Obstetric Flashcards
Indications for continuous EFM
Significant meconium staining of the amniotic fluid.
Abnormal FHR detected by intermittent auscultation.
Maternal pyrexia (temperature ≥38.0°C or ≥37.5°C on two occasions). Fresh vaginal bleeding.
Augmentation of contractions with an oxytocin infusion.
Maternal request.
Active management of the third stage
Intramuscular injection of 10 IU oxytocin, given as the anterior shoulder of the baby is delivered, or immediately after delivery of the baby.
Early clamping and cutting of the umbilical cord.
Controlled cord traction
Signs of placental separation
Apparent lengthening of the cord.
A small gush of blood from the placental bed.
Rising of the uterine fundus to above the umbilicus
Uterine contraction resulting in firm globular feel on palpation.
Findings suggestive of CPD
Fetal head is not engaged.
Progress is slow or arrests despite efficient uterine
contractions. Vaginal examination shows severe moulding and caput formation.
Head is poorly applied to the cervix.
Haematuria.
Risk factors for fetal compromise in labour
Placental insufficiency – FGR and pre-eclampsia. Prematurity.
Postmaturity.
Multiple pregnancy.
Prolonged labour.
Augmentation with oxytocin/hyperstimulation.
Precipitate labour.
Intrapartum abruption.
Cord prolapse.
Uterine rupture/dehiscence. Maternal diabetes.
Cholestasis of pregnancy. Maternal pyrexia/chorioamnionitis. Oligohydramnios.
Side-effects of opioid analgesia
Nausea and vomiting (they should always been given with an antiemetic).
Maternal drowsiness and sedation.
Delayed gastric emptying (increasing the risks of general anaesthesia).
Short-term respiratory depression of the baby.
Possible interference with breastfeeding.
Indications of epidural analgesia
Prolonged labour/oxytocin augmentation.
Maternal hypertensive disorders.
Multiple pregnancy.
Selected maternal medical conditions.
A high risk of operative intervention.
contraindications for epidural analgesia
Coagulation disorders (e.g. low platelet count).
Local or systemic sepsis.
Hypovolaemia.
Logistical: insufficient numbers of trained staff (anaesthetic and midwifery).
Signs of uterine rupture
Sever lower abdominal pain
vaginal bleeding
haematuria
cessation of contractions
maternal tachycardia
Fetal compromise (often a bradycardia
Relative contraindications to VBAC
Two or more previous caesarean section scars.
Need for induction of labour (IOL).
Previous labour outcome suggestive of CPD.
Previous classical caesarean section is an absolute contraindication.
Indications for induction of labour
Prolonged pregnancy (usually offered after 41 completed weeks). PROM.
Pre-eclampsia and other maternal hypertensive disorders.
FGR.
Diabetes mellitus.
Fetal macrosomia.
Deteriorating maternal illness.
Unexplained antepartum haemorrhage.
Twin pregnancy continuing beyond 38 weeks.
Intrahepatic cholestasis of pregnancy.
Maternal isoimmunization against red cell antigens.
‘Social’ reasons.
Breech allowed to deliver virginally when
No other complication
Estimated Fetal size between 2.5 - 3.5 kg
A dequate pelvis
Complications of breech delivery
ROM
cord prolapse
Asphyxia
Infection
Marked molding
Maternal distress
Obstructed labour
Prolong and complicated labour
Indication of C.S in breech presentation
Large fetus
Fetal hypoxia
Unfavorable shape of pelvis
Uterind dysfunction
Previous history of perinatal death of children
Risks of external version
fetal bone
Preciptation of labour
PROM
placenta abruption
Fetomaternal hemorrhage
Cord entanglement
Factors cause cord prolapse
Abnormal lie or presentation (transverse lie, breech) • .Multiple pregnancy • .
Polyhydramnios • .
Prematurity • .
High head •
Unusually long umbilical cord •
Maternal causes Pelvic tumours(e.g. fibroids in the lower segment) Narrow pelvis
Etiology of Placenta Previa
Advancing maternal age ◼ Multiparity ◼ Multifetal gestations ◼ Prior cesarean delivery ◼ Smoking ◼ Prior placenta previa
Risk Factors: of Vasa previa
◼ Bilobed and succenturiate placentas
◼ Velamentous insertion of the
cord
◼ Low-lying placenta
◼ Multiple gestation
◼ Pregnancies resulting from in
vitro fertilization
◼ Palpable vessel on vaginal exam
Risk factor of retained placenta
Previous retained placenta
Prior CS/curettage
Uterine infection
Multiparity
Prior placenta previa
Causes of uterine inversion
Excessive traction on cord
Uterine atony
Fundal pressure
Risk factors of uterine rupture
Prior CS
Parity >4
Hyperstimulation of uterus with oxytocin
Instrumented delivery
Trauma
Prior uterine surgery
Epidural anaesthesia
Placenta abruptio
Breech version
Signs of Uterine Rupture before delivery
Vaginal bleeding.
● Abdominal tenderness.
● Maternal tachycardia.
● Abnormal fetal heart rate tracing.
● Cessation of uterine contractions
Signs of Uterine Rupture after delivery
Hypotension more than expected with apparent blood loss.
● Increased abdominal girth.
مواصفات suture مال birth trauma
Initial suture above the apex of laceration to control retracted arteries
The advantages of the midline episiotomy are:
• less blood loss.
• it is easier to repair.
• the wound heals quicker.
• there is less pain in the postpartum period.
• the incidence of dyspareunia is reduced.
