labor & delivery complications

Question 1

Cord prolapse

Answer 1

The umbilical cord passes through the cervical os prior to fetal delivery causing cord compression and fetal hypoxia.

Question 2

___________ result from sudden drops in fetal heart rate and are associated with cord compression.

Answer 2

cord prolapse: Variable decelerations result from sudden drops in fetal heart rate and are associated with cord compression.

Question 3

Clinical Manifestations of cord prolapse

Answer 3

Fetal bradycardia
Irregular fetal heartbeat
Cord may be visualized on vaginal exam.

Question 4

What is premature rupture of membranes?

Answer 4

ruptures of membranes b/4 start of labor beyond 37 wks gestational age

Question 5

What is preterm premature rupture of membranes?

Answer 5

rupture of membranes b/4 the onset of labor before 37 weeks GA

Question 6

What is prolonged rupture of membranes?

Answer 6

rupture of membranes occurng >18 hrs b/4 delivery

Question 7

When is lungs known to be mature in fetus?

Answer 7

between 32 to 34 weeks

Question 8

What is the major complication of PROM/PPROM?

Answer 8

Chorioamnionitis

Question 9

A positive nitrazine test shows?

Answer 9

Rupture of membranes. Amniotic fluid pH is basic at 7.1, which turns the test strip paper blue.

Question 10

What are the 3 positive signs of premature rupture of membranes?

Answer 10

1) Pooling of amniotic fluid in the posterior fornix
2) Nitrazine test (pH >7.1)
3) Fern test

Question 11

When is group B Strep tested in a pregnant woman? If positive, how and when it is treated?

Answer 11

In late pregnancy 36-37 weeks
- Penicillin is given 4 hours before delivery.
-Clindamycin can be use if pen allergy

Question 12

What abx is given to prevent chorioamnionitis in a patient with Preterm Premature Rupture of Membranes?

Answer 12

Ampicillin + Eruthromycin to prevent infection if delaying delivery

Question 13

When is magnesium sulfate given in PPROM?

Answer 13

If PPROM occur at 24-32 weeks for neuroprotection.

Question 14

how is preterm labor diagnosed?

Answer 14

Labor between 20-37 weeks
1) uterine contractions (4 q20 mins or 8 q60)
2) cervical effacement 80% or dilation of 2cm or more

Question 15

Which screening tests for fetal anomalies are included in the quadruple test?

Answer 15

Alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin A.

Question 16

gestations of less than________________ should receive magnesium sulfate for neuroprotection

Answer 16

gestations of less than 32 weeks should receive magnesium sulfate for neuroprotection

Question 17

What is the turtle sign? What does it indicate?

Answer 17

Retraction of the fetal head onto the perineum following delivery of the chin. associated with shoulder dystocia

Question 18

What is shoulder dystocia?

Answer 18

Failure to deliver the anterior shoulder of the fetus due to impaction with the mother’s pelvis (symphysis)

Question 19

What is the greatest risk factor of shoulder dystocia?

Answer 19

Marcosomic infants (big babies) due to diabetes.

Question 20

What are fetal complications associated with shoulder dystocia?

Answer 20

Brachial plexus injuires
-exceesive lateral traction of the neck damages C5-C6 of the upper brachial plexus causing = Erb-Dunchenne palsy
Clavicular fractures

Question 21

Presentation of Erb’s palsy?

Answer 21

Erb’s palsy is associated with injury to thr the upper branch of the brachial pleus (C5-6)

-arm adducted & internally rotated
-forearm is pronated & elbow is extended.

this presentation is also calle waiter’s tp deformity.