Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
24 Cards in this Set
- Front
- Back
|
Types of breech presentation?
|
Frank - legs extended
Flexed legs (complete) Footing |
|
|
Maternal predisposing factors for breech presentation?
|
Fibroids
Congenital uterine abnormalities uterine surgery |
|
|
Foetal/placental predisposing factors?
|
Multiple gestation
prematurity placenta praevia anencephaly hydrocephalus foetal neuromuscular condition oligohydramnios polyhydramnios |
|
|
Antenatal management?
|
US to confirm
document also AFI, placental site, anomalies 3 options: ECV, vaginal delivery, elective C/S |
|
|
What is ECV?
|
50% success rate, better in multiparous women
performed after 37 weeks performed with a tocolytic, e.g. nifedipine perform CTG before and after US guidance administer anti-D |
|
|
Contraindications to ECV?
|
foetal abnormality (e.g. hydrocephalus)
placenta praevia oligohydramnios/polyhydramnios history of antepartum haemorrhage previous caesarean or myomectomy scar on the uterus multiple gestation pre-eclampsia hypertension |
|
|
Risks of ECV?
|
Placental abruption
PROM Cord accident transplacental haemorrhage (therefore need to give anti-D) foetal bradycardia |
|
|
What is the risk with vaginal delivery of breech?
|
3% increased morbidity mortality
|
|
|
Definition of cord prolapse?
|
Presence of umbilical cord below presenting part when membranes have tuptured.
|
|
|
Maternal risk factors for cord prolapse:
|
pelivc tumours, e.g. fibroids
narrow pelvis |
|
|
Foetal causes for cord prolapse?
|
Prematurity
malpresentation multiple pregnancy polyhydramnios placenta praevia large baby |
|
|
Diagnosis of cord prolaspse?
|
Seeing cord or feeling cord
CTG with abnormal foetal HR: variable decelerations |
|
|
Management of cord prolapse?
|
Decrease pressure on cord while plans are made to deliver baby.
|
|
|
Ways to reduce pressure on cord
|
Woman on to all fours with head down
apply pressure vaginally to push presenting part out fill the bladder with saline |
|
|
Should you handle the cord?
|
Don't touch it! Causes spasm.
|
|
|
Should you keep the cord warm?
|
Should be replaced into the vagina to to keep it warmer.
|
|
|
Management:
|
Not fully dilated: emergency CS
Fully dilated: assisted vaginal delivery |
|
|
Outcomes of cord prolapse?
|
In hospital: usually excellent
cord compression for 10 minutes = cerebral damage. cord compression for 20 inutes = death |
|
|
Maternal risk factors for shoulder dystocia?
|
Diabetes
Short stature Previous shoulder dystocia Obesity |
|
|
Foetal risk factors for shoulder dystocia?
|
Macrosomia
Postmaturity |
|
|
Intrapartum risk factors for shoulder dystocia:
|
long first stage of labour
long second stage interrupted delivery induction of labour use of oxytocin |
|
|
Complications of shoulder dystocia for baby:
|
foetal hypoxia
fractures brachial plexus injury - erb's palsy death |
|
|
Complications of shoulder dystocia for mother:
|
perineal trauma
third and fourth degree tears |
|
|
how long in a shoulder dystocia before cerebral damage occurs?
|
5 minutes due to compression of vessels in the neck
|
