Labor Complications Lecture Powerpoint

Question 1

Preferred type of breech presentation

Answer 1

Frank breech, protective against cord prolapse

Question 2

Risk factors for breech presentation (5)

Answer 2

• increased parity
• multiple fetuses
• polyhydramnios
• oligohydramnios
• previous breech

Question 3

Complications of breech presentation (3)

Answer 3

• prolapsed umbilical cord (if squished will strangulate newborn
• head entrapment
• injuries to newborn

Question 4

Recommendation for type of delivery in breech presentation

Answer 4

-c section

Question 5

Breech delivery procedure

Answer 5

• 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

Question 6

Dystocia

Answer 6

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)

Question 7

Cervical dilation during active phase of labor

Answer 7

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

Question 8

Causes of inadequate labor (4)

Answer 8

• epidural analgesia
• chorioamnionitis
• maternal positioning
• false labor/being in latent phase

Question 9

Different pelvis types and characteristics

Answer 9

Gynecoid (round, most common, good prognosis)
Anthropoid (long and oval, good prognosis)
Android (heat shaped, poor prognosis)

Question 10

Management of inadequate labor (3)

Answer 10

• amniotomy (rupture the membranes, improves contraction)
• pitocin (oxytocin)
• possible c section

Question 11

Preconceptual, antepartum, and intrapartum risks for shoulder dystocia (5)

Answer 11

• previous
• maternal obesity
• abnormal pelvis shape
• macrosomia
• abnormal labor or instrumental use in delivery

Question 12

Shoulder dystocia complications (3)

Answer 12

• maternal lacerations or hemorrhage
• transient brachial plexus palsy (permanent) of the newborn***
• fracture

Question 13

shoulder dystocia maneuvers (8)

Answer 13

• 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)

Question 14

Maternal indications for labor induction (5)

Answer 14

• fetal demise
• severe hypertensive disease
• other medical problems (DM, renal)
• high distance from hospital or quick labor
• premature rupture of membranes

Question 15

Fetal indications for labor induction (5)

Answer 15

• post term pregnancy
• chorioamnionitis
• oligohydramnios
• IUGR
• Rh sensitization

Question 16

Risks of labor induction (5)

Answer 16

• greater c section risk
• iatrogenic prematurity
• more painful
• longer duration
• increased risk of infection

Question 17

Induction of labor methods (4)

Answer 17

• membrane stripping
• amniotomy (cervix has to be dilated to reach)
• pitocin (oxytocin)
• vaginal prostaglandins
• misoprostol

Question 18

Relative contraindications to labor induction (4)

Answer 18

• placenta previa
• abnormal presentation
• active genital herpes infection
• invasive cervical cancer

Question 19

Maternal morbidity from forceps (2)

Answer 19

• maternal injuries increased with rotations

- more episiotomies and lacerations

Question 20

Indication for forceps typically just indicates it would be better to use…

Answer 20

….a c section

Question 21

Fetal morbidity from forceps (2)

Answer 21

• no increase with outlet and low forceps

- midforceps ahve increased rates of neonatal intracranial hemorrhage or facial nerve palsy

Question 22

Vacuum extractor

Answer 22

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”

Question 23

Complications of vacuum extractor use in labor (5)

Answer 23

• scalp lacerations and bruising
• subgaleal hematoma
• cephalohematoma
• intracranial hemorrhage
• subconjunctival hemorrhage