Passenger Flashcards
1
Q
where the long axis of the fetus is not lying along the long axis of the mother’s uterus.
A
abnormal lie
2
Q
3 types of abnormal lie: TOU
A
transverse
oblique
unstable
3
Q
what lie is normal?
A
longitudinal lie
4
Q
two examples of longitudinal lie
A
cephalic and breech
5
Q
where the fetus is lying longitudinally and the vertex is presenting, but not in occiput anterior (OA) position.
A
malposition
6
Q
two types of malposition
A
occiput posterior (OP)
occiput transverse (OT)
7
Q
a malposition of vertex presentation.
A
occiput posterior
8
Q
arrested labor may occur when head does not rotate and/or descend.
A
occiput posterior
9
Q
_ may occur when head does not rotate and/or descend during OP.
A
arrest labor
10
Q
delivery maybe complicated by perineal tears or extension of an episiotomy.
A
occiput posterior
11
Q
OP delivery maybe complicated by _ or _.
A
perineal tears
extension of an episiotomy
12
Q
is the incomplete rotation of occiput posterior to occiput anterior, which results in a horizontal or transverse position of the fetal head.
A
occiput transverse
13
Q
5 factors that favor malpositioning: PAAPA
A
pendulous abdomen – in multiparae
anthropoid pelvic brim – favors direct OP/OA
android pelvic brim
placenta on the anterior uterine wall
absent sacral curve/flat sacrum – transverse position
14
Q
what stage is prolonged if malposition is present? and how many hours does it take?
A
second stage of labor
more than 2 hours
15
Q
abd exam of malposition: lower part of the abd is _
A
flattened
16
Q
abd exam of malposition: difficult to palpate _
A
fetal back
17
Q
abd exam of malposition: fetal small parts are palpable _
A
anteriorly
18
Q
abd exam of malposition: FHT may be heard in the _
A
flanks
19
Q
vaginal exam of malposition: posterior fontanel is towards the _ (difficult)
A
sacral-iliac joint
20
Q
vaginal exam of malposition: anterior fontanel is easily felt, if head is _
A
deflexed
21
Q
vaginal exam of malposition: fetal head may be markedly molded with _, making it more difficult to diagnose the correct station and position.
A
extensive caput
22
Q
from OP, spontaneous rotation to occiput anterior occurs in _ of cases.
A
90%
23
Q
from OP, spontaneous rotation to occiput anterior occurs in 90% of cases. especially if (3): SGA
A
spacious pelvis
good uterine contraction
average size fetus
24
Q
if arrest of labor occurs in the second stage in malpositioned pregnancy, _.
A
emergency CS
25
where the fetus is lying longitudinally, but presents in any manner other than vertex.
malpresentation
26
5 types of malpresentation
breech
brow
face
shoulder
compound
27
3 types of vertex presentation
brow
face
sincipal
28
most uncommon of all presentation
brow
29
babies born vaginally from brow presentation experience _
extreme facial edema
30
on abd ass of brow pres: more than half of fetal head is _ the symphisis pubis and occiput is palpable at a higher level than the _.
more than half of fetal head is **above** the symphisis pubis and occiput is palpable at a higher level than the **sinciput**
31
on vag exam of brow pres: the _ and the _ are felt.
anterior fontanel
orbits
32
brow presentation management
CS only
33
occurs when head is hyper-extended, the face is the presenting part, the chin (mentum) is the denominator.
face presentation
34
what is the denominator in face pres?
chin (mentum)
35
mechanism of labor in face pres: DIFEEE
descent
internal rotation
flexion
extension
external rotation
expulsion
36
5 causes of face pres due to maternal: LCPMO lazy cats play more often
lax uterus
contracted pelvis / CPD
placenta previa
multiple pregnancy
occiput posterior
37
5 causes of face pres due to fetal: LCMMT large cute monkeys make trouble
large fetus
congenital malformation / anencephaly
multiple cord coil
musculoskeletal abnormality (spasm /
shortening of extensor muscle of neck)
tumors around the neck (congenital goiter)
38
2 musculoskeletal abnormalities in fetus that may cause face pres
spasm
shortening of extensor muscle of neck
39
fetal causes of face pres that manifests as tumors around the neck
congenital goiter
40
3 signs and symptoms of face pres
absence of engagement occurs
on IE, the examining fingers feel the mouth, nose, malar bones, and orbital ridges
UTZ confirms the diagnosis
41
upon IE, the examiner feels (4) during face pres
mouth
nose
malar bones
orbital ridges
42
conditions for possible vaginal delivery during face pres (5): LSSSN
LMA/RMA
strong uterine contractions
small head
shoulders in the pelvis
no pelvic contraction
43
what can we use to hasten 2nd stage of labor during face pres?
forceps
44
for face pres, vaginal delivery is impossible and dangerous if _, because it may lead to transverse arrest -> CS.
