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RRPA Clinical Decision Making I > Keppler labor abnormalities > Flashcards

Keppler labor abnormalities Flashcards

1
Q

Management of shoulder dystocia?

A
  1. Swift identification
  2. Assemble team: skilled nurses, obstetrician, anesthesia
  3. Drilling and memorization of appropriate response sequence
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2
Q

Management of Transverse back down?

A

1, External cephalic version

2. Cesarean

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3
Q

What is a category II

A

everything that is not category I or II

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4
Q

What is considered true labor?

A

regular contractions with cervical changes

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5
Q

True or false with VBAC fetus is at risk, with cesarean mom is at risk?

A

True

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6
Q

What is the time frame for a latent stage 1 labor?

A

up to 12-24 hours depending on parity

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7
Q

What is considered late term? Post term?

A

Late term is 41-42 weeks

post term is 42+ weeks

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8
Q

What would make someone a candidate for VBAC?

A
  • 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
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9
Q

What things are considered labor augmentation/induction

A
  1. Oxytocin (pitocin) drip

2. AROM

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10
Q

What is stage 2 of the labor curve more dependent on?

A

more dependent on parity and anesthesia

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11
Q

Around what week of pregnancy is a good time to have a conversation or give the option of a C-section?

A

around 40 weeks

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12
Q

What things can you do to try and increase power of contraction?

A
  1. Can give pitocin
  2. Can do AROM (artificial rupture of membrane)
  3. can do nipple stimulation
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13
Q

What are some other risks associated with VBAC?

A

Cesarean: risk of maternal morbidity

VBAC: fetus shoulders majority of risk

Cesarean: Woman shoulders majority of risk

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14
Q

For face or brow if the mentum is facing posterior can the baby be delivered vaginally?

A

no in this position they cant not

If the mentum is anterior then the baby can possibly be delivered vaginally

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15
Q

What is the definition of Shoulder dystocia?

A

Failure of passage of the anterior (presenting shoulder) under the maternal pubic symphysis

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16
Q

What are some labor abnormalities?

A
  1. Labor presentation or arrest
  2. Fetal malpresentation (external cephalic version)
  3. Post-term pregnancy
  4. Fetal heart Rate abnormalities
  5. Vaginal birth after cesarean
  6. Shoulder dystocia
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17
Q

Compound presentation management?

A
  1. Wait

2. Cesarean

18
Q

What are the first two interventions to try for shoulder dystocia?

A
  1. McRoberts and suprapubic pressure
19
Q

What are all the things you can try for shoulder dystocia?

A
  1. McRoberts
  2. Suprapubic pressure
  3. posterior shoulder
  4. Woods Screw
  5. Episiotomy
  6. Fracture clavicle
  7. Symphasisotomy
  8. Zavanelli
20
Q

By what week in the pregnancy do they recommend bringing mom in for induction of labor?

A

41 weeks

21
Q

What is the main risk associated with VBAC

A

uterine rupture

22
Q

What is considered the active phase?

A

approximately 1 cm/ hour change in dilation

23
Q

What are the two options for operative delivery?

A
  1. Forceps

2. Vacuum

24
Q

What are the indications for external cephalic version?

A
  1. Known position
  2. Singleton
  3. No contraindication to vaginal delivery
  4. Membranes intact
25
Q

What are some risk factors for post term pregnancy?

A
  1. Abnormal fetal tracing
  2. macrosomia
  3. oligohydramnios
  4. protracted / arrested labor
  5. cesarean delivery
  6. IUFD (1.8, 2.9X at 42, 43 wks)
26
Q

What is considered a category III of the FHT?

A

absent variability with recurrent pathologic decelerations or bradycardia, or sinusoidal pattern

27
Q

What are the 3 p’s?

A

Power, passenger, and pelvis

28
Q

What two things are part of the management for VBAC?

A

fetal surveillance and maternal anesthesia

29
Q

What are contraindications to external cephalic version ?

A
  1. Non-reassuring fetal status
  2. Fetal anomalies
  3. Multiple gestations
  4. Cesarean indicated
30
Q

Risk factors of shoulder dystocia?

A
  1. Macrosomia
  2. Post-term pregnancy
  3. DM/GDM
  4. if its happened before
31
Q

What is labor protraction/arrest?

A

This is when rate of dilation lags from expected or has stopped all together

32
Q

How long is the stage 2 of labor for a

  1. Primigravida
  2. Multipara
A
  1. Primigravida 2-3 hours
  2. Multipara 1-2 hours

Hours represent 95%ile of normal

33
Q

baseline 110-160, moderate variability, no pathologic decelerations, +/- early decelerations or acceleration, is what category of the fetal HR three tiered system

A

this is a category 1

34
Q

What are the three different kinds of breech presentations?

A
  1. Complete breech
  2. Incomplete breech
  3. Frank breech
35
Q

What can we do about the Passenger Part of the three P’s?

A

Rotation, or wait to see if little baby fixes themselves

36
Q

What is the expected rate of dilation

A

1 cm per hour for cervical dilation change

37
Q

True or false: VBAC decreases maternal risks associated with having another cesarean

A

True

38
Q

True or false we can manage the “pelvis” part of the three P’s?

A

False

39
Q

What are the different malpresentations for birth?

A
  1. Breech
  2. Transverse
  3. Compound
  4. Face or brow
40
Q

What percentage of face or brow presentations are delivered by cesarean?

A

> 50%

RRPA Clinical Decision Making I (17 decks)

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