Labor Complications Lecture Powerpoint Flashcards
Preferred type of breech presentation
Frank breech, protective against cord prolapse
Risk factors for breech presentation (5)
- increased parity
- multiple fetuses
- polyhydramnios
- oligohydramnios
- previous breech
Complications of breech presentation (3)
- prolapsed umbilical cord (if squished will strangulate newborn
- head entrapment
- injuries to newborn
Recommendation for type of delivery in breech presentation
-c section
Breech delivery procedure
- Pop the legs out one at a time
- once scapulas are visible then pop the arms out one at a time, twisting each time (takes 2 providers)
- delivery of head sometimes with piper forceps
Dystocia
Abnormal labor, consequence of 4 distinct abnormalities (of expulsive force, of bony pelvis, of presentation/position/development of fetus, or of soft tissue of repro tract)
Cervical dilation during active phase of labor
Cervical dilation occurs at rate of at least 1.2cm per hour, cervical dilations of 3-4cm in presence of uterine contractions represents active labor
Causes of inadequate labor (4)
- epidural analgesia
- chorioamnionitis
- maternal positioning
- false labor/being in latent phase
Different pelvis types and characteristics
Gynecoid (round, most common, good prognosis)
Anthropoid (long and oval, good prognosis)
Android (heat shaped, poor prognosis)
Management of inadequate labor (3)
- amniotomy (rupture the membranes, improves contraction)
- pitocin (oxytocin)
- possible c section
Preconceptual, antepartum, and intrapartum risks for shoulder dystocia (5)
- previous
- maternal obesity
- abnormal pelvis shape
- macrosomia
- abnormal labor or instrumental use in delivery
Shoulder dystocia complications (3)
- maternal lacerations or hemorrhage
- transient brachial plexus palsy (permanent) of the newborn***
- fracture
shoulder dystocia maneuvers (8)
- suprapubic pressure applied by assistant (not fundal, but goal is o push on shoulder)
- McRobert’s maneuver - sharply flex legs upon the abdomen
- Woods maneuver (rotating the posterior by grabbing it manually)
- delivery of posterior shoulder (pull arm out and raise it up and around)
- rubin’s maneuver (rock shoulders back and forthe)
- zavanelli maneuver (replacing head in pelvis and proceeding to c section - risk for c section)
- deliberate fracture of the clavicle
- symphysiotomy (cut the cartilage between the pubic symphysis as alternative to c section but concern about cutting bladder)
Maternal indications for labor induction (5)
- fetal demise
- severe hypertensive disease
- other medical problems (DM, renal)
- high distance from hospital or quick labor
- premature rupture of membranes
Fetal indications for labor induction (5)
- post term pregnancy
- chorioamnionitis
- oligohydramnios
- IUGR
- Rh sensitization
Risks of labor induction (5)
- greater c section risk
- iatrogenic prematurity
- more painful
- longer duration
- increased risk of infection
Induction of labor methods (4)
- membrane stripping
- amniotomy (cervix has to be dilated to reach)
- pitocin (oxytocin)
- vaginal prostaglandins
- misoprostol
Relative contraindications to labor induction (4)
- placenta previa
- abnormal presentation
- active genital herpes infection
- invasive cervical cancer
Maternal morbidity from forceps (2)
- maternal injuries increased with rotations
- more episiotomies and lacerations
Indication for forceps typically just indicates it would be better to use…
….a c section
Fetal morbidity from forceps (2)
- no increase with outlet and low forceps
- midforceps ahve increased rates of neonatal intracranial hemorrhage or facial nerve palsy
Vacuum extractor
Alternative to forceps in assisting delivery that doesn’t require precise positioning but has the ssame indications and contraindications, operator should abandon procedure if it does not proceed easily “pop off rule”
Complications of vacuum extractor use in labor (5)
- scalp lacerations and bruising
- subgaleal hematoma
- cephalohematoma
- intracranial hemorrhage
- subconjunctival hemorrhage
