Wk:3 Abnormal Presentation & Multiple Gest

Front 1

Determined by the fetus's presenting part:

-Denotes the portion of the fetus felt through the cervix on vaginal exam

-Denotes that portion of the fetus that overlies the pelvic inlet

Back 1

Presentation

3 types:

-Cephalic, Breech, Shoulder

Front 2

Alignment of fetal spine to maternal spine

Back 2

Lie

Front 3

"Lie" can be subdivided into two categories: What are they

Back 3

Longitudinal

Transverse

Front 4

Vertex or breech presentations have what kind of "Lie"

Back 4

Longitudinal Lie

Front 5

Shoulder presentations have what kind of "Lie"

Back 5

Transverse Lie

Front 6

Denotes the relationship of a specific fetal bony part to the mothers pelvis

Back 6

Position

Front 7

Vertex presentations will have what kind of position

Back 7

Occiput

Front 8

Face presentations will have what kind of "Position"

Back 8

Mentum

Front 9

Breech presentations will have what kind of "Position"

Back 9

Sacrum

Front 10

Shoulder Presentations will have what kind of "Position"

Back 10

Acromion

Front 11

What are the factors associated with the Breech position?

Back 11

Uterine distention or relaxation

Uterine abnormalities

Fetal abnormalities

OB conditions

Front 12

List "Breech associated factors" that involve "uterine distention or relaxation"

Back 12

-Multiparity
-Multiple Gestation
-Hydramnios
-Macrosomia

Front 13

List "Breech associated factors" that involve "Uterine abnormalities"

Back 13

-Pelvic tumors
-Uterine anomalies
-Pelvic contracture

Front 14

List "Breech associated factors" that involve "Fetal abnormalities"

Back 14

Hydrocephalus and Anencephalus

Front 15

List "Breech associated factors" that involve "OB conditions"

Back 15

-previous breech
-preterm gestation
-Oligohydramnios
-Cornual-fundal placenta
-Placenta previa

Front 16

Type of "Breech" position where the lower extremities are flexed at the hips, extended at the knees with the feet in the face

Back 16

Frank Breech

Front 17

What is the most common type of breech presentation

Back 17

Frank Breech

Front 18

Type of "Breech" presentation where flexed at both hips and the buttocks and feet sit on the cervix

Back 18

Complete Breech

Front 19

Type of "Breech" presentation where one or both hips are not flexed - and the feet sit below the the buttocks

Back 19

Incomplete breech

Front 20

This type of Breech presentation is common in 50% of Preterm infants

Back 20

Incomplete breech

Front 21

Cord prolapse is most common in which type of Breech presentation

Back 21

incomplete breech

Front 22

T or F

The occurrence of Cord prolapse is dependent on the infants gestational age

Back 22

False

it is dependent on type of Breech presentation

Front 23

The following definition describes what?

-Converts breech presentation to vertex

Back 23

External cephalic version

Front 24

What factors increase the success of External cephalic version

Back 24

-presenting part not in pelvis

-Normal amniotic fluid volume

-Fetal back is not positioned posteriorly

-Pt not obese

-Pt is parous

-Frank breech or transverse

-Rarely successful if ruptured or dilated

Front 25

List 3 anesthetic emergencies for breech presentation

Back 25

-Uterine hypertonus (tight)

-Fetal Head Entrapment (<32wks)

-Need for cervical and uterine relaxation

Front 26

You have a pt presenting in the "Breech position" who needs emergent delivery. In order to provide cervical and uterine relaxation you would do?

Back 26

-RSI with 2-3 MAC halogenated agent (relaxes in 2-3 mins, but may increase uterine bleeding)

-NTG 50-100 mcg

Front 27

What are the Hazards of "Breech vaginal delivery" that increase maternal morbidity?

Back 27

-Cervical lacerations

-Perineal injuries

-Hemorrhage

-Retained placenta

-infection

Front 28

What are the Hazards to the infant when a "Breech vaginal delivery" is done?

Back 28

-Increased Infant trauma:
- asphyxia (cord compression)
- Head trauma
- Intracranial hemorrhage

Front 29

Describe the maternal physiology with multiple gestation?

Blood volume?
C.O. ?
Resp ?

Back 29

Blood volume increases by 500ml

C.O. is 20% greater

Pre-eclampsia

Edema and anemia

faster weight gain

Dyspnea

Front 30

List "fetal" problems associated with multiple gestations

Back 30

-preterm delivery

-congenital anomalies

-polyhydramnios

-cord entanglement

-cord prolapse

-IUGR

-Malpresentation (30-50% in vertex presentations)

-Twin-to-twin transfusion

-4-6 times greater mortality

Front 31

The following statement defines?

Monochorionic, monoamniotic placenta with vascular anastamosis

Back 31

Twin-to-twin transfusion

Front 32

In twin-to-twin transfusion syndrome:

the "Recipient" has?

the "Donor" has?

Back 32

Recipient: has polycythemia & cardiomegaly

Donor: has decreased blood volume - which causes IUGR

Front 33

What are the advantages of Epidural anesthesia in labor?

Back 33

-provides effective pain relief

-Inhibits early pushing

-Provides relaxed pelvic floor

-Easily extended for emergency C/S

Front 34

How can you achieve Rapid uterine/cervical relaxation?

Back 34

- NTG 50-100 mgs

-RSI-GETA (high concentrations volatile agents

Front 35

(KP)

A higher incidence of breech presentation occurs among pt's with?

Back 35

preterm labor

Front 36

(KP)

What two things are associated with an increased incidence of perinatal morbidity and mortality, regardless of the method of delivery

Back 36

breech presentation and multiple gestation

Front 37

(KP)

What effect does multiple gestation have on the "physiologic and anatomic changes of pregnancy"

Back 37

"exaggerates the effects"

Front 38

(KP)

What is the analgesic technique of choice during labor in the pt with multiple gestation

Back 38

Epidural analgesia