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PAR3031 - MATERNITY > Week 8 > Flashcards

Week 8 Flashcards

1
Q

what are some examples of Malpresentations of a baby in utero?

A 
Breech (we went through this last week)
Occipito-posterior position
Face presentation
Brow presentation
Transverse or oblique lie
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2
Q

What is the occipitoposterior position (OP)

A

Babies back to maternal back

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3
Q

What is the presentation of the occipitoposterior position (OP)

A
  • As per normal labour
  • May feel need to push earlier
  • Foetal head is only delivered once face is cleared of symphysis pubis
  • Can lead to extensive perineal tearing
  • Painful ++
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4
Q

What are the risk factors for the occipitoposterior position (OP)

A

mum sitting hip below knee

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5
Q

How do you manage the the occipitoposterior position (OP)

A

Spontaneous rotation occurs 90-95% of the time

- manage as per normal labour

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6
Q

What is Face Presentation?

A
  • Complete or hyperextension of the foetus’ neck

- Face is presenting part

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7
Q

What are the risk factors for Face Presentation?

A
  • Macrosomicfoetus
  • Contracted pelvis
  • Umbilical cord wrapped around the neck a few times
  • OP position
  • Large neck due to cystic hygroma
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8
Q

What is the presentation of Face Presentation of baby in utero?

A
  • Face in the introitus
  • Will be bruised and oedematous (prepare mum)
  • can be confused with a breech pattern
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9
Q

How do you manage a face presentation?

A

Mentoanterior:

  • deliver as per normal
  • Prepare for extensive perineal tearing and trauma
  • Prepare for haemorrhage
  • Prepare for resus of neonate

Mentoposterior:

  • Can’t be delivered vaginally
  • Needs c-section
  • Rapid transport
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10
Q

What is mentoanterior and mentoposterio in face presentation?

A

Mentoanterior - chin anterior

Mentoposterior - chin posterior

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11
Q

what is brow presentation of the baby during labour?

A

Less “extreme” extension of neck compared to face presentation

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12
Q

How do you manage a brow presentation?

A

May move to a face presentation (unlikely)
Cannot be delivered vaginally –needs a C-section
Management: Rapid transport (consult with PIPER)

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13
Q

What is Transverse or oblique lie (shoulder presentation)

A

Long axis of mum and foetus are at right angles

The baby is sideways

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14
Q

What are the risk factors for Transverse or oblique lie (shoulder presentation)

A
  • Lax uterine muscles
  • Placenta praevia
  • Preterm foetus
  • Twins +
  • Grand multiparity
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15
Q

How does Transverse or oblique lie (shoulder presentation) present?

A
  • shoulder

- cord prolapse

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16
Q

What are some possible complications of Transverse or oblique lie (shoulder presentation)

A

can lead to uterine rupture

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17
Q

What is a cord prolapse

A
  • The cord lies ahead of the presenting part
  • Can be occultor overt
  • Can compromise foetalcirculation-hypoxia-brain injury-death
18
Q

What are the causes/risk factors of cord prolapse?

A 
 Multiparity
 High head
 Prematurity
 Malpresentations
 Polyhydramnious
 Low birth weight
 Placenta praevia
 Pelvic tumours
 Foetalcongenital abnormalities
19
Q

How do you manage a cord prolapse on scene before transport (delivery not imminent)?

A

If delivery not imminent:

  • Position in all fours with head to floor immediately
    - >Genu-pectoral position
  • When ready -walk patient to stretcher or put patient straight on stretcher avoid carry chair
  • Administer oxygen –time critical
20
Q

How do you transport a cord prolapse patient (delivery not imminent)?

A

Exaggerated Sims position
–For transport
–Ensure patient is well secured

21
Q

What is the overall management plan for a cord prolapse patient (delivery not imminent)?

A 
 Document time of cord prolapse
 Transport in exaggerated SIMs position
 Oxygen high flow
 PIPER and MICA
 Rapid transport with pre-alert
 Pain relief if required
 Cord Management:-Insert cord into vagina using fingers only & try not to touch further-Keep cord warm and moist
 If presenting part compressing cord
     – Insert fingers into vagina & hold/push presenting part off cord
 Mum will require urgent c-section
22
Q

What is the overall management plan for a cord prolapse patient (DELIVERY IMMINENT- OMGGGGG)?

A

 PIPER
 MICA
 Ask mother to push through contractions –need to deliver foetusASAP
 Give pain relief
 Assist delivery as per normal keep an eye on cord and compression
 Neonate will most likely require resus –prepare
 Rest and reassure mum ++

23
Q

What are the risk factors of twins?

A 
 In vitro fertilisation/assisted fertility
 Previous history of twins+
 Familial history
 Multiparity
 Maternal age >45
24
Q

What are some complications associated with twins?

