PARA316: Complicated Birth Practice Flashcards

This flashcard set covers the assessment and management of complicated births, specifically focusing on breech presentations and Post-Partum Haemorrhage (PPH) types and causes (The 4 Ts).

Frank breech

A breech presentation where the baby’s legs are straight up in front of its body in a V shape, with feet located up near the face.

Complete or flexed breech

A breech presentation where the baby is in a sitting position with its legs crossed in front of its body and its feet near its bottom.

Footling breech

A breech presentation where one or both of the baby’s feet are hanging below its bottom, resulting in the foot or feet presenting first.

Transverse lie

A form of breech presentation where the baby is positioned horizontally across the uterus instead of vertically, causing the shoulder to enter the vagina first.

Aetiology of breech birth (Maternal/Uterine factors)

Causes include multiple babies, abnormal uterus shape/growths, placenta previa, or having too much or too little amniotic fluid.

Primary Post-Partum Haemorrhage (PPH)

Defined as $>500\,ml$ blood loss occurring in the first $24$ hours post-birth.

Secondary Post-Partum Haemorrhage (PPH)

Blood loss occurring after the first $24$ hours up to $6$ weeks post-birth, most commonly seen between $7-14$ days.

Tone (PPH Cause)

Causes $70\%$ of Post-Partum Haemorrhages; refers to an atonic uterus resulting from precipitate births, prolonged labour, multiple birth, grand parity, or prolonged third stage.

Trauma (PPH Cause)

Causes $20\%$ of Post-Partum Haemorrhages; involves perineal tears, often due to precipitous birth or malposition.

Tissue (PPH Cause)

Causes $10\%$ of Post-Partum Haemorrhages; involves retained products such as either the whole or partial placenta or membranes.

Thrombin (PPH Cause)

Causes $<1\%$ of Post-Partum Haemorrhages; refers to clotting disorders due to pre-eclampsia, HELLP syndrome, pyrexia, or Deep Vein Thrombosis (DVT).

HELLP Syndrome

A condition involving haemolysis, elevated liver enzymes, and low platelets.

Fundal massage

A painful procedure performed ONLY after placental delivery using a circular motion with a cupped hand to rub up the uterine fundus until it is firm to reduce bleeding.

Precipitous labour

An abnormally fast labour that can lead to Post-Partum Haemorrhage (PPH).

Non-pharmacological interventions for uterine firmness

Actions including asking the patient to empty their bladder, encouraging breastfeeding, and facilitating skin-to-skin contact.