Lecture 7.2 - At Risk Birth (Part 2) Flashcards
What is the best prevention for c/s birth?
Early, continuous support of laboring person
–> Provided by someone who is not hospital staff or part of birthing persons social circle
What are some maternal risks of c/s?
Hemorrhage, Endometritis
Amniotic fluid or air embolism
Aspiration pneumonia related to anesthesia, atelectasis, UTI, injury to bowel/bladder.
What are the newborn risks associated with c/s?
Iatrogenic prematurity
Injuries
Asphyxia, respiratory complications, more likely to need resuscitation efforts
What is the difference between an elective and a scheduled c/s?
Elective - personal choice of birthing person
Scheduled - Medically indicated
Are all unplanned c/s emergencies?
No. Some have some flexibility of a few hours.
–> If dyad are stable and labour is not progressing as expected c/s might be indicated
What kind of incision is most commonly used with c/s?
Low transverse
What kind of c/s incision is associated with a higher rate of uterine rupture and is therefore not indicated for trial of labour?
Classical - high vertical
What anesthesia is used for c/s?
Spinal - if planned
–> If epidural has already been inserted and is still in situ, it will be topped up and used if it provides effective freezing
What is the preop checklist before c/s?
Teaching
–> For planned: anticipatory guidance, NPO 8 hours preop
Labs
–> CBC, T&C, urinalysis
Monitor
–> Maternal VS
–> FHR
Prep
–> Assist with epidural/spinal
–> Foley
–> Prepare partner for OR
What is the immediate post-op care following c/s?
Monitor:
–> VS q15 min for 1-2 hours
Regular post-op:
–> Airway, coughing & deep breathing,
–> IV fluids
–> Assess dressing
–> Pain medication
Specific for C/S
–> Assess fundus and lochia
–> Oxytocin as ordered
Bonding
–> Time together, Skin-to-skin, breastfeed within 60 minutes and early hand expression.
How often are vitals done following c/s immediately post-op?
VS q15 for 1-2 hours
How does postpartum care differ for c/s patients?
Enhanced needs for pain relief
TED/SCD –> Prevent DVT
Early ambulation (6-8 hours)
Must void following foley removal
Assess incision and dressing
What are some signs of post-op complication following c/s?
Temperature > 38°C
UTI: Pain or urgency with urination, cloudy urine
INCISION: REEDA, severe increasing pain
LOCHIA: Heavier than period, large clots, odour
Is TOLAC indicated with a previous transverse uterine scar?
Yes, if there are no contraindications
What kind of facility should TOLAC take place in? What kind of monitoring should be used?
In a facility with the capacity to to an emergent CS within 30 minutes
–> With continuous EFM
What is the most serious complication of TOLAC?
Uterine rupture
How quickly can oxytocin be cleared from the system following stopping an infusion?
6-7 minutes
This makes it preferable to offering PGEs that have unreversible effects.
Meconium Stained Amniotic Fluid causes which complications?
Blocking airway, irritate lung tissue, aspiration pneumonia
What causes meconium stained fluid?
Fetal distress - such as hypoxia or infection causes blood shunting from GI tract and relaxation of sphincter muscles
GA - Post-date babies
How is meconium stained fluid managed?
Stimulate baby and assess respiratory effort, heart rate, tone
–> If all good then only suction mouth
–> If one is depressed then suction trachea
What causes shoulder dystocia?
When the anterior shoulder cannot pass under the pubic arch
How is shoulder dystocia managed?
McRoberts Maneuver + Suprapubic pressure
–> Bring knees towards head to open outlet and facilitate delivery
What is a sign of shoulder dystocia?
“turtling sign”
i do not like this turn of phrase
When do most uterine ruptures occur?
During TOLAC
What are some signs of uterine rupture?
Abnormal FHR, cessation of contraction, vaginal bleeding, constant abdominal pain, hypovolemic shock
How is uterine rupture managed immediately after occurring?
O2, fluids, blood products
Prepare for surgery
Family support
How is uterine rupture treated?
Depends on severity
–> Laparotomy to hysterectomy
What is the maternal mortality rate following an amniotic fluid embolism?
Greater than 60%
What occurs with amniotic fluid embolism?
Reaction to amniotic fluid mixing with maternal blood and causing immune reaction
–> Bronchoconstriction and pulmonary and vasoconstriction
–> DIC, HypoTN, Hypoxia, hemorrhage
What are the emergency interventions following amniotic fluid embolism?
Oxygenate, prepare for intubation, CPR, administer IV fluids and blood products.
Foley + prepare for emergency birth
What are the neonatal consequences of amniotic fluid embolism?
Survival rate is 20-60%, half with neurological consequences
Who is less likely to have a successful VBAC?
Recurrent indication for initial CS
Increased age of labouring person
GA > 40 weeks
Pre-eclampsia
Interpregnancy interval < 18-months
Induction/augmentation of labour
Increased NB birth weight
What is another word for amniotic fluid embolism?
Anaphylactoid syndrome of pregnancy
