Labor Complications

Question 1

RF for labor complications

Answer 1

early gestation
increased parity
multiple fetuses
polyhydramnios
oligohydramnios Placenta previa
Previous breech
Uterine anomalies
Pelvic tumors
Fetal anomalies

Question 2

complications of breech

Answer 2

Prolapsed umbilical cord
Footling 17%
Complete 5%
Frank 0.5%
Head entrapment (smaller part comes out first and the bigger part aka head is too big. Premature baby- bigger RF because head is much bigger than body vs term and the cervix is not fully dilated 
Injuries to newborn

Question 3

what does acog recommend for breech singletons

Answer 3

c-section

Question 4

how to deliver breech baby

Answer 4

For most part, don’t touch the baby until you can see the
scapula
They should be born BACK up
Use two fingers to support baby DON’T pull while its
coming out
Delivered to the shoulders (hold legs up and sweep in
finger to release the shoulder)

Question 5

dystocia

Answer 5

literally means abnormal labor

Question 6

dystocia 4 distinct

Answer 6

1. Abnormality of expulsive force (mother cant push hard enough)
   
   2. Abnormality of the bony pelvis (most women have gynecoid pelvis but others can cause problems)
   3. Abnormality of the presentation, position or development of the fetus
   4. Abnormality of the soft tissue of the reproductive tract

Question 7

first stage of labor

Answer 7

Latent phase: Regular contraction, cervical effacement, and softening. Prolonged if greater than 20 hours.

Active phase: Cervical dilation at a rate of at least 1.2cm per hour. Cervical dilatation of 3-4 cm in the presence of uterine contractions represents active labor

Question 8

hypotonic uterine dysfunction

Answer 8

no basal hypertonus, and the intensity of the contraction is insufficient to dilate the cervix

Question 9

Hypertonic uterine dysfunction

Answer 9

basal tone is elevated or the contractions are incoordinate

usually due to infection or htn

Question 10

MC type of fetopelvic disproportion

Answer 10

Contracted midpelvis—most common, transverse arrest of an engaged fetal head—no descent or internal rotation

Question 11

shoulder dystocia

Answer 11

Basically babies head is out and the rest of the body wont come out

The anterior shoulder gets caught above the pubic symphysis

Question 12

shoudler dystocia complications

Answer 12

Maternal: lacerations & hemorrhage
Fetal consequences:
     25% will have some injury—of those:
     *Transient brachial plexus palsies most common :65% 
            (may be permanent, MOST FEARED) 
     Fractured clavicle: 38%
     Humeral fracture: 17%
     Permanent palsy or fetal death rare

Question 13

shoulder dystocia drill

Answer 13

Call for help while attempting gentle traction
Generous episiotomy
Doesn’t ease delivery, just allows you to put the hand in the vagina to manipulate body 
Suprapubic pressure
McRobert’s maneuver-MC?
The Wood’s screw maneuver
Attempt delivery of the posterior arm
Zavanelli maneuver

Question 14

erbs palsy nerves involved

Answer 14

C5 C6

Question 15

labor induction indications maternal indications

Answer 15

Fetal demise
Severe hypertensive disease
Other medical problems (DM, renal)
Risk of precipitous labor or distance from hospital
Premature rupture of the fetal membranes
        National standard is at 34 wks

Question 16

labor induction indications fetal indications

Answer 16

Post-term pregnancy
Chorioamnionitis
Oligohydramnios
IUGR
Rh sensitization

Question 17

relative contraindications for induction (indications for C section)

Answer 17

Placenta previa
Abnormal lie or presentation
Prior classic incision
Active genital herpes
Pelvic abnormalities
Invasive cervical cancer
Presenting part above pelvic inlet

Question 18

risk of induction

Answer 18

Induction of nulliparas doubles the cesarean risk
Iatrogenic prematurity
More painful
Longer duration
Increase infections

Question 19

prerequisites for forceps delivery

Answer 19

1. The membranes must be ruptured.
2. The cervix must be fully dilated.
3. The operator must be fully acquainted with the use of
   the instrument.
4. The position and station of the fetal head must be
   known with certainty.
5. Adequate maternal anesthesia for proper application of
   the forceps must be presentThe maternal pelvis must
   be adequate in size for atraumatic delivery.
6. The characteristics of the maternal pelvis must be
   appropriate for the type of delivery being considered.
7. The fetal head must be engaged and mostly have completed descent.

Question 20

classification of forceps delivery

Answer 20

1. Outlet forceps:
   a. Scalp is visible at the introitus without separating the
   labia
   b. Fetal skull has reached the pelvic floor
   c. The sagittal suture is OA or OP, or ROA, LOA, ROP,
   LOP
   d. Fetal head is at or near the perineum
   e. Rotation does not exceed 45 degrees
2. Low forceps: have to spread labia to see head
   a. Fetal skull is at 2+ station or lower but not on the
   pelvic floor
   b. Rotation is 45 degrees or less
3. Midforceps: not many people can do this or do it
   a. Station above +2
   b. head is engaged
   c. rotation is greater than 45 degrees
4. High forceps—station 0-very dangerous don’t really
   do