Objectives 11-20 Flashcards
What is the difference between a long arc vs a short arc when baby rotates from an ROA position?
Long Arc Rotatation: 135 degrees to the Anterior. Descent: head enters the inlet with the sagittal suture in the right oblique diameter. Long labor. Flexion: is imperfect and often is not complete until the head reaches the pelvic floor. Internal rotation: The occiput rotates 135 degrees anteriorly under the symphysis: ROP to ROT to ROA to OA (picture in Oxhorn, p. 165). Extension: head is born by extension. Restitution: OA to ROA. External Rotation: ROA to ROT
Short Arc Rotation: 45 degrees to the Posterior. Descent: head enters the inlet with the sagittal suture in the right oblique. Descent continues throughout labor. Flexion: is imperfect, resulting in a longer presenting diameter. Internal Rotation: the occiput turns posteriorly 45 degrees ( ROP to OP) into the hollow of the sacrum. The sagittal suture is in the AP diameter of pelvis. Bregma is behind pubis. Birth of head: Birth of head is by a combo of flexion and extension . When there is good flexion, the area anterior to the bregma pivots under the symphysis. Presenting diameter is the subocciitofrontal of 10.5 cm. When flexion is incomplete, the presenting diameter is the occipitofrontal of 11.5 cm. more traumatic. Restitution: OP to ROP, and then ROT to ROT to birth shoulders and rest of body.
When is a somersault delivery of the shoulders appropriate vs delivery of the shoulders through the nuchal cord?
Somersault for tight cord ○ deliver shoulder through cord if loose
Somersault: If cord it too tight to slip over shoulders, but has some room to move, deliver both shoulders. As shoulder deliver, flex baby’s head so that face is pushed toward maternal thigh, keep head next to perineum while body is delivered, unwrap cord
Delivery of shoulders through cord: If cord too tight to reduce, but not too tight around neck, slip over shoulers as baby’s body is born and deliver through cord.
What are the steps you must use when confronted with continued postpartum bleeding in the third stage?
○ if you check uterus =firm and pit was given ○
■ then check for trauma and lac
■ check for clots or retained placenta (fragments prevent uterine vessels from occluding with contraction)
■ 4 Ts: Tone, Tissues (P&M), Trauma, Thrombin (<1%)
What is a second degree laceration?
Stables: a tear that involves the skin of the fourchette, perineum and perineal body (superficial bulbocaernosus and transverse perineal muscles, deep pelvic floor pubococcygeus muscle). Deeper, mainly in the midline and estend through the perineal body.
- often transverse perineal muslce is torn - tear may go down to but not through rectal sphincter - triangular in apperance with base at fourchette, one apex at vagina, other base at rectum
What is a sulces laceration?
sides: vaginal wall tears, lots of bleeding ○ IFM (scalp electrode) can cause sulces tear
What are the steps in attempting to resolve a shoulder dystocia?
HELPERR
H: call for help
E: eval for epis or bladder
L: legs (mcRoberts or gaskin)
P: pressure
E: enter (internal rotation)
R :Remove the posterior Arm
R: Roll the patient
What is the Wood screw maneuver?
2 hands to twist baby ○ Rubin: 2 fingers on babies baby rotate anterior shoulder to toward babies face.
Operator’s hand may be passed behind the occiput into the vagina, and the anterior shoulder may be pushed forward to the oblique, after which , with maternal efforts and gental posterior pressure, delivery should occur.
Alternatively, the posterior shoulder may be rotated forward, through a 180 degree arc, and pass under the pubic ramus as in turning a screw. As the posterior shoulder rotates anteriorly, delivery will often occur. (p. 410)
What are the reasons for postpartum perineal pain?
sutures
hematoma
infection
What would be the signs that you observe? ○ hematoma: unilateral edema, very painful
What is the average length of third stage of labor?
510 mins, up to 30 minutes ○ increased risk of hemorrhage after 30 mins
What is the normal time range for the third stage of labor?
5-30 min
How does placental separation take place?
uterine contraction and retract -> causing bunching and doubling of the placenta to shear of the decidua
-Placental separation is the result of the abrupt decrease in size of the uterine cavity durand and following delivery. This decrease in size means a concomitant decrease in area of placental attachment. Placenta first accomodates to uterine size decreae by becoming thicker, but the site of attachment is not able to stand the stress and buckles. A hemotoma is formed between the separating placenta and the remaining decidua as a result of bleeding into the intervillous space. This is called a retroplacental hematoma and it facilitates separation.
What is a retroplacetal hematoma?
caused by separation of the separation of the placental
What is a third degree laceration?
Stables: skin of fourchette, peineum, perineal body, and the anal sphincter. extend through perineal body, the tranverse perineal muscle, and rectal sphincter
What is a fourth degree laceration?
skin of fourchette, perineum, and perineal body, external anal sphincter, internal anal sphincter, and anal epithelium