RMP/LMP
chin posterior
45
for face pres, vaginal delivery is impossible and dangerous if chin posterior because it may lead to _; hence, CS.
transverse arrest
46
occurs when the larger diameter of the fetal head is presented.
sincipal presentation
47
labor progress is slowed with slower descent of the fetal head.
sincipal presentation
48
flexed vertex pres
suboccipitobregmatic
49
suboccipitobregmatic diameter
9.5 cm
50
partially deflexed vertex
suboccipitofrontal
51
suboccipitofrontal diameter
10.5 cm
52
deflexed vertex
occipitofrontal
53
occipitofrontal diameter
11.5 cm
54
brow
mentovertical
55
mentovertical diameter
13 cm
56
face
submentobregmatic
57
submentobregmatic diameter
9.5 cm
58
most common cause of fetal malpresentation.
breech presentation
59
4 types of breech
frank breech
complete breech
footling (double or single) breech
kneeling breech
60
type of breech presentation where buttocks comes first, and hips are flexed, knees are extended.
frank breech
61
type of breech presentation where buttocks comes first, hips and knees are flexed.
complete breech
62
type of breech presentation where 1 or both feet come first, rare in term, common in premature.
footling (double or single) breech
63
type of breech presentation where 1 or both legs extended at the hips & flexed at the knees. extremely rare
kneeling breech
64
abd exam for breech, when LP #1 (fundal grip) is done, where is the head felt?
fundus
65
auscultation for breech, when LP #2 (lateral grip) is done, where should FHT be heard?
upper quadrant of the abd
66
upon vaginal exam of breech, what are the findings? (2)
buttocks and feet felt
thick dark meconium stain
67
maternal etiology of breech (7)
polyhydramnios
oligohydramnios
uterine abnormalities
pelvic tumor
uterine surgery
contracted pelvis
previous breech delivery
68
fetal etiology of breech (5)
prematurity
multiple pregnancy
fetal anomalies
• hydrocephalus
• anencephaly
69
placental etiology of breech (1)
placenta previa
70
complications of breech (6): PBDMIF please bring down my ill fetus
prolapse cord
birth trauma
dysfunctional and prolonged labor
meconium aspiration
intrauterine anoxia
fetal death
71
complication of breech: presenting part does not fit well enough into the pelvic brim.
prolapse cord
72
birth trauma is a complication of breech, which includes (3): FIR
fracture of the skull, clavicle, humerus
intracranial hemorrhage
rupture of abd organs
73
complications in breech: soft buttocks does not aid in cervical dilatation.
dysfunctional and prolonged labor
74
complications in breech: pressure on abdomen and buttocks can force passage of meconium into the amniotic fluid before birth.
meconium aspiration
75
to confirm breech, at what month is UTZ done?
at or after 36 weeks
76
ECV
external cephalic version
77
when should we attempt ECV for breech?
at or after 37 weeks
78
for breech and ECV is done, vaginal delivery is possible if ff. are not present (8): FPUPHMO fancy princesses usually pick high-maintenance outfits
fetal abnormality
placenta previa
uterine bleeding
previous uterine surgery
hypertension
multiple gestation
oli or polyhydramnios
79
risks of ECV in breech (5): PPCTF please protect cute tiny fetuses
placental abruption
PROM
cord accident
transplacental hemorrhage
fetal bradycardia
80
vaginal breech delivery may be attempted if (5)
• there is **no pelvic contraction**
• fetal weight is **not more than 3,500 grams**
• there is **experienced/skilled personnel** in breech delivery
• spontaneous labor occurs with **progressive cervical dilatation**
• **no feto-pelvic disproportion**
81
principle for breech delivery
masterly inactivity (hand-off)
82
t/f: during breech delivery, never pull from below, let the mother expel the fetus by her own effort with uterine
contractions.
t
83
during breech delivery, always keep the fetus with its back _.
anterior
84
keep a pair of _ ready if necessary to assist the coming head in breech delivery.
obstetric forceps
85
_ and _ should attend the delivery for breech.
anesthetist
pediatrician
86
3 general techniques of vaginal breech delivery
spontaneous breech delivery
partial breech extraction
total breech extraction
87
breech delivery born without traction or manipulation from OB
spontaneous breech delivery
88
breech delivery born up to the umbilicus; rest of the body is extracted
partial breech extraction
89
breech delivery entire body is extracted by OB
total breech extraction
90
7 different maneuvers for breech delivery
pinard’s
loveset maneuver
mauriceau-smellie-veit maneuver (jaw flexion and shoulder traction)
prague maneuver
bracht maneuver
abdominal rescue
cleidotomy
91
jaw flexion and shoulder traction
mauriceau-smellie-veit maneuver
92
maneuver that is done in breech with extended leg
pinard’s
93
in pinard’s, once the groin is visible, gentle pressure can be applied to _ the thigh and reach the knee
abduct
94
in pinard’s, the knee can be flexed with pressure in the _ & _
popliteal fossa
leg
95
in pinard’s, what leg is delivered first?
