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Women's Health Rotation > Labor and Delivery Complications > Flashcards

Labor and Delivery Complications Flashcards

1
Q

Preterm birth

A

Defined as birth before 37 completed weeks of gestation

Most common cause of perinatal morbidity and mortality

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2
Q

RF for preterm labor

A

Previous preterm delivery
Low SES
Non-white race
Maternal age <18 yrs or >40 yrs
Preterm premature rupture of the membranes
Multiple gestation
Maternal hx of one or more spontaneous second trimester abortions

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3
Q

Maternal causes of preterm labor

A

Maternal complications (medical or obstetric)
Maternal behaviors:
-Smoking
-Illicit drug use
-Alcohol use
-Lack of prenatal care
Hx of preterm labor with previous pregnancies

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4
Q

Uterine causes of preterm labor

A

Leiomyomas (particularly submucosal or subplacental)
Uterine septum
Bicornuate uterus
Cervical incompetence- natural or surgical
Exposure to diethylstilbestrol (DES)

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5
Q

Infectious causes of preterm labor

A 
Chorioamnionitis
BV
Asymptomatic bacteriuria
Acute pyelonephritis
Cervical/vaginal colonization
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6
Q

Fetal causes of preterm labor

A 
Intrauterine fetal death
Intrauterine growth retardation
Congenital anomalies
Abnormal placentation
Polyhydramnios
Multiple gestation
Macrosomia
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7
Q

Prognosis of preterm labor

A

Perinatal survival has improved in babies >27 gestational weeks
Minimal improvement in survival in babies <27 wks

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8
Q

Definition of preterm labor

A

Regular contractions occurring every 10 minutes or less, with each contraction lasting at least 30 secs, accompanied by cervical changes and/or the descent of the fetus into the pelvis, between 20 and 36 wks gestation
Preterm contractions is the term used to describe contractions that do not meet the above criteria

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9
Q

Sx of preterm labor

A 
Menstrual-like cramps
Backache
Pelvic pressure
Increased vaginal d/c
Uterine contractions that may be painless
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10
Q

Assessment of preterm labor

A

Uterine monitoring
Fetal fibronectin testing-negative test is reassuring that labor/delivery will not occur within 7-14 days
Cervical eval via u/s- cervical shortening may be appreciated on u/s before it can be noted on vaginal exam
Cultures of cervix and urine

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11
Q

Tx of preterm labor

A

Aggressively treat any confirmed or suspected infections
Reverse dehydration
Left lateral rest
Treat earlier gestations more aggressively
Typically do not start tocolysis after 35-36 wks
From 24-34 wks, steroids have been shown to hasten lung maturity in the fetus

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12
Q

Preterm labor tx contraindications

A 
Heavy vaginal bleed suggestive of placental disruption
Fetus with significant anomalies
Intrauterine infection
Advanced labor
Maternal contraindications
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13
Q

Premature rupture of membranes

A

Defined as the rupture of the amniotic membrane before labor

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14
Q

What is a contraindication to conservative management of PROM?

A

Chorioamnionitis

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15
Q

In pregnancies before 24 wks, what normally prevents nl development of the alveoli within the fetal lungs?

A

Inadequate amniotic fluid

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16
Q

Causes of PROM

A 
Infection (including BV)
Doubled risk in women who smoke
Previous PROM
Polyhydramnios
Multiple gestation
Premature cervical dilation
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17
Q

PROM management

A

Heavily dependent on gestational age
Must weigh risks against benefits according to gestational age and presence/absence of infection
If very preterm and no signs of infection may try to delay to get steroids in
Do not do a vaginal exam
Sterile speculum exam to confirm ROM and obtain cultures. May be able to visually see whether cervix is open or closed

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18
Q

Attitude

A

Refers to the posturing of the joints and relation of fetal parts to one another
The normal fetal attitude when labor begins is with all joints in flexion

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19
Q

Lie

A

This refers to the longitudinal axis of the fetus in relation to the mother’s longitudinal axis

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20
Q

Presentation

A

This describes the part of the fetus lying over the inlet of the pelvis or at the cervical os

21
Q

Complete breech

A

Both legs flexed

22
Q

Incomplete breech

A

One leg flexed, other leg extended

23
Q

Frank breech

A

Both legs extended

24
Q

RFs for breech

A 
Prematurity
Multiple fetuses
Polyhydramnios
Oligohydramnios
Too roomy uterus
Hydrocephaly
Anencephaly
Uterine abnormalities
Placenta previa
Nuchal cord
25
Q

