Maternal And Neonatal Resus Part 1 Flashcards
What are maternal factors for malpresentation?
- lax abdominal/uterine muscles
- uterine anomalies (fibroids or bicornuate uterus)
What are placental or pregnancy risk factors for malpresentation
- placenta previa
- preterm labour
- polyhydraminos
- multiple pregnancies
What labour complications do malpresentation carry?
- limb prolapse
- uterine rupture due to obstructed labour
- obstructed delivery increasing maternal and fetal mortality
What is normal fundal height and position?
Normal vertex: fungus reaches under the ribs as the babies head descends into the pelvis
Fundal height and positioning in malpresentation
Fungus height might be lower due to the baby being sideways
Twin births are most common in what age range of mothers?
37 years or older
Hormonal factors of having twins
High levels of FSH increase the likelihood of having twins
What are complications with multiple gestation (9)
- prematurity due to limited space
- discordant growth (one twin grows larger than the other)
- twin-twin transfusion syndrome
- congenital abnormalities
- polyhydraminos
- malpresentation of the second twin
- perinatal mortality
- gestational HTN
- PPH
How should you manage and deliver twins?
- Deliver first twin
- Clamp and cut the cord (do not delay)
- Visualize for PPH
- Delivery of second twin
What interventions can midwives perform?
- bimanual uterine compression
- fundal massage
Can you leave a patient in the care of a midwife?
Yea, only if they are Ontario certified and capable
What are signs that the second twin may deliver soon?
- increased contractions
- more bleeding
- visible presenting parts
How much time is typically passed before the second twin is born?
20 - 30 mins
What can be indicators of a second baby in undiagnosed twins?
- the first baby is smaller than expected
- fundus remains high after delivery of the first baby
- palpation s reveals another head or body part in abdomen
Nearly half of twins are delivered preterm, with a significant proportion under ____ weeks
32 weeks
Why do mothers of twins have a higher risk of PPH?
Due to uterine overdistension
What is twin-twin transfusion syndrome
Donor twin: receives too little blood flow and causes growth restrictions
Recipient twin: receives too much blood flow which increases the risk of heart failure
For preterm neonates, avoid traditional dry stimulation. Instead you should…
Place the neonate in a plastic bag to maintain warmth
Placenta management with twins
- Guard the uterus during delivery to prevent uterine inversion
- Hold both cords together in one hand and use gentle traction
What should you document with twins?
- time of ROM
- Time of baby 1 head delivery and time of entire baby delivery
- presentation of baby 2
- time of birth for baby 2s head and entire baby delivery
- time of placental delivery
Why doe preterm neonates run the risk of hypothermia?
- thin skin
- reduced fat stores
- immature thermoregulatory systems
what are key indicators of PPH
- excessive bleeding following the delivery of one or both babies
- retained placenta or uterine atony
what is the consequencial sequence of heat loss?
heat loss causes cold stress
which causes peripheral vasoconstriction which reduces oxygen delivery.
this triggers pulmonary vasoconstriction which decreases oxygen supply
at what gestation age is the plastic bag method used?
neonates <32 weeks gestation
what is a denied pregnancy?
an individual is unconsciously denies their pregnancy due to dissociative psychopathology
what is la belle indefference
mother expresses no emotional response to the experience of pregnancy
what are hidden pregnancies?
the individual is consciously aware of their pregnancy but hides it intentionally
what risks are associated with denied and hidden pregnancies?
lack of prenatal care causes no screening for gestational diabetes or preeclampsia or malpositioning of fetus or placenta
