Week 8 - Labour complications Flashcards
what are the different malpresentation?
occipital-posterior position
face presentation
brow presentation
transerve/ oblique lie
what is occipitoposterior position (OP)?
how might this present? what causes it?
and can we manage on scene?
back to back
presents as normal labour
may feel need to push earlier
foetal head is only delivered once face is cleared of pubic symphysis
unknown causes- spontaneous rotation occur in 90-95 percent of the time
manage as per normal labour
what is face presentation?
what are some things you might expect to see and how common is it?
can we continue with the birth?
face in the Introits
will be bused and odeamatous- can be confused with a breach pattern
face is the presenting part- complete/hyperextension of foetus neck
occurs roughly in 1 in 500 deliveries
what are the risk factors for a face presentation?
macrocosmic foetus contracted pelvic chord wrapped around neck OP position large neck due to cystic hygroma
what are mentoanterior/mentoposterior ?
mentoanterior- face up towards mums tummy
mentoposterior- chin facing towards mums bum
what is the managment for a mentoanterior presentation?
deliver as per normal- prepare for extensive perineal tearing and trauma
prepare for hemmoarge
prepare for rests of baby
what is the managment for a mentoposterior presentation?
can’t be vaginally delivered- requires a c section
rapid transport
what is brow presentation?
how often does it occur and why?
can it be delivered on scene?
brow is presenting part
rare occurs in 1 in 2000 delivers
less extreme extension of neck compared to face presentation
cannot be delivered vaginally- need c section
treatment- rapid transport - consult with piper
what is transverse or oblique lie?
how will this present?
presentation of shoulder or chord prolapse
lon axis of mum and foetus are at right angles
what are the risk factors for transverse or oblique lie?
lax uterine muscles placenta previa preterm foetus twins grand multiparty
how common is trnasverse/oblique lie?
in in 500
what is the managment of transverse/oblique lie?
rapid transport
what us a chord prolapse?
the decent of the umbilical chord below the presenting part in association with rupture of membranes
what are the different types of chord prolapses
occult- adjacent to presenting part
overt- below presenting part
how common are chord prolapses?
0.01-6% of pregnancies
what are the consequences of chord prolapses?
compromise foetal circulation- hypoxia, brain injury, health
what are the risk factors for a chord prolapse?
multiparity high head prematuirty polyhydramitous- lost of fluid low birth weight placenta previa
what is the on scene managment of chord prolapse?
position in all fours with head on floor immediately
when ready walk to stretcher
administer oxygen
how do we transport a chord prolapse
exaggerate sims postion - mum lies on left side with left hip raised and right leg raised
ensure patient is well secured
what is the manamgne too non-imminate chord prolapse
document time of prolapse transport in exaggerated sims postion oxygen MICA and Piper rapid transport with pre-alert pain relief if required chord managment: -insert chord into vagina using fingers only and try not to touch further keep chord and warm and moist
if presenting part compressing chord - insert fingers into vagina and hold/push presenting part off chord
mum urgent c section
what is the managment if delivery is imminate with a chord prolapse?
PIPER
MICA
ask mum to push through contractions
give pain relief
assist delivery as normal and keep eye on compression
neonate most likely require rests - prepre
rest and reassurance
what are the different lies of twins?
vertex and vertex 45 vertex and breach 37 breach and breach 10 vertex and trnsverse 5 breach and transvere 2 transverse and transvers 0.5
what is the incidence and different types of twins?
twins- 1 in 80
triplete 1 in 6400
fraternal - two ova and two sperm
identical0 one egg split
Monochorionic- shared placenta or dichronionic- seperate placentas
what are the risk factors for having twins?
in vitro fertilisation previous history of twins family history multiparity maternal age over 45
what are some of the complications of twins?
prematurity
foetal growth restriction
cereal pausing
antepartum/postpartum hemmorage
what is the managment of twins?
not imminante- transport
imminate- deliver first baby then second
what are some risk factors for preterm birth
previous preterm delivery twins smoker low ses previous cervical incompetence known SCROM in current pegenacy poor nutrition alcohol and drug use environmental stress
what is the managment for non-imminate preterm birth
reassure mother PIPER and MICA good obstetric history pain relif mother in lateral potion if > 34 weeks basic care if <34 weeks in AV consult to give GTN patch on abdomen Notify hospital - transport to NICU hospital - dependent on genstation
what is PROM?
what will happen if there is prom?
when can PROM occur and what would suggest that it has?
premature rupture of membranes
50% deliver within a week and 75 deliver within two weeks
may occur at any gestation and prior to the commencemeant of labour
History of gush- may be sudden - forewaters
may be slow- hind waters
what are some complications of PROM?
can progress to delivery of preterm
infection risk
prolapsed chord
not In labour- rr , oxygen, pain relief not usually requited
what is an episiotomy?
surgical incision of the perineum to aid vaginal birth
what is instrumental delivery ?
when are they indicated and contraindicated and how is delivery acchived?
forceps
indicated when there is distress
C/I if cervix not fully dilated
placed into vagina either side of head- traction applied on each contraction to pull the foetus out
what is a Caesarean section?
incision through mums abdomen
- laparotomy and hysterotomy
what are the indications for a c section?
previous c section imminate life threat effective failure to progress in labour malpresentation
what are some complication of a c section?
heammorage infection uti organe damage VTEA psychological trauma