anterior leg
96
maneuver that automatically corrects any upward displacement of arms
loveset maneuver
97
loveset maneuver
baby’s trunk is rotated with _ traction, holding at the _ so that posterior shoulder comes _ the symphysis pubis, arm is delivered by _ the shoulder followed by hooking at the elbow and flexing it, followed by bringing down the forearm like a “_”.
baby’s trunk is rotated with **downward** traction, holding at the **iliac crest** so that posterior shoulder comes **above** the symphysis pubis, arm is delivered by **flexing** the shoulder followed by hooking at the elbow and flexing it, followed by bringing down the forearm like a “**hand shake**”.
98
loveset maneuver
same procedure is repeated by reverse rotation of _ so that anterior shoulder comes _ the symphysis pubis.
180 degrees
below
99
loveset maneuver
anterior shoulder to the SP: _
posterior shoulder to the SP: _
below
above
100
maneuver that is used to extract the head after delivery of infant’s body
mauriceau-smellie-veit maneuver
101
MSV maneuver
baby is rested on obstetrician’s _ hand, with limbs hanging on either side.
supinated
non-dominant
102
MSV maneuver
non-dominant index and middle finger placed on the _.
dominant index and ring finger placed on the _.
dominant middle finger placed on the _.
malar bone
shoulders
sub-occipital region
103
MSV maneuver
to achieve flexion, traction is given in _ and _ direction and
simultaneous _ is maintained by the assistant until nape is visible.
upward
downward
suprapubic pressure
104
MSV maneuver
baby is pulled _ and _ direction so that face is born, and by _ the head is born.
upward
forward
depress the trunk
105
maneuver used when the back of the fetus fails to rotate to the anterior.
prague maneuver
106
prague maneuver
what does the two hands do during this?
one hand **delivers the shoulder** while the other **exerts pressure above the symphysis pubis**.
107
delivery by extension of the legs and trunk of the fetus over the symphysis pubis and abd of the mother.
bracht maneuver
108
maneuver where the fetal head is born spontaneously as the legs and trunk are lifted above the maternal pelvis, and as the body of the infant is extended by the operator.
bracht maneuver
109
maneuver where fetus is replaced when fully deflexed head is entrapped and cannot be delivered vaginally. CS follows.
abdominal rescue
110
involves cutting of shoulder to facilitate delivery. also used in shoulder dystocia.
cleidotomy
111
management for breech delivery: monitor progress of labor (5) CEDSP
contractions
effacement
dilatation
station
presentation
112
management for breech pregnancy: assessment of fetal condition through UTZ to determine abnormalities like (3) HAM
hydrocephaly
anencephaly
microcephaly
113
occurs when fetus assumes a transverse or oblique lie.
shoulder presentation
114
the fetus does not engage in this presentation so there is a great danger of cord prolapsed after membranes have ruptured.
shoulder presentation
115
causes of shoulder presentation (6): LCFPPM lazy cats find precarious positions messy
lax uterine and abdominal muscles
contracted pelvis
fibroids and congenital abnormality of the uterus
preterm fetus, hydrocephalus
placenta previa
multiple pregnancy
116
signs of shoulder presentation: uterus is more _ than vertical.
horizontal
117
signs of shoulder presentation: LP, the _ and _ occupy the sides of the uterus.
fetal head
buttocks
118
management for shoulder presentation before labor
external version
119
if EV does not work for shoulder presentation, what is next?
CS
120
a fetal presentation in which an extremity presents alongside the part of the fetus closest to the birth canal. the majority of it consist of a fetal hand or arm presenting with the vertex.
compound presentation
121
management for compound pres: observed closely to ascertain whether the arm _ out of the way with descent of the presenting part
retracts
122
management for compound pres: if it fails and appears to prevent descent of the head, prolapsed arm should be pushed gently _ and the head simultaneously _ by _.
if it fails and appears to prevent descent of the head, prolapsed arm should be pushed gently **upward** and the head simultaneously **downward** by **fundal pressure**.
