Labor and Delivery Complications Flashcards
labor and delivery complications to know
breech presentation
dystocia
fetal distress
premature rupture of membranes
preterm labor
prolapsed umbilical cord
breech birth happens when a baby is born
bottom first
prevalence of breech deliveries decreases with
increasing gestational age
25% of breech births occur with fetuses < _ weeks old
28
tx for breech fetus
- external cephalic version at/near term
- if version is successful: trial of vaginal delivery
- if version is unsuccessful: c section
20 yo G2P1 f w. GDM and pre pregnancy BMI 43 presents in labor - labor begins w.o complication but becomes stalled as pt attempts to push shoulders thru - head delivers and then suddenly retracts against pelvis and will not budge
shoulder dystocia
aka
obstructed labor
baby does not exit pelvis during childbirth due to being physically blocked despite normal uterine contractions
shoulder dystocia/obstructed labor
what does dystocia mean
abnormal labor progression
main complication of obstructed labor for baby
hypoxia
3 main complications of obstructed labor for mom
infxn
uterine rupture
post partum bleeding
3 rf for obstructed labor
large or abnormally positioned baby
small pelvis
problems w. birth canal
3 rf for small pelvis
malnutrition
vit D deficiency
adolescence
problems w. the birth canal include
narrow vagina
narrow perineum
2 causes of narrow vagina/perineum
female genital mutilation
tumors
3 categories of dystocia
power
passenger
passage
problem of power
uterine contractions
problems of passenger
presentation
size -> macrosomia
position of fetus -> dystocia
dx of shoulder dystocia
PE
what is turtle sign and what does it make you think of
retraction of delivered head against maternal perineum
obstructed labor
what might a dystocia’ed (not a real word) baby look like
red puffy face
increasingly long time in labor indicates a _ issue,
and makes you concerned about _
mechanical
obstructed labor
tx for obstructed labor
- first try to change maternal positioning
- if unsuccessful: c section or vacuum extraction
- surgical opening of symphysis pubis (symphysiotomy)… oooooooooowwwwwwie!
tx for shoulder dystocia specifically
- non manipulative maneuvers: suprapubic pressure, flexion of maternal hips
- manipulative maneuvers: rotation of fetal shoulders 180 degrees, delivery of posterior arm
- push head back in and do a c section
what is the mcroberts maneuver
flexion of maternal hips w. shoulder dystocia’ed baby
what is wood’s corkscrew
rotation of the fetal shoulders 180 degrees with shoulder dystocia’ed baby
what is the zavanelli maneuver
pushing head of shoulder dystocia’ed baby back up in there for c section
that zavanelli guy was one crazy mofo
fetal tachycardia is defined as:
fetal bradycardia is defined as:
tachycardia: > 160 bpm x 10 min
bradycardia: < 120 bpm x 10 min
simple, noninvasive way of checking on baby’s health
nonstress testing (NST)
NST records baby’s (3)
movements
heartbeat
contractions
what is considered a good NST/fetal well being
reactive
2 accelerations in 20 min, indicated by:
increased fetal HR >/= 15 bpm from baseline lasting > 15 sec
what is a bad NST
nonreactive
no fetal HR accelerations OR < 15 bpm lasting < 15 sec
what should you do if you have a pt w. a NST
order a contraction test
contraction stress test measures
fetal response to stress at times of uterus contraction
management of NST
delivery asap
definition of premature rupture of membranes (PROM)
rupture of membranes at >/= 37 weeks gestation PRIOR to the start of contractions
definition of preterm PROM (PPROM)
rupture of membranes at < 37 weeks gestation PRIOR to start of contractions
2 major risks of PROM/PPROM
infxn
cord prolapse
sx of PROM/PPROM
sudden gush of clear/pale yellow fluid
work up of PROM/PPROM
confirm that fluid is amniotic fluid:
-speculum: fluid pooling
-nitrazine test: pH > 7.1 = (+)
-microscopic exam: fern pattern
what is “ferning”
crystallization of estrogenon microscopic exam of amniotic fluid
tx for PROM/PPROM
> 34 weeks: induce labor
32-34 weeks: collect fluid, check lung maturity, induce
<32 weeks: stop contractions, 2 doses steroid injxn, deliver, give abx
definition of preterm delivery
delivery of viable infant before 37 weeks gestation
sx of preterm labor
-uterine contractions more often than q 10 min
-leaking of fluid from vagina
the earlier a baby is born, the greater the risk/severity/variet of complications to infant - which system is esp at risk for complications
respiratory
earliest age at which a baby has at least 50% chance of survival
24 weeks
6 rf for preterm labor
-smoking
-cocaine
-uterin malformations
-cervical incompetence
-infxn
-low birth weight
3 tests useful in preterm delivery
fetal fibronectin
placental alpha microglobulin (PAMG-1)
US
gs test to differentiate women at high risk for impending preterm delivery
fetal fibronectin via cervical/vaginal secretions
best predictor of imminent spontaneous delivery w.in 7 days of a pt presenting w. s/sx of preterm delivery
placental alpha microglobulin-1 (PAMG-1) aka
PartoSure test
usefullness of US in preterm delivery
assessment of cervix to determine risk
what length of cervix is unfavorable
< 25 mm at or before 24 weeks gestation = incompetent cervix
tx for preterm labor
tocolysis (labor delay via meds):
NSAIDs
nifedipine
beta agonists
atosiban (oxytocin antagonist)
moa for tocolytics
relax uterus
goal of tocolytics
delay onset of labor until corticosteroids have been administered for fetal lung maturity < 34 weeks gestation
tocolytics rarely delay delivery beyond _ hr
24-48
what 2 tocolytics together can dely delivery by 2-7 days
atosiban (oxytocin antagonist)
PLUS
nifedipine
what drug is not a tocolytic, but can reduce risk of cerebral palsy in preterm baby
Mg sulfate
what drug can reduce risk for preterm delivery in at risk pt
progesterone
what med when given btw 24-37 weeks gestation can improve fetal outcomes
corticosteroids
umbilical cord comes out of uterus w. or before the presenting part of the fetus
umbilical cord prolapse
3 complications of umbilical cord prolapse
hypoxia
brain damage
death
2 mc rf for umbilical cord prolapse
malpresentation
rupture of membranes
first sx of umbilical cord prolapse
sudden/severe decrease in fetal HR that does not immediately resolve
fetal HR tracing would show _ with umbilical cord prolapse
mod-severe variable decelerations
gs tx for umbilical cord prolapse
immediate c section
alternate management of prolapsed uterine cord (2)
-manueal elevation of presenting fetal part
-repositioning of mother to knee-chest position
