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73 Cards in this Set
- Front
- Back
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Indications for instrumental delivery
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maternal exhaustion
ineffective pushing effort expedite birth |
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Forceps assisted birth requires
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pain management and episiotomy
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Classification of forceps is based on
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station of the fetal head when the forceps are applied
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outlet forceps are used when
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fetal head is on the perinium
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low forceps are used when
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baby is at 2+ station
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mid forceps are used when
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baby is between 0 and 2+ station
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high forceps are used when
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when baby is about 0 station
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advantages of forceps delivery is
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shorter 2nd stage
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For forceps use to be affective the mother needs to have
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an empty bladder
fully dilated ROM |
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Risks include
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neonatal birth trauma (facial palsy)
neonatal respiratory depression perineal trauma PPH bladder injury |
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Vacuum Assisted Birth can be done as an alternative to
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forceps
cannot use both |
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How many times can a practitioner attempt using a vacuum?
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2 times
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Use of a vacuum can cause
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hematoma
scalp lacerations subdural hematoma perineal trauma |
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cesarean birth is birth
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through transabdominal incision of the abdomen
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C-section cut should not be done at
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the top of the fundus
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primary c-section increase risk of
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secondary c-sections
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indication of c-sections
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maternal or fetal distress
CPD Malpresentation Placenta previa or abruption prolapsed cord failed induction multi-fetal pregnancy preeclampsia/eclampsia HSV (active) |
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What is a classical C-section?
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vertical incision into the upper body of the uterus
VBAC contraindicated not used often anymore |
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What is a lower uterine segment c-section?
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low transverse incision
VBAC is possible OR Low vertical incision |
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Advantage of low transverse c-section?
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unlikely to rupture
VBAC possible less blood easy repair less adhesion |
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disadvantage of low transverse c-section?
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limited ability to extend incision
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Advantages of low vertical c-section?
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extend upward to make a larger incision if needed
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Disadvantages of low vertical c-section?
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more likely to rupture
tear may extend incision further |
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Advantages of Classical c-section?
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placenta previa
adhesions transverse lie |
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Disadvantages of classical c-section?
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most likely to ruptrue
eliminates VBAC option |
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Contraindications for C-section
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fetal death
maternal coagulation defects |
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normal platelet levels
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165-415
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Maternal risk with c-sections
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infection
hemorrhage UTI thrombophlebitis atelectasis anthestesia complications |
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Neonatal risk with c-section
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inadvertent preterm birth
lacerations bruising |
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risk of uterine rupture with VBAC
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.5%
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Uterine Rupture occurs
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1 in 1500-2000 births
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Causes of uterine rupture
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seperation of scar from previous c-section
congenital anomaly intense spontaneous contractions labor stim over distended uterus malpresentation |
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incomplete uterine rupture
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rupture extends through the endometrium, myometrium but the peritoneum surrounding the uterus remains intact
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complete uterine rupture
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extends through the entire uterine wall and uterine contents spill into abdominal cavity
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signs and symptoms of incomplete uterine rupture
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no symptoms
non-reassuring signs vomiting faitness increased abdominal tenderness hypotonic uterus lack of progress lost fetal heart tones |
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complete rupture
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sudden sharp pain
sharp shooting abdominal pain "something gave way" |
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Retained Placenta may be due to
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partial separation
abnormal adherence of placenta mismanagement of 3rd stage |
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Retained placenta management
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IV Sedation or anesthesia
manual removal of placenta prophylactic antibiotic therapy |
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Adherent Placenta: Acreta
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slight penetration of myometrium
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Adherent Placenta: increata
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deep penetration of myometrium
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Adherent Placenta : Percreta
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complete perforation of the uterus
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the placenta should adhere to the
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endometrium
no deeper |
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Predisposing factors for Adherent Placenta
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high parity (scarring)
previous c-section previous myomectomy Curettage Abnormal site of implantation malformation of placenta |
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Prolapsed cord
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cord lies below the presenting part of the fetus
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an occult prolapsed cord is
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a hidden prolapsed cord
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a frank prolapsed cord is
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is visible
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Management for a prolapsed cord
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keep pressure of the cord
knee to chest hand in vagina |
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With a prolapsed cord the baby is delivered via
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c-section
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Shoulder dystocia
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anterior shoulder can not pass under the pubic arch of maternal pelvis
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Shoulder dystocia can be cause by
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macrosomia- big baby
pelvic anomolies |
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turtle sign
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sign of shoulder dystocia
baby's head crowns and then retracts |
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Signs and Symptoms of Shoulder dystocia
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slowing of labor
formation of catput that increases in size turtle sign |
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Shoulder dystocia management
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free anterior shoulder
change pelvic diameter suprapubic pressure |
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what position can be used to change pelvic diameter to accomodate a shoulder dystocia
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McRoberts Maneuver
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Maternal Complications with shoulder dystocia
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uterine rupture
vaginal lacerations unterine infection |
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neonatal complications with shoulder dystocia
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clavical fracture
asphyxia erb's palsy |
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PPH stands for
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post partum hemorrhage
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normal blood loss in vaginal birth
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less then 500ml
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normal blood loss in c-section
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less then 1000ml
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Early PPH occurs within
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24 hours
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Late PPH occurs within
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6 weeks but after 24 hours
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Risk factors for post partum hemorrhage
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uterine atony
retained placenta placenta acreta uterine rupture cervical or vaginal lacerations hematomas infection coagulations |
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uterine atony is
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marked hypotonia of the uterus
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Uterine atony occurs with
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over-distention, overstimulation, or trauma on the uterus
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Management of PPH
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bimanual compression
pharma uterine exploration surgical intervention |
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pharma management of PPH
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pitocin 10-40 U
methergine - .2mg IM second line |
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methergine is contraindicated for patients with
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HTN/ PIH
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inversion of the uterus
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uterus turns inside out
partial or complete |
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Primary signs and symptoms of inversion of uterus
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hemorrhage
pain shock |
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postpartum infection
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any infection that occurs within 28 days after miscarriage, ETOP, and childbirth
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fever indicative of postpartum depression is
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100.4 or higher on 2 successive days of the first 10PP days
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common post partum infections
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endometritis
wound infection mastitis UTI URI |
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most common organism in infection
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streptococcal
anaerobic |
