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Obstetrics > Obs Emergencies, IPV, Perinatal Loss > Flashcards

Obs Emergencies, IPV, Perinatal Loss Flashcards

1
Q

GBV and IPV rates _______ during pregnancy

A

Increase

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2
Q

___ of women >16 reported at least 1 incident of physical/sexual assault

A

51%

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3
Q

______ of women had been abused by their intimate partners

A

25%

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4
Q

Of Canadian women who reported being abused by their partner in pregnancy, 40% stated violence _________ during the pregnancy

A

Began

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5
Q

Indigenous females in Canada have been shown to have ______ the odds of being a victim of IPV (generally)I

A

4-5x

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6
Q

Impact of Domestic Violence on Pregnancy

A

§ Delayed/less PN care
§ Stress/depression
§ Financial effects
§ Inadequate weight gain
§ Substance use/abuse
§ Physical and sexual health complaints

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7
Q

Impact of domestic violence on fetus

A

Direct physical trauma causing injury or miscarriage
Negative effects of behaviours
Preterm labour/birth
Low birthweight/SGA

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8
Q

Impact of domestic violence on postnatal period

A
  • Decreased likelihood of breastfeeding
  • Maternal mental health issues associated with difficulties in parenting and mother-child bonding
  • Increased risk of aggression, emotional disorders, and hyperactivity in the child
  • Increased risk of child abuse, associated with risk-taking behaviours in adolescence and adulthood
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9
Q

Studies have found insufficient evidence that recommend ____ or _____ “routine” screening.

Providers should include queries about violence in the assessment of new patients at annual visits as part of prenatal care.

A

for or against

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10
Q

Several validated screening tools exist; however, the ___________________ and how questions are asked seem more important than the screening tool.

A

nature of the clinician–patient relationship

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11
Q

Ensure you have __________ with the client in case they need to speak in confidence
* In ______ or _______

A

time alone

shower/bathroom

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12
Q

Dystocia

A

Something not going as planned; difficult labour

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13
Q

What dystocias exist with powers/uterine contractions?

A

Hypotonic Contractions

Hypertonic Contraction

Arrested Labour (complete cessation)

Precipitious Labour (<3hr)

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14
Q

Risks associated with Precipitious labour

A

pelvic injury, trauma risk for fetus, doesn’t allow full dilation, potential for rupture and intracranial hemorrhage/hypoxia to fetus

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15
Q

Any presentation other than ______ or slight variation in fetal position or size increases probability of ________

A

occiput anterior

dystocia

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16
Q

What problems with the passenger cause dystocia?

A

Persistent Occiput Anterior

Cephalopelvic Disproportion

Breech

Shoulder Dystocia

Cord Prolapse

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17
Q

Breech presentation is associated with:

A

multiple gestation, grand parity, previa, hydramnios, preterm, uterine abnormalities

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18
Q

Breech presentation is most common in _____. Why?

A

Preterm

Lots of room to move around, nothing stressing fetus to get into that position

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19
Q

Frank Breech

A

50-70%

Feet up by ears

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20
Q

Footling Breech

A

Foot presents first

10-30%

Require C/S

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21
Q

Complete breech

A

Head up top in fundus

5-10%

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22
Q

Diagnosis of Breech

A
  1. maternal perception
  2. leopolds
  3. FH
  4. Vag exam
  5. Ultrasound
  6. Passage of Thick Meconium
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23
Q

Maternal Perception of Breech presentation

A
  • In cephalic/head down most movement is felt up top where feet are
  • If felt in lower abdomen, likely breech
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24
Q

Leopolds Maneuver of Breech Presentation

A
  • hard, ballotable part (head) in uterine fundus (top)
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25
Q

FH of Breech Presentation

A

auscutated above umbilicus
* pre-term or small fetus - may still be below umbilicus.

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26
Q

Vag exam of breech presentation

A

Not palpating fontanelles

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27
Q

Why is passage of meconium a diagnostic factor of breech?

