UW - shoulder dystocia + GDM Flashcards
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.
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UW table. definition? failure of usual obstetric maneuvers to deliver fetal shoulders
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UW table. Risk factors?
fetal macrosomia
Maternal obesity
Excessive pregnancy weight gain
Gestational DM
Postterm pregnancy
UW table. warning signs?
Protracted labor
Restraction of fetal head into the perineum after delivery (turtle sign)
fetal macrosomia definition?
> 4.5 kg (9 lb 14 oz).
common sign showing fetal macrosomia?
A common sign is uterine size greater than dates, as in this patient with a fundal height measuring 43 cm at 39 weeks gestation.
greatest risk factor for shoulder dystocia?
fetal macrosomia
However, shoulder dystocia also frequently occurs in patients with no risk factors and can be difficult to predict
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(Choice A) Postterm pregnancy (≥42 weeks gestation) is a risk factor for shoulder dystocia due to ???
increased birth weight
HTN compromises placental perfusion and oxygenatin –> fetal growth restriction rather than macrosomia
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Complications of low weight gain? 2
low birth weight
preterm delivery
Svorio lenteles kiek tipo galima priaugti pagal BMI nera cia, tik wordo faile.
cia surasiau tik komplikacioja
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Complications of high weight gain? 3
GDM
fetal macrosomia
cesarean delivery
GDM. when screen?
screening at 24-28 weeks gestation
if risk factors= earlier
GDM. If initial modification is not effective (islieka aukstos glikemijos), next step?
insulin - first line, does not cross placenta
GDM. kodel weight loss not recommended?
due to increased risk for a small-for-gestational-age infant and possible preterm delivery.
GDM. Is dietary modification -> glucose above the target range ?? what target
what need to do?
above the target range (ie, fasting >95 mg/dL, 1-hr >140 mg/dL, 2-hr >120 mg/dL).
ADD PHARMACOTHERAPY
GDM table. pathophysiology?
Human placental lactogen secretion
GDM table. screening?3
24-28 weeks
1h 50g GCT
3h 100g GTT
GDM table. Tx first line?
diet
GDM table. Tx 2nd line (pharmotherapy)?
INSULIN. first line
other: glyburide, metformin
GDM table. target glucose goals. fasting?
=<95
GDM table. target glucose goals. 1h postprandial?
=<140
GDM table. target glucose goals. 2h postprandial?
=<120
GDM table. Postpartum Mx?
Fasting glucose at 24-72h
2h 75g GTT at 6-12 week visit
BE CALM. table. B?
Breath; do no push
BE CALM. table. E?
Elevate legs and flex hips, tights against abdomen (McRobets)
BE CALM. table. C?
Call for help
BE CALM. table. A?
Apply suprapubic pressure
BE CALM. table. L?
EnLarge vaginal opening with episiotomy
BE CALM. table. M?
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
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.!!!!
Nuhal cord tai kai virkstele aplink kakla apsivynioja
Complication = Erb-Duchenne palsy. Mx?
observation and physical therapy
up to 80% of patients have spontaneous recovery within 3 months.
Complication = Erb-Duchenne palsy. When need surgery?
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
Complication = Erb-Duchenne palsy. what nerves damaged?
involves the 5th, 6th, and sometimes 7th cervical nerves (C5-7).
Complication = Erb-Duchenne palsy. C5 inervation?
deltoid and infraspinatus muscles (innervated by C5)
Complication = Erb-Duchenne palsy. C6 inervation?
biceps and wrist extensors (innervated by C6
Complication = Erb-Duchenne palsy. C7 inervation?
and finger extensors (innervated by C7) leads to predominance of the opposing muscles
Complication = Erb-Duchenne palsy.
waiter’s tip
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Complications of dystocia? 5
tik pavadinimai, mechanizmu lenteles nera kortose.
Fractured clavicle
fractured humerus
Erb-Duchenne palsy
Klumpke palsy
Perinatal asphyxia
Complication = Klumpke palsy. nerves?
eighth cervical (C8) and first thoracic (T1) nerves
Complication = Klumpke palsy. Mx?
gentle massage and physical therapy to prevent contractures. In most cases, function returns within a few months
Complication = Klumpke palsy. gali pasireiksi hornerio sindromas
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Complication = Klumpke palsy. when surgery?
If there is no improvement by age 3-9 months, surgical intervention may be considered.
