L&D complications Flashcards
what is tocolysis
delay PTL for 48 hrs to allow for fetal lung maturity with bethamethasone
What are the tocolytics?
nifedipine: CCB (first line) MgSO4: competes with Ca for Ca channels Terbutaline: B2 agonist Ritodrine: B2 agonist Indomethacin: NSAID
MC side effects of CCB, nifedipine
HA, flushing, dizzy
MC side effects of B2 agonists, terbutaline and ritodrine
HA, tachycardiam anxiety
how to determine if ROM has occured?
- visualise fluid pooling
- nitrazine test (alkaline pH turns nitrazine paper blue)
- fern test (see ferning under microscope)
- amnio dye/tampon test (inject dilute indigo-carmine dye into amniotic sac and look for leakage into tampon)
What is PROM?
rupture of membranes > 1 hr before labor, inc risk of infx
PROM management
≥34 wk: delivery
24-33 wk: expectant management, tocolytics + betamethasone
<24 wk: pt counseling, expectant management or induced labor
What is prolonged PROM
rupture >18 hrs before labor, ↑↑risk of infx
What is PPROM?
rupture >1 hr before labor, preterm
What is cephalopelvic disproportion? Management?
fetal head is too big to pass through maternal pelvis; MCC active phase prolongation
suspected CPD → trial of labor anyways, if CPD confirmed by CT or U/S → C/S
Complete breech vs frank breech vs incomplete/footing breech
Complete breech: thighs and legs FLEXED
Frank breech: thighs flexed, legs STRAIGHT
Incomplete (footling) breech: feet first
How is breech presentation managed?
external version to vertex, C/S, or breech delivery (rare)
What are the complications of a breech delivery
cord prolapse, head entrapment, neurologic injury
What are malpresentations?
includes face, brow, compound, persistent OP and OT
Face presentation: face first Brow presentation: orbital ridge first Compound presentation: vertex/breech + limb, Persistent OP: facing anterior Persistent OT: facing sideways
what malpresentation has high risk for cord prolapse
compound presentation
what malpresentation has high risk for deep transverse arrest with platylelloid pelvis type
persistent OT
WHat is the management of malpresentations
vaginal delivery but needs close monitoring
What are causes of fetal bradycardia
Preuterine causes: maternal hypotension or hypoxia (seizure, PE, AFE, MI, etc.)
Uteroplacental causes: placental abruption, infx, hemorrhage
Postplacental causes: cord prolapse, cord compression, fetal vx rupture
How is fetal bradycardia managed?
place in Left lat decub/RLD → start 2L O2 NC → look for cause → Tx appropriately
What is shoulder dystocia?
anterior shoulder gets caught behind pubic symphysis
what are complications of shoulder dystocia?
fetal humerus/clavicle fx
brachial plexus injury
phrenic nerve palsy
hypoxia → brain injury → death
RF for shoulder dystocia
previous dystocia, ↑fetal size (macrosomia, diabetes, maternal obesity, postterm delivery), prolonged stage 2
if manuvers to correct shoulder dystocia fail, what is next step?
cut clavicle or pubic symphysis— if this fails then Zavanelli manuver ( push head back in + perform C/S)
What are the manuvers to correct shoulder dystocia
Suprapubic pressure: add pressure to dislodge anterior shoulder
McRoberts maneuver: sharp flexion of maternal hips increases pelvic AP diameter
Rubin maneuver: apply pressure behind either shoulder to decrease fetal diameter
Wood corkscrew: apply pressure behind posterior shoulder to rotate infant
Posterior arm delivery: deliver posterior arm first, then rotate infant to for anterior shoulder
Zavanelli maneuver: push head back in + perform C/S
Causes of maternal hypotension in labor
amniotic fluid embolus regional anesthesia vasovagal anaphylaxis hemorrhage
how to manage maternal hypotension
IVFs, ephedrine + treat cause
How is amniotic fluid embolus diagnosed
fetal cells in pulm vasculature at autopsy
how to distingush between syncope and seizure
seizure will have postictal confusion
