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OB/GYN > L&D Complications > Flashcards

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
Q

Risks of Amniotomy

A

Fetal heart rate deceleration due to cord compression

Increased incidence of chorioamnioitis

26
Q

Oxytocin

A

Increases uterine activity (contractions) which in turn should result in cervical change & descent

27
Q

Risks of Oxytocin

A

Hypertonic uterus

Avoid more than 5 contractions in 10 minutes (causes decreased blood flow to fetus)

28
Q

Indications for a C-Section

A 
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
Q

Methods of Assisted Vaginal Delivery

A

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
Q

Complications of Forceps

A

Mother: perioneal trauma, hematoma, pelvic floor injury
Baby: injuries to brain or spine, MSK injury, corneal abrasion, shoulder dystocia

31
Q

Complications of Vacuum

A

Mother: less trauma than forceps
Baby: intracranial hemorrhage, subgaleal hematoma, scalp laceration, hyperbilirubinemia, retinal hemorrhage, cephalohematoma

32
Q

Umbilical Cord Prolapse

A

Precedes the presenting part

Pressure on the cord causes fetal bradycardia and can eventually cause fetal demise

33
Q

Umbilical Cord Prolapse Management

A

Prompt delivery usually by c-section

Maneuvers to reduce cord pressure

34
Q

Maneuvers to Reduce Cord Pressure

A

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
Q

Define Shoulder Dystocia

A

Need for additional obstetric maneuvers to effect delivery of the shoulders at the time of vaginal birth

36
Q

Diagnosis of Shoulder Dystocia

A

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
Q

Shoulder Dystocia Management

A 
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
Q

Define McRoberts Maneuver

A

Extreme flexion of the hips

39
Q

Define Suprapubic Pressure

A

Directing pressure on the anterior should downward away from the pubic bone

40
Q

Define Rubin Maneuver

A

Adduction of the fetal shoulder, displacing them from the anteroposterior diameter

41
Q

Delivery of the Posterior Arm (Barnum Maneuver)

A

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
Q

Shoulder Dystocia Management

A

McRoberts & suprapuic pressure

Place mother on hands & knees

43
Q

3 Different Presentations of Breech Babies

A

Frank breech
Complete breech
Incomplete breech

44
Q

Define Frank Breech

A

Hips flexed/knees extended

45
Q

Define Complete Breech

A

Hips & knees flexed

46
Q

Define Incomplete Breech

A

One or both hips extended (foot or feet first)

47
Q

External Cephalic Version Procedure

A 
Done in final trimester
Monitor fetus
Often given uterus relaxants
Perform cephalic version
Monitor mom & baby
Give Rhogam if mother Rh negative
48
Q

Risks of External Cephalic Version

A 
Transient fetal HR changes
Fetomaternal transfusion
Emergency cesarean delivery
Vaginal bleeding
Ruptured membranes
Fetal death
Placental abruption
Cord prolapse
49
Q

Define Retained Placenta

A

Placenta that has not been expelled 30-60 minutes after delivery of the baby

50
Q

Pharmacologic Interventions of a Retained Placenta

A 
IV nitroglycerin (monitor BP)
Intraumbilical injection of oxytocin solution in saline
51
Q

Manual Removal of a Retained Placenta

A

Follow umbilical cord into lower uterine segment with hand
Other hand holds fundus
Hand inside the uterus frees remaining placenta

52
Q

Define Uterine Inversion

A

Uterine fundus collapses into the endometrial cavity

53
Q

Treatment of Uterine Inversion

A 
Summon assistance
Large bore IV access for fluids
Uterine relaxation: magnesium sulfate, terbutaline, nitroglycerin
Manual correction
Removal of placenta
Uterotonic agents
54
Q

Normal Pathophysiology of Uterine Hemostasis

A

Contraction of myometrium to compress blood vessels
Local decidual hemostatic factors: tissue factor, plasminogen activator inhibitor, platelets, circulating clotting factors

55
Q

Causes of PPH

A

Incomplete placental separation: retained placenta or membranes
Ineffective myometrial contraction (ATONY)
Bleeding diatheses: failure to clot

56
Q

PPH Diagnosis

A

Excessive bleeding

Results in light-headedness, vertigo, syncope, hypovolemia

57
Q

PPH Management

A

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
Q

Secondary Management of PPH

A

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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