Objectives 61-70

Question 1

61. How many pop offs is considered safe for a vacuum delivery?

Answer 1

• general consensus is that if no descent after 3 pulls, the attempt should be stopped.
• Max number of pop offs be limited to 2-3; and duration of vacuum extraction be limited to 20-30 minutes

Question 2

62. What type of incision is used if Fetal bradycardia has been noted for 10 minutes?

Answer 2

• Oxhorn: vertical incision is used in cases of acute fetal distress

Question 3

63. What is the definition for fetal pelvic disproportion?

Answer 3

• Refers to the inability of the fetus to pass through the pelvis. Disproportion may be absolute or relative.
  
  • Absolute is when under no circumstances can the baby pass safely through the birth canal.
  • Relative disproportion is when other factors contribute to the problem like poor contractions, rigid soft parts, abnormal positions and inability of the head to mold properly to made vaginal delivery possible.

Question 4

64. Why does deflexion,asynclitism, and failure to internal rotate occur?

Answer 4

• Cephalic pelvic disproportion/Deep Transverse Arrest: associated with platypelloid and android pelvic types due to flat posterior pelvic configuration.
• Android has convergent sidewall and prominent ischial spines. This inhibits internal rotation (sag suture from transverse to AP diameter).
• Prolonged second stage. Signs and symptoms: sag suture transverse, development of second stage hypotonic uterine dysfunction, formation of caput, lack of descent, extensive molding

Question 5

65. Why is it difficult to assess station?

Answer 5

• Caput. Important to locate parietal bones to assess station

Question 6

66. What factors are associated with malpresentation? What are the fetal risks?

Answer 6

• True malpresentations are face and brow, transverse (shoulder presentation).
• Causes of face presentation: primary causes may be because the fetus is abnormal and anencephaly is common. Secondary causes of face: flat pelvis, poor uterine muscle tone, prematurity, polyhydramnios, or multiple pregnancy.
• Risks to fetus: obstructed labor, maternal perineal trauma, cord prolapse, facial bruising, cerebral hemmorrhage
• Causes of brow presentation: causes are the same for the face except for anencephaly .
• Risks to fetus: obstructed labor Causes of shoulder presentation: grand multiparity, lax uterine and abdominal muschles, placenta previa, multiple pregnancy, polyhydramnios, uterine abnormality, large uterine fibroid, or contracted pelvis. Risk to fetus: cord prolapse.

Question 7

67. When should a cephalic version be performed?

Answer 7

• Stables (573) reviewed studies says 37 weeks. I am assuming this question is asking “when in the pregnancy?”
• transverse or breech
• >34 weeks (to try to prevent reverting and premie)

Question 8

68. What are the risks of a cephalic version?

Answer 8

• Stables: (572): bleeding from the placental site, cord entanglement, causing fetal distress, converting the lie and presentation to an undeliverable one and initiating perterm labor
• Gabbe 405> cord compression, placental abruption, ROM, high c/s rate, fetomaternal hemorrhage (Rh neg unsensitized women should get Rhogam)

Question 9

69. What are the different types of breech presentation?

Answer 9

• Complete or flexed breech: thighs and knees are flexed. most common in multips. 10-15 %,
• extended or frank breech: fetal thighs are flexed and the legs extended at the knees. feet are near the head. Most common of breech presentations 45-50% of them. mostly in primigravids because of the firm uterine muscles
• **Footling presentation: ** one or both hips and knees are extended and the fee present below the buttocks. Rare and is mostly seen in preterm labor.
• Knee presentation:. Knee is present below the buttocks. rarest

Question 10

70. How do you know when you can begin to assist with the delivery of the head in a breech presentation? How do you prevent deflexion of the head?

Answer 10

• no handling is necessary and delivery should proceed spontaneously until the fetal umbilicus appears at introitus..
• The Mauriceau-Smellie-Veit maneuver is recommended for delivery of the head and these movements promote head flexion:
  
  • One of the practitioner’s hands should be placed above the fetus, with one finger inserted into the vagina and placed on the occiput and one finger on each of the fetal shoulders.
  • The other hand is placed beneath the fetus by placing a finger in the mouth or two fingers on the maxilla.
  • An assistant should follow the head abdominally and be prepared to apply suprapubic pressure to flex the head through the pelvis. The fetus may be draped on the practitioner’s lower arm