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L&D Complications Flashcards

1
Q

Complications of Labor & Delivery

A 
Preterm labor
Group B strep
Failure to progress
Umbilical cord prolapse
Shoulder Dystocia
Breech Delivery
Retained Placenta
Uterine inversion
Post-Partem Hemorrhage (PPH)
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2
Q

Define Preterm Labor

A

Prior to 37 weeks
Most common perinatal morbidity & mortality in U.S.
Regular uterine contractions associated with cervical change

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3
Q

Risk Factors for Preterm Labor

A 
Multiple gestation
Prior preterm birth
Preterm uterine contractions
Premature maternal pre-pregnancy weight
Smoking
Substance abuse
Short inter pregnancy interval
Infection: UTI, genital tract periodontal disease
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4
Q

Pathophysiology of Preterm Labor

A

Activation of maternal or fetal hypothalamic-pituitary-adrenal axis due to maternal or fetal stress
Decidual-chorioamniotic or systemic inflammation caused by infection
Decidual hemorrhage
Pathologic uterine distension

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5
Q

Example of Decidual Hemorrhage

A

Abruption

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6
Q

Pathologic Uterine Distension

A

Multiple pregnancy
Polyhydramnios
Uterine abnormality

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7
Q

Signs & Symptoms of Preterm Labor

A

Menstrual like cramps
Low, dull backache
Pelvic pressure
Abdominal cramping with or without diarrhea
Increase or change in vaginal discharge: mucus, water, light bloody discharge
Uterine contractions

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8
Q

Evaluation of Preterm Labor

A 
Fetal monitoring
UA
Test for group B strep
CBC
Ultrasound
Amniocentesis
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9
Q

Management of Preterm Labor

A

Primary goal: delay delivery until maturity attained
Detection & treatment of underlying disorder
Therapy

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10
Q

Define Tocolytics

A

Medications that stop preterm labor

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11
Q

Tocolytic Medications

A

Calcium Channel Blockers (nifedipine)
NSAIDS (indocin)
B-adrenergic receptor agonists (terbutaline)
Magnesium sulfate

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12
Q

Contraindications to Tocolytics

A 
Advance labor*
Mature fetus*
Severely abnormal fetus or fetal demise
Intrauterine infection
Significant vaginal bleeding
Severe pre-eclampsia or eclampsia
Placental abruption
Advanced cervical dilation
Fetal compromise
Placental insufficiency
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13
Q

Corticosteroids

A

24-34 weeks gestation (pre-mature labor)
For lung maturity
Dosing over 48 hours

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14
Q

Corticosteroids Reduce

A

Fetal respiratory distress
Intraventricular hemorrhage
Necrotizing enterocolitis

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15
Q

Group B Strep

A

Screening between 35-36 weeks gestation
If positive: prophylactic antibiotic during labor or premature rupture of membranes
Mother with prior GBS infection in infant

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16
Q

Group B Strep Antibiotic Prophylaxis

A

PenG

Best if 4 hours prior to delivery

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17
Q

Group B Strep Antibiotic Prophylaxis if Penicillin Allergy

A

Cefazoline (no anaphylaxis to PCN)
Clindamycin
Vancomycin

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18
Q

What does Group B strep colonization prevent in the mother?

A

Postpartum endometritis, sepsis, & meningitis

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19
Q

Define Dystocia

A

Lack of progressive cervical dilation or lack of descent of fetal head in birth canal or both

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20
Q

What does dystocia lead to?

A

C-section

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21
Q

How to evaluate the progression of labor?

A 
Uterus contracting accurately?
What is the fetal position?
Indication of cephalopelvic disproportion?
Fetal status?
Concern for chorioaminonitis?
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22
Q

Progression of Labor

A

Nulliparous: 1 cm/hr
Multiparoud: 1.5 cm/hr

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23
Q

Management of Delay of Labor

A

Observation
Augmentation: amniotomy, oxytocin
Caesarian section: maternal/fetal distress, unstable condition of mother

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24
Q

Amniotomy

A

Manual rupture of membranes with “hook”

