L&D Complications Flashcards Preview

OB/GYN > L&D Complications > Flashcards

Flashcards in L&D Complications Deck (58)
Loading flashcards...
1

Complications of Labor & Delivery

Preterm labor
Group B strep
Failure to progress
Umbilical cord prolapse
Shoulder Dystocia
Breech Delivery
Retained Placenta
Uterine inversion
Post-Partem Hemorrhage (PPH)

2

Define Preterm Labor

Prior to 37 weeks
Most common perinatal morbidity & mortality in U.S.
Regular uterine contractions associated with cervical change

3

Risk Factors for Preterm Labor

Multiple gestation
Prior preterm birth
Preterm uterine contractions
Premature maternal pre-pregnancy weight
Smoking
Substance abuse
Short inter pregnancy interval
Infection: UTI, genital tract periodontal disease

4

Pathophysiology of Preterm Labor

Activation of maternal or fetal hypothalamic-pituitary-adrenal axis due to maternal or fetal stress
Decidual-chorioamniotic or systemic inflammation caused by infection
Decidual hemorrhage
Pathologic uterine distension

5

Example of Decidual Hemorrhage

Abruption

6

Pathologic Uterine Distension

Multiple pregnancy
Polyhydramnios
Uterine abnormality

7

Signs & Symptoms of Preterm Labor

Menstrual like cramps
Low, dull backache
Pelvic pressure
Abdominal cramping with or without diarrhea
Increase or change in vaginal discharge: mucus, water, light bloody discharge
Uterine contractions

8

Evaluation of Preterm Labor

Fetal monitoring
UA
Test for group B strep
CBC
Ultrasound
Amniocentesis

9

Management of Preterm Labor

Primary goal: delay delivery until maturity attained
Detection & treatment of underlying disorder
Therapy

10

Define Tocolytics

Medications that stop preterm labor

11

Tocolytic Medications

Calcium Channel Blockers (nifedipine)
NSAIDS (indocin)
B-adrenergic receptor agonists (terbutaline)
Magnesium sulfate

12

Contraindications to Tocolytics

Advance labor*
Mature fetus*
Severely abnormal fetus or fetal demise
Intrauterine infection
Significant vaginal bleeding
Severe pre-eclampsia or eclampsia
Placental abruption
Advanced cervical dilation
Fetal compromise
Placental insufficiency

13

Corticosteroids

24-34 weeks gestation (pre-mature labor)
For lung maturity
Dosing over 48 hours

14

Corticosteroids Reduce

Fetal respiratory distress
Intraventricular hemorrhage
Necrotizing enterocolitis

15

Group B Strep

Screening between 35-36 weeks gestation
If positive: prophylactic antibiotic during labor or premature rupture of membranes
Mother with prior GBS infection in infant

16

Group B Strep Antibiotic Prophylaxis

PenG
Best if 4 hours prior to delivery

17

Group B Strep Antibiotic Prophylaxis if Penicillin Allergy

Cefazoline (no anaphylaxis to PCN)
Clindamycin
Vancomycin

18

What does Group B strep colonization prevent in the mother?

Postpartum endometritis, sepsis, & meningitis

19

Define Dystocia

Lack of progressive cervical dilation or lack of descent of fetal head in birth canal or both

20

What does dystocia lead to?

C-section

21

How to evaluate the progression of labor?

Uterus contracting accurately?
What is the fetal position?
Indication of cephalopelvic disproportion?
Fetal status?
Concern for chorioaminonitis?

22

Progression of Labor

Nulliparous: 1 cm/hr
Multiparoud: 1.5 cm/hr

23

Management of Delay of Labor

Observation
Augmentation: amniotomy, oxytocin
Caesarian section: maternal/fetal distress, unstable condition of mother

24

Amniotomy

Manual rupture of membranes with "hook"

25

Risks of Amniotomy

Fetal heart rate deceleration due to cord compression
Increased incidence of chorioamnioitis

26

Oxytocin

Increases uterine activity (contractions) which in turn should result in cervical change & descent

27

Risks of Oxytocin

Hypertonic uterus
Avoid more than 5 contractions in 10 minutes (causes decreased blood flow to fetus)

28

Indications for a C-Section

Failure to progress during labor*
Non-reassuring fetal status*
Fetal malpresentation*
Abnormal placentation
Maternal infection
Multiple gestation
Fetal bleeding diathesis
Umbilical cord prolapse
Macrosomia
Obstruction of birth canal
Uterine rupture

29

Methods of Assisted Vaginal Delivery

Forceps
Vacuum extraction
Mother's pushing & contractions are insufficient to deliver the infant
Sudden onset of severe maternal or fetal compromise & mother is fully dilated & effaced

30

Complications of Forceps

Mother: perioneal trauma, hematoma, pelvic floor injury
Baby: injuries to brain or spine, MSK injury, corneal abrasion, shoulder dystocia