Obstetric Complications Flashcards
What should you do for latent phase arrest (prodromal labor)?
Expectant management if no indication to deliver
What is hypertonic dysfunction/ what do you do for it?
High frequency low amplitude contractions with significant maternal discomfort
Therapeutic rest (morphine sleep)
What are the two active phase disorders?
Protraction disorders
Arrest disorders
What is protraction of the active phase of labor in a nullipara and multipara?
What is arrest of active phase?
Cessation of previously normal active phase dilation for >2 hours
What can cause active phase disorders?
Inadequate ctx
Malpresentation
CPD
How many MVU’s are needed in a 10 minute period to be considered adequate ?
200-250
What is considered protraction of second stage for a nullipara/multipara?
Nullipara
How long can second stage take as long as the fetus is tolerating labor for a nullipara/multipara?
Nullipara- 2hrs without anesthesia, 3 with
Multipara- 1 hr without anesthesia, 2 with
How long does third stage normally last?
10 minutes
When is it considered a retained placenta?
If placenta not delivered by 30 minutes
*risk of hemorrhage inc proportionally to time
What is expectant management of third stage?
No early cord clamping, no cord traction, no oxytocin
What does dystocia mean/what three things can cause it?
Abnormal labor
Powers
Passenger
Passageway
What is active management of third stage?
Early cord clamping, controlled cord traction, oxytocin
What is considered precipitous labor?
Delivery
What can be associated with precipitous labor?
Tachysystole, cocaine use, abruption
A shoulder dystocia occurs when head to delivery time is > ___
One minute OR use of ancillary measures to deliver
What are risk factors for a shoulder dystocia?
AMA Inc gest age DM obesity Prior shoulder dystocia Prior infant >4500grams Dystocia Operative vaginal delivery Large paternal birth weight Hispanic Male fetus Positive 50g screen with neg 3hr GTT macrosomia (>4000grams, inc abdominal circumference)
What is a sign of shoulder dystocia?
Turtle sign
Failure to achieve external rotation
What are fetal complications of a shoulder dystocia?
Asphyxia and/or acidosis
Brachial plexus injuries (erbs/klumpkes palsy)
Fractured humerus or clavicle
Fetal death
What are maternal complications of a shoulder dystocia?
Bladder injury Cervical/vaginal/perineal lacs Hematoma Separation of symphysis Uterine rupture Pp hemorrhage Infection
What is a normal amniotic fluid volume?
1000ml at 36wks, then slowly decreases
What is oligohydramnios?
AFI
What is polyhydramnios?
AFI >24cm at term
Associated with CNS or GI anomalies or maternal diabetes
Can cause preterm labor (uterine distention)
Can do amnioreduction
How can hypoxia cause meconium stained fluid?
Hypoxia results in fetal vagal response
What is PROM? What is active vs expectant management with PROM?
SROM >1hr prior to start of labor
Active- induction
Expectant- can delay induction 96 hours
What is PPROM?
SROM prior to 37 wks
Antibiotics and glucocorticoid for 24-34 wks
What is anaphylactoid syndrome of pregnancy?
“Amniotic fluid embolism”
Amniotic fluid/debris enter maternal circulation
Massive anaphylactic response
Two phases:
Acute cardiorespiratory collapse
Hemorrhagic phase/DIC
mortality 80%
Most pts die within one hour
What is placenta previa?
Placenta covers cervical os
Marginal- edge of placenta within 2-3cm
Bright red painless bleeding
Cesarean delivery
What are the risk factors for a placenta previa?
AMA prior uterine surgery Fibroids or other uterine abnormalities Cigarette smoking Multiple gestational Multiparity
What is abruptio placentae?
Detachment of placenta from uterine wall
Bleeding with pain
Bleeding may be concealed
Ultrasound may not be reliable
Rigid, tender abdomen
Risk of DIC
fetal tachycardia, bradycardia, absent variability, late decels, sinusoidal
What is vasa previa?
Fetal vessels over cervical os
Extremely dangerous
ROM or dilation and rupture vessels
What happens if the decidua basalis fails to control trophoblast invasion beyond the endometrium?
Placenta accrete
What is placenta accreta vera?
Chorionic villi attach to myometrium but do not invade muscle tissue
May be able to manually remove
What is placenta increta?
Chorionic villi invade INTO myometrium
Cannot be removed
What is placenta percreta?
Chorionic Villi invade THROUGH myometrium and penetrate uterine serosa (perimetrium)
May invade surrounding tissue/organs
What is the most significant risk factor for placenta accreta?
Prior cesarean section(s)
What are the risks after 40 wks gestation?
Oligo, macrosomia, meconium, IUFGR
What are the main causes of preterm delivery?
50% idiopathic- unknown
30% underlying infectious processes
20% iatrogenic- elective for complications
What do you need to know about fetal fibronectin? (fFN)
Glycoproteins found in plasma Done between 24-34wks Collected from posterior vaginal fornix High negative predictive value Poor positive predictive value Not valid within 24 hrs of intercourse/sve
What cervical length is associated with PTL?
What are the four classes of tocolytics?
Sympathimimetics: terbutaline
Magnesium sulfate
Calcium channel blockers: nifedipine
NSAIDS: indomethacin
How do glucocorticoids work?
Stimulates the synthesis of fetal proteins and peptides
Stimulated synthesis of surfactant
Promotes maturation of germinal matrix which reduces occurrence of intraventricular hemorrhage
What are monozygotic twins?