25
Risks of Amniotomy
Fetal heart rate deceleration due to cord compression | Increased incidence of chorioamnioitis
26
Oxytocin
Increases uterine activity (contractions) which in turn should result in cervical change & descent
27
Risks of Oxytocin
Hypertonic uterus | Avoid more than 5 contractions in 10 minutes (causes decreased blood flow to fetus)
28
Indications for a C-Section
``` Failure to progress during labor* Non-reassuring fetal status* Fetal malpresentation* Abnormal placentation Maternal infection Multiple gestation Fetal bleeding diathesis Umbilical cord prolapse Macrosomia Obstruction of birth canal Uterine rupture ```
29
Methods of Assisted Vaginal Delivery
Forceps Vacuum extraction Mother's pushing & contractions are insufficient to deliver the infant Sudden onset of severe maternal or fetal compromise & mother is fully dilated & effaced
30
Complications of Forceps
Mother: perioneal trauma, hematoma, pelvic floor injury Baby: injuries to brain or spine, MSK injury, corneal abrasion, shoulder dystocia
31
Complications of Vacuum
Mother: less trauma than forceps Baby: intracranial hemorrhage, subgaleal hematoma, scalp laceration, hyperbilirubinemia, retinal hemorrhage, cephalohematoma
32
Umbilical Cord Prolapse
Precedes the presenting part | Pressure on the cord causes fetal bradycardia and can eventually cause fetal demise
33
Umbilical Cord Prolapse Management
Prompt delivery usually by c-section | Maneuvers to reduce cord pressure
34
Maneuvers to Reduce Cord Pressure
Examiner's hand in vagina to elevate presentation part of the cord while arrangements made for emergency c-section Patient placed in steep trendelenberg Filling the bladder with NS Give tocolytic to stop contractions
35
Define Shoulder Dystocia
Need for additional obstetric maneuvers to effect delivery of the shoulders at the time of vaginal birth
36
Diagnosis of Shoulder Dystocia
Fetal head retracts into the perineum after expulsion (Turtle's sign) When gentle, downward traction of the fetal head fails to accomplish delivery of the anterior shoulder
37
Shoulder Dystocia Management
``` Excessive neck rotation, head & neck traction & fundal pressure should be avoided Drain distended bladder McRoberts maneuver Suprapubic pressure Rubin maneuver Delivery of the posterior arm ```
38
Define McRoberts Maneuver
Extreme flexion of the hips
39
Define Suprapubic Pressure
Directing pressure on the anterior should downward away from the pubic bone
40
Define Rubin Maneuver
Adduction of the fetal shoulder, displacing them from the anteroposterior diameter
41
Delivery of the Posterior Arm (Barnum Maneuver)
Best under adequate anesthesia Introduce hand into vagina & locate posterior arm & shoulder Follow it to elbow, flex elbow across fetal chest Grasp forearm & arm is then pulled out of vagina Greatest risk is fracture of the humerus
42
Shoulder Dystocia Management
McRoberts & suprapuic pressure | Place mother on hands & knees
43
3 Different Presentations of Breech Babies
Frank breech Complete breech Incomplete breech
44
Define Frank Breech
Hips flexed/knees extended
45
Define Complete Breech
Hips & knees flexed
46
Define Incomplete Breech
One or both hips extended (foot or feet first)
47
External Cephalic Version Procedure
``` Done in final trimester Monitor fetus Often given uterus relaxants Perform cephalic version Monitor mom & baby Give Rhogam if mother Rh negative ```
48
Risks of External Cephalic Version
``` Transient fetal HR changes Fetomaternal transfusion Emergency cesarean delivery Vaginal bleeding Ruptured membranes Fetal death Placental abruption Cord prolapse ```
49
Define Retained Placenta
Placenta that has not been expelled 30-60 minutes after delivery of the baby
50
Pharmacologic Interventions of a Retained Placenta
``` IV nitroglycerin (monitor BP) Intraumbilical injection of oxytocin solution in saline ```
51
Manual Removal of a Retained Placenta
Follow umbilical cord into lower uterine segment with hand Other hand holds fundus Hand inside the uterus frees remaining placenta
52
Define Uterine Inversion
Uterine fundus collapses into the endometrial cavity
53
Treatment of Uterine Inversion
``` Summon assistance Large bore IV access for fluids Uterine relaxation: magnesium sulfate, terbutaline, nitroglycerin Manual correction Removal of placenta Uterotonic agents ```
54
Normal Pathophysiology of Uterine Hemostasis
Contraction of myometrium to compress blood vessels Local decidual hemostatic factors: tissue factor, plasminogen activator inhibitor, platelets, circulating clotting factors
55
Causes of PPH
Incomplete placental separation: retained placenta or membranes Ineffective myometrial contraction (ATONY) Bleeding diatheses: failure to clot
56
PPH Diagnosis
Excessive bleeding | Results in light-headedness, vertigo, syncope, hypovolemia
57
PPH Management
Fundal massage IV access: fluid & blood; draw for type & cross Ultrasound: looking for debris Uterotonic Drugs: oxytocin, misoprostol SL or PR, methylergonovine IM, carboprost tromethamine
58
Secondary Management of PPH
Taken to OR room Provide adequate anesthesia Explore uterus & remove retained fragments or fetal membranes Inspect for & repair cervical & vaginal lacerations Bakri tamponade: similar to massive tampon

OB/GYN (12 decks)

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