L+D Flashcards
what is a cord prolapse?
Cord Prolapse: umbilical cord descends below the presenting part of fetus and through cervix into vagina after rupture of foetal membranes
what is the risk of a cord prolapse?
- Risk of foetal hypoxia due to cord compression
how does a cord prolapse arise?
RF: fetus is an abnormal lie after 37 gestation
- In cephalic lie head typically descends the pelvis without room fro cord to descend
how do you diagnose a cord prolapse?
Diagnosis: umbilical cord prolapse should be suspected there are signs of fetal distress on CTG
- Speculum can be used to confirm diagnosis
how do you manage cord prolapse?
emergency c.section
- Pushing cord back is not recommended need to keep warm and wet, want minimal
- Woman can lie in left lateral position (pillow under hip)
- Tocolytic medication (eg tebutaline) can minimise contractions whilst waiting for delivery by c.section
why is pushing cord back not recommended?
- Pushing cord back is not recommended need to keep warm and wet, want minimal
what is a shoulder dystocia?
when anterior shoulder of baby becomes stuck behind pubic symphasis of pelvis after head
what conditions are linked to shoulder dystocia?
- Linked to macrosomia secondary to gestational diabetes
how would shoulder dystocia present?
Presentation: difficulty in face and head and obstruction in delivering of shoulders
- Failure of restitution
- Head remains face downwards (occipito-anterior) and does not turn sideways as expected after delivery of head
what is restitution?
turning of head in delivery
what is a turtle neck sign?
- Turtle neck sign – where head is delivered but retracts back, in vagina
what obstetric techniques can be used in shoulder dystocia?
episiotomy
McRoberts
Rubins manoeuvre
woods screw manoeuvre
what is an episiotomy?
enlarge the vaginal opening and reduce the risk of perineal tears
what is McRoberts in obstetrics?
McRoberts: involves hyperflexion of mother at hip (bringing her knees to abdo) posterior pelviv tilt, lifting pubic symphysis up and out of way
what is rubins manoeuvre?
involves reaching into vagina to put pressure on posterior aspect of babys anterior shoulder to help move under pubic symphysis
what is wood screw manoeuvre?
during rubins reach in vagina and push pressure on anterior aspect of posterior shoulder
- Top shoulder is pushed forwards and bottom shoulder is pushed back and rotate baby and helping delivery
what are complications of shoulder dystocia?
- Fetal hypoxia (subsequent cerebral palsy)
- Brachial plexus injusy and Erbs palsy
- Perineal tears
- PPH
how many births in the UK use instruments?
10%
what would indicate the need for instrumental delivery?
Indication: based on clinical judgement of midwife/ obstetric
- Failure to progress
- Foetal distress
- Maternal exhaustion
- Control of heads in various foetal position
instrumental delivery puts mum at extra risks, what are they?
: having instrumental delivery increases risk to mother:
- PPH
- Episiotomy
- Perineal tears
- Injury to anal sphincter
- Incontinence of bladder/ bowel
- Nerve injury (obturator or femoral nerve)
what risks can baby get from instrumental delivery?
subgaleal haemorrhage (most dangerous), intracranial haemorrhgae, skull haemorrhage, spinal cord injury
what is ventouse?
suction cup on a cord