123
table: management for breech
vaginal delivery if ECV was done
CS
124
table: management for face
vaginal delivery (chin anterior)
CS (chin posterior)
125
table: management for brow
CS
126
table: management for shoulder
CS
127
table: management for compound presentation
replacement of prolapsed arm —> vaginal delivery/CS
128
refers to the presence of signs in a pregnant woman before or during childbirth that suggest that the fetus may not be well.
fetal distress
129
signs and symptoms of fetal distress (6)
• decreased movement felt by the mother
• meconium stained amniotic fluid
• non-reassuring patterns seen on cardiotocography:
• increased or decreased fetal heart rate (tachycardia and bradycardia), especially during and after
a contraction
• decreased variability in the HR
• late decelerations
130
liver disorder during pregnancy
intrahepatic cholestasis of pregnancy
131
causes of fetal distress (10): BAMSUNPPUI big angry moms should use nice plans plus useful infos
breathing problems
abnormal position and presentation of the fetus
multiple births
shoulder dystocia
umbilical cord prolapse
nuchal cord
placental abruption
premature closure of ductus arteriosus
uterine rupture
intrahepatic cholestasis of pregnancy
132
treatment for fetal distress: instead of referring to "fetal distress", current recommendations hold to look for more specific signs and symptoms, assess them, and take the appropriate steps to remedy the situation through the implementation of _.
intrauterine resuscitation
133
treatment for fetal distress: traditionally the diagnosis of "fetal distress" led the obstetrician to recommend rapid delivery by _ or by _ if vaginal delivery is not advised.
instrumental delivery
cesarean delivery
134
occurs when the cord passes out the uterus ahead of the presenting part.
prolapse umbilical cord
135
occurs after membranes have ruptured when the fetus is not yet engaged or does not completely cover the pelvic inlet.
prolapse umbilical cord
136
prolapse umbilical cord always lead to _ as the presenting part descends the canal.
cord compression
137
causes of prolapse umbilical cord (6): PLMPPP please let my period pass peacefully
polyhydramnios
long cord
malposition and malpresentation (shoulder and foot)
prematurity
placenta previa
premature rupture of membranes
138
risk factors of PUC: abnormal fetal lie tends to result in space below the fetus in the maternal pelvis, which can then be occupied by the cord.
fetal malpresentation
139
risk factors of PUC: an abnormally high amount of amniotic fluid.
polyhydramnios
140
risk factors of PUC: likely related to increased chance of malpresentation and relative polyhydramnios.
prematurity
141
risk factors of PUC: usually described as <2500g at birth, though some studies will use <1500g.
low birth weight
142
risk factors of PUC: being pregnant with more than one fetus at a given time: more likely to occur in the fetus that is not born first.
multiple gestation
143
risk factors of PUC: about half of prolapses occur within 5 minutes of
membrane rupture, two-thirds within 1 hour, 95 % within 24 hours.
spontaneous rupture of membranes
144
a risk factor of PUC is spontaneous rupture of membranes which about
half of prolapses within _ of membrane rupture
2/3 within _
95% within _
5 mins
1 hour
24 hours
145
6 risk factors of PUC: PFPLMS poor fetal position lead to many surprises
polyhydramnios
fetal malpresentation
prematurity
low birth weight
multiple gestation
spontaneous rupture of membranes
146
3 treatments for PUC: AIM
amniotomy
internal monitors
manual rotation of fetal head
147
one treatment for PUC is placement of internal monitors, which includes (2)
internal scalp electrode (ISE)
intrauterine pressure catheter (IUPC)
148
3 signs and symptoms of PUC
cord protrudes from the vagina.
cord is palpable in vaginal canal /cervix during IE.
fetal distress, especially variable deceleration in FHT pattern.
149
3 classifications of PUC
overt umbilical cord prolapse
occult
funic
150
type of PUC where descent of the umbilical cord past the presenting fetal part.
overt UCP
151
type of PUC where cord is through the cervix and into or beyond the vagina.
overt UCP
152
type of PUC that requires rupture of membranes.
overt UCP
153
most common type of PUC
overt UCP
154
type of PUC where there is descent of the umbilical cord alongside the presenting fetal part, but has not advanced past the presenting fetal part.
occult UCP
155
type of PUC that can occur in intact or ruptured membranes.
occult UCP
156
type of PUC where there is presence of the umbilical cord between the presenting fetal part and fetal membranes.
funic (cord) UCP
157
type of PUC where the cord has not passed the opening of the cervix.
funic (cord) UCP
158
type of PUC where the membranes are not yet ruptured.
funic (cord) UCP
159
reduce pressure on the cord during PUC by placing the client in (3) positions.
knee-chest
trendelenburg
place folded towel under hips
160
management for PUC: if cord is exposed to air, cover with _ to prevent it from drying because drying of the cord may lead to atrophy and constriction of blood vessels.
saline moistened sterile compress
161
during PUC, never replace cord back into the vagina as this can result in _ or _.
cord kinking
knotting
