L&D complications

Question 1

what is tocolysis

Answer 1

delay PTL for 48 hrs to allow for fetal lung maturity with bethamethasone

Question 2

What are the tocolytics?

Answer 2

nifedipine:  CCB (first line)
MgSO4: competes with Ca for Ca channels
Terbutaline: B2 agonist
Ritodrine: B2 agonist
Indomethacin: NSAID

Question 3

MC side effects of CCB, nifedipine

Answer 3

HA, flushing, dizzy

Question 4

MC side effects of B2 agonists, terbutaline and ritodrine

Answer 4

HA, tachycardiam anxiety

Question 5

how to determine if ROM has occured?

Answer 5

1. visualise fluid pooling
2. nitrazine test (alkaline pH turns nitrazine paper blue)
3. fern test (see ferning under microscope)
4. amnio dye/tampon test (inject dilute indigo-carmine dye into amniotic sac and look for leakage into tampon)

Question 6

What is PROM?

Answer 6

rupture of membranes > 1 hr before labor, inc risk of infx

Question 7

PROM management

Answer 7

≥34 wk: delivery
24-33 wk: expectant management, tocolytics + betamethasone
<24 wk: pt counseling, expectant management or induced labor

Question 8

What is prolonged PROM

Answer 8

rupture >18 hrs before labor, ↑↑risk of infx

Question 9

What is PPROM?

Answer 9

rupture >1 hr before labor, preterm

Question 10

What is cephalopelvic disproportion? Management?

Answer 10

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

Question 11

Complete breech vs frank breech vs incomplete/footing breech

Answer 11

Complete breech: thighs and legs FLEXED
Frank breech: thighs flexed, legs STRAIGHT
Incomplete (footling) breech: feet first

Question 12

How is breech presentation managed?

Answer 12

external version to vertex, C/S, or breech delivery (rare)

Question 13

What are the complications of a breech delivery

Answer 13

cord prolapse, head entrapment, neurologic injury

Question 14

What are malpresentations?

Answer 14

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

Question 15

what malpresentation has high risk for cord prolapse

Answer 15

compound presentation

Question 16

what malpresentation has high risk for deep transverse arrest with platylelloid pelvis type

Answer 16

persistent OT

Question 17

WHat is the management of malpresentations

Answer 17

vaginal delivery but needs close monitoring

Question 18

What are causes of fetal bradycardia

Answer 18

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

Question 19

How is fetal bradycardia managed?

Answer 19

place in Left lat decub/RLD → start 2L O2 NC → look for cause → Tx appropriately

Question 20

What is shoulder dystocia?

Answer 20

anterior shoulder gets caught behind pubic symphysis

Question 21

what are complications of shoulder dystocia?

Answer 21

fetal humerus/clavicle fx
brachial plexus injury
phrenic nerve palsy
hypoxia → brain injury → death

Question 22

RF for shoulder dystocia

Answer 22

previous dystocia, ↑fetal size (macrosomia, diabetes, maternal obesity, postterm delivery), prolonged stage 2

Question 23

if manuvers to correct shoulder dystocia fail, what is next step?

Answer 23

cut clavicle or pubic symphysis— if this fails then Zavanelli manuver ( push head back in + perform C/S)

Question 24

What are the manuvers to correct shoulder dystocia

Answer 24

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

Question 25

Causes of maternal hypotension in labor

Answer 25

amniotic fluid embolus
regional anesthesia
vasovagal
anaphylaxis 
hemorrhage

Question 26

how to manage maternal hypotension

Answer 26

IVFs, ephedrine + treat cause

Question 27

How is amniotic fluid embolus diagnosed

Answer 27

fetal cells in pulm vasculature at autopsy

Question 28

how to distingush between syncope and seizure

Answer 28

seizure will have postictal confusion