Objectives 71- to end

Question 1

71. Why is a nonflexed head in latent phase of labor a concern?

Answer 1

• Associated with more painful, prolonged and obstructed labor and difficult delivery. Head needs to flex for labor to proceed normally.
• If head remains deflexed, problems arise. Engaging diameter is the occipitofrontal (11.5 cm) Early ROM may occur with a non-engaged head. Risk of cord prolapse.

Question 2

72. How does one deliver a face presentation? Where does the mentum need to be in order for there to be a successful vaginal birth?

Answer 2

• In mentoanterior position if contractions are good, labor can progress to spontaneous delivery.
• In the second stage, when the face appears at the vulva, the sinciput (forehead) must be held back to permit extension. This allows the mentum to escape under the pubic arch before the occiput sweeps the perineum. This allows the smallest possible diameter, which is the submentovertical (11.5 cm) distend the vaginal orifice

Question 3

73. What would you note on exam with a brow presentation? Is this presentation able to deliver vaginally?

Answer 3

• Brow partially deflexed cephalic attitude midway between full flexion and full extension
• the frontal bones are the point of designation> document frontum anterior (most common position at diagnosis)
• most brows convert to either vertex or face & then managed accordingly
• fewer than 50% with persistent brow presentation will SVD, trial of labor is not contraindicated

Question 4

74. What is required immediately post SROM? Note fetal bradycardia, what then? Note prolapsed cord, what then?

Answer 4

1. HELP
2. Lift the presenting part off the cord
3. leave the cord alone- excessive manipulation can cause it to spasm
4. knee chest / Trendelenburg
5. Get into the OR riding on bed with the patient with your hand supporting baby off of cord

Question 5

75. What mechanisms if note compound presentation of hand? Gabbe, 395

(let it resolve on its own)

Answer 5

• The combination of an upper extremity and the vertex is the most common
• Determined by: arrest of labor in the active phase or failure to engage during active labor
• Diagnosis is made by vaginal examination by discovery of an irregular mobile tissue mass adjacent to the larger presenting part
  
  • A simple compound presentation(e.g., hand) may be allowed to labor if progressing normally with reassuring fetal status
  • • prolapsed extremity should not be manipulated. The accompanying extremity may retract as the major presenting part descends
  • • 75% of vertex/upper extremity combinations deliver spontaneously
  • Occult or undetected cord prolapse is possible, and, therefore, continuous electronic FHR monitoring is recommended

Question 6

76. Risks/benefits of a VBAC?

Answer 6

risks or rupture related to;

• type of uterine scar
• o number of prior cesarean deliveries
• prior vaginal delivery
• interdelivery interval
• uterine closure technique
• benefit: <1% have rupture
• ever C/S increase risk of placental attachemnt problem (acreta)
• no difference in pelvic floor dysfuction
• prior vaginal birth decreases risk of uterine rupture