Labor and Delivery Complications Flashcards
what is the treatment for breech presentation
external cephalic version at or near term
followed by a trial of a vaginal delivery if the version is successful and planned cesaarean delivery if breech presentation persists
what is dystocia
obstructed labor, aka labor dystocia.
when the baby does not exit the pelvis during childbirth due to being physically blocked, despite the uterus contracting normally
how is dystocia defined
abnormal labor progression
what are different categories of dystocia
problems of power
problems of passenger
problems of passage
what is problems of power
uterine contraction issues
what is problems of passenger
presentation, size (macrosomia), or position of the fetus (shoulder dystocia)
wha tis problems of passage
uterus or soft tissue abnormalities
what is shoulder dystocia
failure of the shoulders to deliver spontaneously after delivery of the fetal head
- obstetric emergency
what is turtle sign
retraction of the delivered head against the maternal perineum
what is the treatment for dystocia
before considering surgical options, change the posture of the mother during labor can help to progress labor
- c-section or vacuum extraction may be necessary
what are treatment options for shoulder dystocia
non-manipulative maneuvers (first line)
- suprapubic pressure, flexion of maternal hips
manipulative maneuvers
- rotation of fetal shoulders 180 degrees, delivery of poterior arm
emergency cesarean section
what is mcroberts maneuver
flexion of maternal hips for shoulder dystocia presentation
what is woods’corkscrew
rotation of fetal shoulders 180 degrees for shoulder dystocia
what is the zavanelli maneuver
pushing fetal head back into vaginal canal with immediate transport to cesarean section
what is considered fetal tachycardia
HR > 160 for 10 minutes
what is considered fetal bradycardia
HR < 120 for 10 minutes
what is the clinical definition of PROM
rupture of membranes prior to 27 weeks gestation prior to the start of uterine contractions
what is PPROM
preterm premature rupture of membranes - < 37 weeks gestation
what are risks of PROM
infection or cord prolapse
what are s/sx of PROM
sudden “gush” of clear or pale yellowish fluid from vagina that occurs after 37 weeks of gestation
how is PROM diagnosed
confirmation of amniotic fluid - Nitrazine test (blue)
microscopic “fern pattern”
what is the treatment of PROM
> 34 weeks - induce labor
32-34 weeks collect fluid and check for lung maturity - then induce
< 32 weeks stop contractions and start 2 doses of steroid injection then deliver the baby - give abx
what is the definition of preterm delivery?
delivery of a viable infant before 37 weeks gestation
how is preterm labor diagnosed
fetal fibronectin in cervical or vaginal secretions
placental alpha microglobulin (PAMG-1)
obstetric US
what is the treatment of preterm labor
tocolysis - number of meds may be used to delay delivery including NSAIDs, CCB, beta mimetics and atosiban
what is the use of Tocolytics
helps to relax uterus and are used in the tx of preterm labor
a 32-year-old G1P1 who you are monitoring on the obstetrics ward as part of your clinical rotation is progressing well when you begin to note a sudden and severe decrease in fetal heart rate that does not immediately resolve. On fetal heart tracing, you note moderate to severe variable decelerations.
what is the moste likely diagnosis
prolapsed umbilical cord
what can prolapsed umbilical cord lead to
fetal hypoxia
brain damage
and death
what is the treatment of prolapsed umbilical cord
immediate cesarean section