A 
Prematuriy
Foetal growth restriction (FGR)
Cerebral palsy
Still birth
Antepartum and postpartum haemorrhage
Thromboembolic disease
25
Q

How to manage delivery of twins?

A 
Transport if able-if not:
Call for back up, MICA, PIPER
Notify hospital
Oxygen for 2ndtwin

If in imminent delivery -
–deliver first twin as singleton
–Identify neonate as first twin
 Clamp cord in two places & cut cord
Do not attempt to deliver placenta
Do not allow the placental end to bleed
–the second twin may be attached
Transport to hospital if able
–before second delivery
Deliver 2ndbaby as singleton
Cut cord & clamp
Prepare to resuscitate
Identify as second twin
–Identify cord clamps
Check for third foetus
Check for PPH
26
Q

What do you do after the delivery of both twins in the management of this patient?

A 
Attempt to transport
Allow 3rdstage to remain in-utero
–Beware of risk of hemorrhage
Check fundus is firm & remains so
–Blood loss minimal
Only if bleeding or “boggy fundus”
–Deliver 3rdstage with cord traction
–Give oxytocic if available
•Syntocinonor Mysoprostyl
Keep fundus firm & central
27
Q

What is pre-term labour?

A

Labour prior to 37 weeks.

Very premmy = <28 weeks

28
Q

How can preterm labour present?

A

Mother will complain of labour
–regular contractions (may or may not have pain)
–cramp like period pain or backache.
•Manage as per labour

29
Q

What are the causes of preterm labour?

A
  • Infection
  • > Haematogenous
  • > Latrogenic
  • Stress
  • > Maternal
  • > foetal
  • Multiple pregnancy
  • Uterine distension
  • Placental abruption
  • Cervical weakness
30
Q

What are the risk factors for pre-term labour?

A 
Previous premature delivery
Twins+
Smoker
Low SES
Previous cervical incompetence
Known SROM in current pregnancy
Environmental stress
Alcohol and drug use
Poor nutrition
Interestingly…. Marital status
31
Q

How to you manage a preterm labour in pre-hospital environment (delivery not imminent)?

A 
Reassure mother
PIPER &amp; MICA
Good obstetric history
Pain relief
Mother in lateral position if transporting

If >34 weeks (AV) –basic care
If <34 weeks gestation (in AV) consult to give GTN via 50mg patch on abdomen

Notify hospital -Transport ?NICU
–Dependent on gestation

32
Q

How to you manage a preterm labour in pre-hospital environment (DELIVERY IS imminent GAHHHH)?

A 
Back up –second crew + MICA + PIPER
Prepare for delivery
Prepare for resuscitation
Risk of cord prolapse
Breech presentation common prior to 34 weeks
Keep neonate warm
–If very prem. place baby in baking bag
–Wrap head
Observe ABC’s refer neonatal resus lecture
33
Q

What is PROM (premature rupture of membranes)

A 
Occurs in approx. 2% of all pregnancies
50% will deliver within 1 week &amp; 75% within 2 weeks
May occur during the ante-natal period
–Prior to the commencement of labour
–At any gestation

History of gush of fluid
–May be sudden → forewaters
– May be slow → hindwater

34
Q

What are some complications of PROM?

A

Can progress to delivery of prem. infant
Infection risk
Prolapsed cord

35
Q

How do you manage PROM?

A
  • PIPER
  • Not in labour
    –> R&R +++; Oxygen; pain relief is not usually required
  • Transport
36
Q

What is an Episiotomy?

A

Episiotomy –surgical incision of perineum to aid vaginal birth

37
Q

What is an instrumental delivery?

A

Forceps

  • Indicated when there is foetal or maternal distress or issues associated with the 5 P’s
  • C/I in patients whose cervix isn’t fully dilated-Large metal forceps are placed inside the vagina on either side of the foetus’ head
  • Traction is applied with each contraction to effectively pull the foetus out (normally within 3 pulls)
38
Q

What are the risks of operative (instrument) delivery

A
  • High risk of trauma to mum and foetus

- High risk of haemorrhage due to tearing (even in the presence of episiotomy)

39
Q

What is a caesarean section?

A

Incision through mums abdo(laparotomy) and uterus (hysterotomy)

40
Q

What are the indications for a C section

A

Indications

  • Previous c-section
  • Immediate life threat
  • Elective
  • Failure to progress in Labour
  • Malpresentation
41
Q

What are some complications of c sections?

A 
Haemorrhage
Infection
UTI
Transient tachypnoea is neonate
Organ damage (bowel/bladder)
VTE
Psychological

PAR3031 - MATERNITY (11 decks)

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