UW - shoulder dystocia + GDM 03-24 (2)

Question 1

Shoulder dystocia is an obstetric emergency due to the risk for neonatal brachial plexus injury, clavicular and humeral fracture, and, if prolonged, hypoxic brain injury and death.

Answer 1

.

Question 2

UW table. definition? failure of usual obstetric maneuvers to deliver fetal shoulders

Answer 2

.

Question 3

UW table. Risk factors?

Answer 3

fetal macrosomia
Maternal obesity
Excessive pregnancy weight gain
Gestational DM
Postterm pregnancy

Question 4

UW table. warning signs?

Answer 4

Protracted labor
Restraction of fetal head into the perineum after delivery (turtle sign)

Question 5

fetal macrosomia definition?

Answer 5

> 4.5 kg (9 lb 14 oz).

Question 6

common sign showing fetal macrosomia?

Answer 6

A common sign is uterine size greater than dates, as in this patient with a fundal height measuring 43 cm at 39 weeks gestation.

Question 7

greatest risk factor for shoulder dystocia?

Answer 7

fetal macrosomia

Question 8

However, shoulder dystocia also frequently occurs in patients with no risk factors and can be difficult to predict

Answer 8

.

Question 9

(Choice A) Postterm pregnancy (≥42 weeks gestation) is a risk factor for shoulder dystocia due to ???

Answer 9

increased birth weight

Question 10

HTN compromises placental perfusion and oxygenatin –> fetal growth restriction rather than macrosomia

Answer 10

.

Question 11

Complications of low weight gain? 2

Answer 11

low birth weight
preterm delivery

Question 12

Svorio lenteles kiek tipo galima priaugti pagal BMI nera cia, tik wordo faile.
cia surasiau tik komplikacioja

Answer 12

.

Question 13

Complications of high weight gain? 3

Answer 13

GDM
fetal macrosomia
cesarean delivery

Question 14

GDM. when screen?

Answer 14

screening at 24-28 weeks gestation

if risk factors= earlier

Question 15

GDM. If initial modification is not effective (islieka aukstos glikemijos), next step?

Answer 15

insulin - first line, does not cross placenta

Question 16

GDM. kodel weight loss not recommended?

Answer 16

due to increased risk for a small-for-gestational-age infant and possible preterm delivery.

Question 17

GDM. Is dietary modification -> glucose above the target range ?? what target
what need to do?

Answer 17

above the target range (ie, fasting >95 mg/dL, 1-hr >140 mg/dL, 2-hr >120 mg/dL).

ADD PHARMACOTHERAPY

Question 18

GDM table. pathophysiology?

Answer 18

Human placental lactogen secretion

Question 19

GDM table. screening?3

Answer 19

24-28 weeks
1h 50g GCT
3h 100g GTT

Question 20

GDM table. Tx first line?

Answer 20

diet

Question 21

GDM table. Tx 2nd line (pharmotherapy)?

Answer 21

INSULIN. first line

other: glyburide, metformin

Question 22

GDM table. target glucose goals. fasting?

Answer 22

=<95

Question 23

GDM table. target glucose goals. 1h postprandial?

Answer 23

=<140

Question 24

GDM table. target glucose goals. 2h postprandial?

Answer 24

=<120

Question 25

GDM table. Postpartum Mx?

Answer 25

Fasting glucose at 24-72h 2h 75g GTT at 6-12 week visit

Question 26

BE CALM. table. B?

Answer 26

Breath; do no push

Question 27

BE CALM. table. E?

Answer 27

Elevate legs and flex hips, tights against abdomen (McRobets)

Question 28

BE CALM. table. C?

Answer 28

Call for help

Question 29

BE CALM. table. A?

Answer 29

Apply suprapubic pressure

Question 30

BE CALM. table. L?

Answer 30

EnLarge vaginal opening with episiotomy

Question 31

BE CALM. table. M?

Answer 31

Maneuvers - buvo visokiu pavadinimu, nemanau kad reikia. tiesiog is eiles ka reikia daryt kai nesuveikia McRobers and suprapubic pressure. Svarbiausia: jeigu neveikia nei vienas = Do Zavanelli - replace fetal head to pelvis + DO CESAREAN DELIVERY

Question 32

During shoulder dystocia, clamping and cutting the umbilical cord (even a nuchal cord) is absolutely contraindicated because it would sever the only source of oxygen to the fetus, resulting in fetal hypoxia, hypoxic encephalopathy, and fetal death.!!!!

Answer 32

Nuhal cord tai kai virkstele aplink kakla apsivynioja

Question 33

Complication = Erb-Duchenne palsy. Mx?

Answer 33

observation and physical therapy up to 80% of patients have spontaneous recovery within 3 months.

Question 34

Complication = Erb-Duchenne palsy. When need surgery?

Answer 34

Surgical intervention (eg, nerve graft, reconstruction, decompression) can be considered for infants with no improvement by age 3-9 months but is not necessarily curative

Question 35

Complication = Erb-Duchenne palsy. what nerves damaged?

Answer 35

involves the 5th, 6th, and sometimes 7th cervical nerves (C5-7).

Question 36

Complication = Erb-Duchenne palsy. C5 inervation?

Answer 36

deltoid and infraspinatus muscles (innervated by C5)

Question 37

Complication = Erb-Duchenne palsy. C6 inervation?

Answer 37

biceps and wrist extensors (innervated by C6

Question 38

Complication = Erb-Duchenne palsy. C7 inervation?

Answer 38

and finger extensors (innervated by C7) leads to predominance of the opposing muscles

Question 39

Complication = Erb-Duchenne palsy. waiter's tip

Answer 39

.

Question 40

Complications of dystocia? 5 tik pavadinimai, mechanizmu lenteles nera kortose.

Answer 40

Fractured clavicle fractured humerus Erb-Duchenne palsy Klumpke palsy Perinatal asphyxia

Question 41

Complication = Klumpke palsy. nerves?

Answer 41

eighth cervical (C8) and first thoracic (T1) nerves

Question 42

Complication = Klumpke palsy. Mx?

Answer 42

gentle massage and physical therapy to prevent contractures. In most cases, function returns within a few months

Question 42

Complication = Klumpke palsy. gali pasireiksi hornerio sindromas

Answer 42

.

Question 43

Complication = Klumpke palsy. when surgery?

Answer 43

If there is no improvement by age 3-9 months, surgical intervention may be considered.