A

If getting contractions on torso

28
Q

Fetal risks associated with breech

A
  1. cord prolapse
  2. traumatic injury
  3. preterm breech leading to entrapment
29
Q

Cord Prolapse as a risk for breech

A

more likely with ROM

r/t softer bum/ not hard head on cervix – cord has higher likelihood/easier for slipping down

30
Q

Traumatic injury as risk for breech

A

to the aftercoming head can cause

  1. intracranial hemorrhage
  2. anoxia
  3. congenital dislocated hips because they are used to that position
31
Q

How does entrapment happen in preterm breech?

A

Preterm breech – footling & body may deliver before full dilatation  entrapment

32
Q

Criteria for vaginal delivery of breech (6)

A
  1. uncomplicated
  2. term,
  3. frank or complete breech,
  4. singleton,
  5. > 2500 and <4000g
  6. with flexed head
33
Q

When is external cephalic version done?

A

Option if patient does not want C/S

Baby is manually turned externally

Best 34-37 weeks (risk baby flips himself back) or after 37 weeks (inducing)

34
Q

In external cephalic version, fetus cannot be

A

Engaged

35
Q

What medication is given prior to external cephalic version

A

Tocolytic to relax uterus (if done preterm)

36
Q

Risk for external cephalic version

A

Nuchal cord

37
Q

Indications for a C/S (10)

A
  1. non reassuring FHR
  2. herpes
  3. multiple gestation (>3)
  4. cord prolapse
  5. pelvic size
  6. lack of progression/failed induction
  7. maternal infection/severe disease
  8. previa
  9. vertical C/S incision
  10. fetal anomalies in size
38
Q

Intra-operative C/S risks

A
  • aspiration
  • difficult airway management
  • PPH (>1000 mls)
39
Q

Post op C/S risks

A
  • Endometritis/Infection
  • Hemorrhage
  • Poor bladder emptying
  • Paralytic ileus (rare)
  • Thrombophlebitis
40
Q

use of ranitidine or sodium citrate pre C/S

A

Patient’s may not have been NPO if urgent but need to decrease acidity of gastric acid

41
Q

TOLAC depends on what 2 things

A
  • Indication and type of 1st section
  • Maternal health
42
Q

Most common risks for TOLAC

A

Hemorrhage

Uterine rupture - Complete separation of the myometrium with/without extrusion of fetal parts into the maternal peritoneal cavity

Infant death or neurological complications

43
Q

5 Key Management pieces for TOLAC

A
  1. continuous EFM
  2. contraction monitoring
  3. Avoid oxytocin (rupture)
  4. Avoid cervical ripening methods (rupture)
  5. c/s available
44
Q

Uterine rupture

A

Most serious complication of TOLAC

Complete separation of the myometrium with/ without extrusion of fetal parts into the maternal peritoneal cavity usually at scar

45
Q

Signs of Uterine Rupture

A
  1. First sign: abnormal FHR (specifically if patient has epidural)
  2. vaginal bleeding/hematuria
  3. maternal hypovolemic shock
  4. Abdominal palpation of fetal parts
  5. unexpected elevation of presenting part
  6. chest/shoulder pain/sudden SOB (bleeding into cavity displacing organs)
46
Q

How can operative vaginal birth be prevented?

A

Support through early labour

  • mobility
  • position changes
  • rest
  • bladder empty
  • well hydrated/nourished
46
Q

Indications for operative vaginal birth

A

Any need to expedite 2nd stage

  • FHR indications
  • maternal exhaustion/inability to push
  • lack of rotation of fetal head/largest diameter won’t line up
  • maternal CAD
47
Q

Important considerations in operative vaginal birth?

A
  1. Completely dilated / membranes ruptured
  2. Empty bladder
  3. Fetal position known / adequate pelvis
  4. Analgesia if able
  5. What is the plan if it doesn’t work?
    § OR availability
48
Q

When can you expect progression using vacuum?

