changes
True or false with VBAC fetus is at risk, with cesarean mom is at risk?
True
What is the time frame for a latent stage 1 labor?
up to 12-24 hours depending on parity
What is considered late term? Post term?
Late term is 41-42 weeks
post term is 42+ weeks
What would make someone a candidate for VBAC?
- 1 or 2 prior cesareans
- Known (or assumed) low transverse uterine scar, no other prior uterine surgery
- No contraindications to vaginal delivery
- Obstetrician and anesthesia in house
What things are considered labor augmentation/induction
- Oxytocin (pitocin) drip
2. AROM
What is stage 2 of the labor curve more dependent on?
more dependent on parity and anesthesia
Around what week of pregnancy is a good time to have a conversation or give the option of a C-section?
around 40 weeks
What things can you do to try and increase power of contraction?
- Can give pitocin
- Can do AROM (artificial rupture of membrane)
- can do nipple stimulation
What are some other risks associated with VBAC?
Cesarean: risk of maternal morbidity
VBAC: fetus shoulders majority of risk
Cesarean: Woman shoulders majority of risk
For face or brow if the mentum is facing posterior can the baby be delivered vaginally?
no in this position they cant not
If the mentum is anterior then the baby can possibly be delivered vaginally
What is the definition of Shoulder dystocia?
Failure of passage of the anterior (presenting shoulder) under the maternal pubic symphysis
What are some labor abnormalities?
- Labor presentation or arrest
- Fetal malpresentation (external cephalic version)
- Post-term pregnancy
- Fetal heart Rate abnormalities
- Vaginal birth after cesarean
- Shoulder dystocia
Compound presentation management?
- Wait
2. Cesarean
What are the first two interventions to try for shoulder dystocia?
- McRoberts and suprapubic pressure
What are all the things you can try for shoulder dystocia?
- McRoberts
- Suprapubic pressure
- posterior shoulder
- Woods Screw
- Episiotomy
- Fracture clavicle
- Symphasisotomy
- Zavanelli
By what week in the pregnancy do they recommend bringing mom in for induction of labor?
41 weeks
What is the main risk associated with VBAC
uterine rupture
What is considered the active phase?
approximately 1 cm/ hour change in dilation
What are the two options for operative delivery?
- Forceps
2. Vacuum
What are the indications for external cephalic version?
- Known position
- Singleton
- No contraindication to vaginal delivery
- Membranes intact
What are some risk factors for post term pregnancy?
- Abnormal fetal tracing
- macrosomia
- oligohydramnios
- protracted / arrested labor
- cesarean delivery
- IUFD (1.8, 2.9X at 42, 43 wks)
What is considered a category III of the FHT?
absent variability with recurrent pathologic decelerations or bradycardia, or sinusoidal pattern
What are the 3 p’s?
Power, passenger, and pelvis
What two things are part of the management for VBAC?
fetal surveillance and maternal anesthesia
What are contraindications to external cephalic version ?
- Non-reassuring fetal status
- Fetal anomalies
- Multiple gestations
- Cesarean indicated
Risk factors of shoulder dystocia?
- Macrosomia
- Post-term pregnancy
- DM/GDM
- if its happened before
What is labor protraction/arrest?
This is when rate of dilation lags from expected or has stopped all together
How long is the stage 2 of labor for a
- Primigravida
- Multipara
- Primigravida 2-3 hours
- Multipara 1-2 hours
Hours represent 95%ile of normal
baseline 110-160, moderate variability, no pathologic decelerations, +/- early decelerations or acceleration, is what category of the fetal HR three tiered system
this is a category 1
What are the three different kinds of breech presentations?
- Complete breech
- Incomplete breech
- Frank breech
What can we do about the Passenger Part of the three P’s?
Rotation, or wait to see if little baby fixes themselves
What is the expected rate of dilation
1 cm per hour for cervical dilation change
True or false: VBAC decreases maternal risks associated with having another cesarean
True
True or false we can manage the “pelvis” part of the three P’s?
False
What are the different malpresentations for birth?
- Breech
- Transverse
- Compound
- Face or brow
What percentage of face or brow presentations are delivered by cesarean?
> 50%