Come from same egg
Identical
Can share placenta and/or amnion
What are dizygotic twins?
Come from two eggs
Not identical
Always have separate placentas and amnions
What is twin-to-twin transfusion syndrome?
Blood supply of monochrorionic twins become connected- they share a blood supply
Donor twin- smaller, pale, anemic, dehydrated
Recipient twin- larger, red, too much blood, inc blood pressure, may develop cardiac failure
What is a big concern with mono/mono twins?
Becomes easy for twins to become entangled in each other’s cords
Entanglement may cause one twin to become stuck in birth canal
What is active management of third stage?
Early cord clamping, controlled cord traction, oxytocin
What is considered precipitous labor?
Delivery
What can be associated with precipitous labor?
Tachysystole, cocaine use, abruption
A shoulder dystocia occurs when head to delivery time is > ___
One minute OR use of ancillary measures to deliver
What are risk factors for a shoulder dystocia?
AMA Inc gest age DM obesity Prior shoulder dystocia Prior infant >4500grams Dystocia Operative vaginal delivery Large paternal birth weight Hispanic Male fetus Positive 50g screen with neg 3hr GTT macrosomia (>4000grams, inc abdominal circumference)
What is a sign of shoulder dystocia?
Turtle sign
Failure to achieve external rotation
What are fetal complications of a shoulder dystocia?
Asphyxia and/or acidosis
Brachial plexus injuries (erbs/klumpkes palsy)
Fractured humerus or clavicle
Fetal death
What are maternal complications of a shoulder dystocia?
Bladder injury Cervical/vaginal/perineal lacs Hematoma Separation of symphysis Uterine rupture Pp hemorrhage Infection
What is a normal amniotic fluid volume?
1000ml at 36wks, then slowly decreases
What is oligohydramnios?
AFI
What is polyhydramnios?
AFI >24cm at term
Associated with CNS or GI anomalies or maternal diabetes
Can cause preterm labor (uterine distention)
Can do amnioreduction
How can hypoxia cause meconium stained fluid?
Hypoxia results in fetal vagal response
What is PROM? What is active vs expectant management with PROM?
SROM >1hr prior to start of labor
Active- induction
Expectant- can delay induction 96 hours
What is PPROM?
SROM prior to 37 wks
Antibiotics and glucocorticoid for 24-34 wks
What is anaphylactoid syndrome of pregnancy?
“Amniotic fluid embolism”
Amniotic fluid/debris enter maternal circulation
Massive anaphylactic response
Two phases:
Acute cardiorespiratory collapse
Hemorrhagic phase/DIC
mortality 80%
Most pts die within one hour
What is placenta previa?
Placenta covers cervical os
Marginal- edge of placenta within 2-3cm
Bright red painless bleeding
Cesarean delivery
What are the risk factors for a placenta previa?
AMA prior uterine surgery Fibroids or other uterine abnormalities Cigarette smoking Multiple gestational Multiparity
What is abruptio placentae?
Detachment of placenta from uterine wall
Bleeding with pain
Bleeding may be concealed
Ultrasound may not be reliable
Rigid, tender abdomen
Risk of DIC
fetal tachycardia, bradycardia, absent variability, late decels, sinusoidal
What is vasa previa?
Fetal vessels over cervical os
Extremely dangerous
ROM or dilation and rupture vessels
What happens if the decidua basalis fails to control trophoblast invasion beyond the endometrium?
Placenta accrete
What is placenta accreta vera?
Chorionic villi attach to myometrium but do not invade muscle tissue
May be able to manually remove
What is placenta increta?
Chorionic villi invade INTO myometrium
Cannot be removed
What is placenta percreta?
Chorionic Villi invade THROUGH myometrium and penetrate uterine serosa (perimetrium)
May invade surrounding tissue/organs
What is the most significant risk factor for placenta accreta?
Prior cesarean section(s)
What are the risks after 40 wks gestation?
Oligo, macrosomia, meconium, IUFGR
What are the main causes of preterm delivery?
50% idiopathic- unknown
30% underlying infectious processes
20% iatrogenic- elective for complications
What do you need to know about fetal fibronectin? (fFN)
Glycoproteins found in plasma Done between 24-34wks Collected from posterior vaginal fornix High negative predictive value Poor positive predictive value Not valid within 24 hrs of intercourse/sve
What cervical length is associated with PTL?
What are the four classes of tocolytics?
Sympathimimetics: terbutaline
Magnesium sulfate
Calcium channel blockers: nifedipine
NSAIDS: indomethacin
How do glucocorticoids work?
Stimulates the synthesis of fetal proteins and peptides
Stimulated synthesis of surfactant
Promotes maturation of germinal matrix which reduces occurrence of intraventricular hemorrhage
What are monozygotic twins?
Come from same egg
Identical
Can share placenta and/or amnion
What are dizygotic twins?
Come from two eggs
Not identical
Always have separate placentas and amnions
What is twin-to-twin transfusion syndrome?
Blood supply of monochrorionic twins become connected- they share a blood supply
Donor twin- smaller, pale, anemic, dehydrated
Recipient twin- larger, red, too much blood, inc blood pressure, may develop cardiac failure
What is a big concern with mono/mono twins?
Becomes easy for twins to become entangled in each other’s cords
Entanglement may cause one twin to become stuck in birth canal