Complications of breech presentations

A

Perinatal morbidity and mortality from difficult birth
Possible perineal trauma from difficult birth
Possible low birth weight d/t prematurity
Prolapsed cord
Placenta previa (if the cause of the breech)
Fetal anomalies
Uterine anomalies

26
Q

Position

A

Describes the relation of the point of reference to one of the eight octanes of the pelvic inlet

27
Q

Engagement

A

This occurs when the biparietal diameter is at or below the inlet of the true pelvis

28
Q

Station

A

This references the presenting part to the level of the ischial spines measured in plus or minus centimeters

29
Q

What does an external fetal heart rate monitor do?

A

Tracks variability in the FHR, which, as the fetus matures, is a marker for fetal well-being
-Short-term variability: beat to beat variance
-Long-term variability: changes in the rate over time
Used to perform non stress and contraction stress testing

30
Q

How to confirm rupture of membranes

A

Nitrazine paper to test pH- royal blue is suggestive for rupture
Nl vaginal pH 4.5-6, with ROM it’s greater than or equal to 7
Not 100% accurate as some vaginal infections cause a good deal of wetness and also change nl vaginal pH
Other things that can cause a false positive: blood, semen, UTI
Can use pool test with speculum inserted in the vagina

31
Q

Fern test

A

Fluid is applied to a microscope slide and allowed to dry for 10 mins
Then observed under microscopy
Fern leaf pattern to the slide is diagnostic of ROM

32
Q

When is umbilical cord prolapse most likely?

A

If presenting part is not engaged
If polyhydramnios is present
With multiples

33
Q

When does umbilical cord prolapse happen?

A

Usually happens at time of rupture of membranes

34
Q

Management of umbilical cord prolapse

A

Fetal presenting part can compress cord
Delivery needs to be accomplished ASAP by c-section
Pressure must be kept off cord

35
Q

Causes of dystocia

A

Uterine forces that are not sufficiently strong or appropriately coordinated to efface and dilate the cervix
Forces generated by voluntary muscles during the second stage of labor that are inadequate to overcome the nl resistance of the bony birth canal and maternal soft parts
Faulty presentation or abnl development of the fetus of such character that the fetus cannot be extruded through the birth canal
Abnormalities of the birth canal that form an obstacle to the descent of the fetus

36
Q

Protracted latent phase

A

Nulliparas: 20 hr or more
Multiparas: 14 hr or more

37
Q

Protracted active phase

A

Nulliparas 1.2 cm/hr or less

38
Q

Protracted descent

A

Nulliparas 1 cm/hr or less

Multiparas 2 cm/hr or less

39
Q

Secondary arrest of dilation

A

Arrest greater than or equal to 2 hr

40
Q

Arrest of descent

A

Arrest greater than or equal to 1 hr

41
Q

Failure of descent

A

No descent in 2nd stage

42
Q

Arrest patterns in labor

A

Striking association with cephalopelvic disproportion makes these disorders especially ominous
Whenever encountered, arrest patterns should signal the likelihood that a bony impediment exists
Prolonged active phase and prolonged second stage are associated with shoulder dystocia

43
Q

What is the most common risk factor for shoulder dystocia?

A

The use of vacuum or forceps to achieve the delivery

44
Q

Maternal shoulder dystocia risk factors

A 
Abnormal pelvic anatomy
Gestational DM
Post-dates pregnancy
Previous shoulder dystocia
Short stature
45
Q

Fetal shoulder dystocia risk factors

A

Suspected macrosomia

46
Q

Labor-related shoulder dystocia risk factors

A

Assisted vaginal delivery
Protracted active phase of first-stage labor
Protracted second-stage labor

47
Q

Maternal complications of shoulder dystocia

A 
Postpartum hemorrhage
Rectovagainal fistula
Symphyseal separation or diathesis
3rd or 4th degree episiotomy or tear
Uterine rupture
48
Q

Fetal complications of shoulder dystocia

A 
Brachial plexus palsy
Clavicular fx
Fetal death
Fetal hypoxia (with or without permanent neurologic damage)
Fracture of the humerus
49
Q

Shoulder dystocia delivery

A

H- Call for help
E- Evaluate benefit of episiotomy
L- Move legs back to mother’s abdomen with the head flat
P- Suprapubic pressure
E- Enter maneuvers (force internal rotation)
R- Remove the posterior arm
R- Roll the pt over on hands and knees

Women's Health Rotation (15 decks)

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