Labor Complications Lecture Powerpoint Flashcards Preview

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Flashcards in Labor Complications Lecture Powerpoint Deck (23)
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1
Q

Preferred type of breech presentation

A

Frank breech, protective against cord prolapse

2
Q

Risk factors for breech presentation (5)

A
  • increased parity
  • multiple fetuses
  • polyhydramnios
  • oligohydramnios
  • previous breech
3
Q

Complications of breech presentation (3)

A
  • prolapsed umbilical cord (if squished will strangulate newborn
  • head entrapment
  • injuries to newborn
4
Q

Recommendation for type of delivery in breech presentation

A

-c section

5
Q

Breech delivery procedure

A
  • Pop the legs out one at a time
  • once scapulas are visible then pop the arms out one at a time, twisting each time (takes 2 providers)
  • delivery of head sometimes with piper forceps
6
Q

Dystocia

A

Abnormal labor, consequence of 4 distinct abnormalities (of expulsive force, of bony pelvis, of presentation/position/development of fetus, or of soft tissue of repro tract)

7
Q

Cervical dilation during active phase of labor

A

Cervical dilation occurs at rate of at least 1.2cm per hour, cervical dilations of 3-4cm in presence of uterine contractions represents active labor

8
Q

Causes of inadequate labor (4)

A
  • epidural analgesia
  • chorioamnionitis
  • maternal positioning
  • false labor/being in latent phase
9
Q

Different pelvis types and characteristics

A

Gynecoid (round, most common, good prognosis)
Anthropoid (long and oval, good prognosis)
Android (heat shaped, poor prognosis)

10
Q

Management of inadequate labor (3)

A
  • amniotomy (rupture the membranes, improves contraction)
  • pitocin (oxytocin)
  • possible c section
11
Q

Preconceptual, antepartum, and intrapartum risks for shoulder dystocia (5)

A
  • previous
  • maternal obesity
  • abnormal pelvis shape
  • macrosomia
  • abnormal labor or instrumental use in delivery
12
Q

Shoulder dystocia complications (3)

A
  • maternal lacerations or hemorrhage
  • transient brachial plexus palsy (permanent) of the newborn***
  • fracture
13
Q

shoulder dystocia maneuvers (8)

A
  • suprapubic pressure applied by assistant (not fundal, but goal is o push on shoulder)
  • McRobert’s maneuver - sharply flex legs upon the abdomen
  • Woods maneuver (rotating the posterior by grabbing it manually)
  • delivery of posterior shoulder (pull arm out and raise it up and around)
  • rubin’s maneuver (rock shoulders back and forthe)
  • zavanelli maneuver (replacing head in pelvis and proceeding to c section - risk for c section)
  • deliberate fracture of the clavicle
  • symphysiotomy (cut the cartilage between the pubic symphysis as alternative to c section but concern about cutting bladder)
14
Q

Maternal indications for labor induction (5)

A
  • fetal demise
  • severe hypertensive disease
  • other medical problems (DM, renal)
  • high distance from hospital or quick labor
  • premature rupture of membranes
15
Q

Fetal indications for labor induction (5)

A
  • post term pregnancy
  • chorioamnionitis
  • oligohydramnios
  • IUGR
  • Rh sensitization
16
Q

Risks of labor induction (5)

A
  • greater c section risk
  • iatrogenic prematurity
  • more painful
  • longer duration
  • increased risk of infection
17
Q

Induction of labor methods (4)

A
  • membrane stripping
  • amniotomy (cervix has to be dilated to reach)
  • pitocin (oxytocin)
  • vaginal prostaglandins
  • misoprostol
18
Q

Relative contraindications to labor induction (4)

A
  • placenta previa
  • abnormal presentation
  • active genital herpes infection
  • invasive cervical cancer
19
Q

Maternal morbidity from forceps (2)

A
  • maternal injuries increased with rotations

- more episiotomies and lacerations

20
Q

Indication for forceps typically just indicates it would be better to use…

A

….a c section

21
Q

Fetal morbidity from forceps (2)

A
  • no increase with outlet and low forceps

- midforceps ahve increased rates of neonatal intracranial hemorrhage or facial nerve palsy

22
Q

Vacuum extractor

A

Alternative to forceps in assisting delivery that doesn’t require precise positioning but has the ssame indications and contraindications, operator should abandon procedure if it does not proceed easily “pop off rule”

23
Q

Complications of vacuum extractor use in labor (5)

A
  • scalp lacerations and bruising
  • subgaleal hematoma
  • cephalohematoma
  • intracranial hemorrhage
  • subconjunctival hemorrhage