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Maternity > Week 8 - Labour complications > Flashcards

Week 8 - Labour complications Flashcards

1
Q

what are the different malpresentation?

A

occipital-posterior position
face presentation
brow presentation
transerve/ oblique lie

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2
Q

what is occipitoposterior position (OP)?

how might this present? what causes it?

and can we manage on scene?

A

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

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3
Q

what is face presentation?

what are some things you might expect to see and how common is it?

can we continue with the birth?

A

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

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4
Q

what are the risk factors for a face presentation?

A 
macrocosmic foetus
contracted pelvic
chord wrapped around neck 
OP position
large neck due to cystic hygroma
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5
Q

what are mentoanterior/mentoposterior ?

A

mentoanterior- face up towards mums tummy

mentoposterior- chin facing towards mums bum

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6
Q

what is the managment for a mentoanterior presentation?

A

deliver as per normal- prepare for extensive perineal tearing and trauma
prepare for hemmoarge
prepare for rests of baby

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7
Q

what is the managment for a mentoposterior presentation?

A

can’t be vaginally delivered- requires a c section

rapid transport

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8
Q

what is brow presentation?

how often does it occur and why?

can it be delivered on scene?

A

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

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9
Q

what is transverse or oblique lie?

how will this present?

A

presentation of shoulder or chord prolapse

lon axis of mum and foetus are at right angles

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10
Q

what are the risk factors for transverse or oblique lie?

A 
lax uterine muscles
placenta previa
preterm foetus
twins
grand multiparty
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11
Q

how common is trnasverse/oblique lie?

A

in in 500

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12
Q

what is the managment of transverse/oblique lie?

A

rapid transport

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13
Q

what us a chord prolapse?

A

the decent of the umbilical chord below the presenting part in association with rupture of membranes

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14
Q

what are the different types of chord prolapses

A

occult- adjacent to presenting part

overt- below presenting part

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15
Q

how common are chord prolapses?

A

0.01-6% of pregnancies

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16
Q

what are the consequences of chord prolapses?

A

compromise foetal circulation- hypoxia, brain injury, health

17
Q

what are the risk factors for a chord prolapse?

A 
multiparity
high head
prematuirty
polyhydramitous- lost of fluid
low birth weight 
placenta previa
18
Q

what is the on scene managment of chord prolapse?

A

position in all fours with head on floor immediately
when ready walk to stretcher
administer oxygen

19
Q

how do we transport a chord prolapse

A

exaggerate sims postion - mum lies on left side with left hip raised and right leg raised
ensure patient is well secured

20
Q

what is the manamgne too non-imminate chord prolapse

A 
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

21
Q

what is the managment if delivery is imminate with a chord prolapse?

A

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

22
Q

what are the different lies of twins?

A 
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
23
Q

what is the incidence and different types of twins?

A

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

24
Q

what are the risk factors for having twins?

A 
in vitro fertilisation
previous history of twins
family history
multiparity
maternal age over 45
25
Q

what are some of the complications of twins?

A

prematurity
foetal growth restriction
cereal pausing
antepartum/postpartum hemmorage

26
Q

what is the managment of twins?

A

not imminante- transport

imminate- deliver first baby then second

27
Q

what are some risk factors for preterm birth

A 
previous preterm delivery
twins
smoker
low ses
previous cervical incompetence
known SCROM in current pegenacy
poor nutrition
alcohol and drug use
environmental stress
28
Q

what is the managment for non-imminate preterm birth

A 
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
29
Q

what is PROM?

what will happen if there is prom?

when can PROM occur and what would suggest that it has?

A

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

30
Q

what are some complications of PROM?

A

can progress to delivery of preterm
infection risk
prolapsed chord
not In labour- rr , oxygen, pain relief not usually requited

31
Q

what is an episiotomy?

A

surgical incision of the perineum to aid vaginal birth

32
Q

what is instrumental delivery ?

when are they indicated and contraindicated and how is delivery acchived?

A

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

33
Q

what is a Caesarean section?

A

incision through mums abdomen

- laparotomy and hysterotomy

34
Q

what are the indications for a c section?

A 
previous c section 
imminate life threat
effective
failure to progress in labour
malpresentation
35
Q

what are some complication of a c section?

A 
heammorage
infection 
uti
organe damage
VTEA 
psychological trauma

Maternity (30 decks)

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