A

Suction applied to fetal head (occiput – not over fontanelles)

Pull with contractions

Should be progressive descent with first two pulls (with contractions – should only be 3 pulls)

49
Q

Common newborn vacuum complications

A

Bruising, laceration, edema (caput)

50
Q

Uncommon operative vaginal birth complications for newborn (7)

A
  • Retinal hemorrhages
  • Nerve injury
  • Cephalhematoma (vacuum)
  • Cerebral hemorrhage
  • Skull fracture (forceps)
  • Intracranial bleeding
  • Subgaleal hemorrhage (vacuum)
51
Q

What should you be assessing a newborn for after use of operative vaginal delivery tools?

A

hyperbilirubinemia

  • Extra blood and RBC destruction
  • Already at risk – given extra load r/t bruising/hemorrhage
52
Q

Complications of operative vaginal delivery for labouring client

A
  • Genital tract trauma
  • Increased bleeding
  • Risk for PPH
  • Bruising and edema
  • ? Shoulder dystocia
  • Without descent in first couple pulls, shoulder dystocia could be cause
53
Q

Shoulder dystocia definition

A

Anterior shoulder impacts against maternal symphysis pubis.

  • Fetal shoulders do not deliver spontaneously
  • Failure to deliver with expulsive effort & usual maneuvers
54
Q

Major risk factors for Shoulder Dystocia

A
  • maternal obesity/diabetes
  • macrosomic infant
55
Q

Interventions for Shoulder Dystocia

A

A - ask for help

L - lift/hyperflex legs with stools (McRoberts)

A - anterior should disimpaction (suprapubic pressure)

R - rotate posterior shoulder

M - manual removal/delivery of posterior arm

E - episiotomy

R - roll over onto all 4’s

56
Q

McRobert’s Manoevre

A

Lift / hyperflex legs with stools

Pelvis tilts, orienting symphysis more horizontally to facilitate shoulder delivery

57
Q

Suprapubic pressure

A

NOT fundal pressure

Lateral pressure above symphysis in direction of fetal nose to bring shoulders closer together

Protect your back (foot stool and get on bed)

Support/inform patient and support person

58
Q

Complications of Shoulder Dystocia to client

A

§ Episiotomy
§ Extended Lacerations
§ Hematomas
§ Uterine atony
§ Hemorrhage
§ Bladder Injury
§ Rectal Injury

59
Q

Fetal complications of shoulder dystocia

A

§ Fracture of clavicle or humerus
§ Brachial plexus injury or spinal nerve damage
§ Erb’s palsy
§ Asphyxia
§ Death

60
Q

How is cord prolapse detected?

A

Sudden, severe, variable decelerations or no fetal heart

Feel or see cord
* Or not…. May not have protruded all the way out of vagina

61
Q

Causes/Increase Risk for Cord Prolapse

A
  1. polyhydraminos
  2. long cord
  3. malpresentation
  4. PROM
  5. amniotomy before engaged vertex
62
Q

Why is polyhydraminos a risk for cord prolapse?

A

Fetus and cord floating around, come down together and cord wins

63
Q

Why is malpresentation a risk for cord prolapse?

A

Head isn’t blocking opening

64
Q

What precaution is taken to assure cord prolapse isn’t occuring and why?

A

Immediately after ROM - displacement of fluid - CHECK FHR - if normal lack of risk of prolapse

65
Q

Why is cord prolapse bad/emergency

A

Cord = only way baby gets oxygen - prolapse completely cuts of oxygen source

66
Q

Management of cord prolapse

A

Keeping pressure off of cord!

  • trendelnburg/knee to chest position
  • keep gloved hand in vagina to prevent compression
  • decrease contractions (C/S coming - don’t need)
  • warm, wet sterile cloth if outside vagina
  • only VD if fully dilated (often C/S)

Obstetrics (12 decks)

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