Week Seven - Also? Birth?

Occipito-posterior position (OP)

• fetal back to mothers back

• often very painful for the mother

• manage as per normal birth

• often results in flat head

Face Presentation

• complete or hyperextension of the fetal neck, face is the presenting part

• face will be badly bruised/swollen

• mentoanterior or mentoposterior

How do we deliver a Face Presentation Mentoanterior?

• deliver as normal

• prepare for EXTENSIVE tearing and trauma

• prepare for haemorrhage

• prepare for resus

How do we deliver a Face Presentation Mentopostterior?

• WE CANNOT DELIVER

• RAPID TRANSPORT TO HOSPITAL FOR C-SECTION

Brow Presentation

• less extreme version of face presentation but large diameter - 13cm ish

• cannot be delivered. Requires cesarean section for safe delivery.

Transverse or Oblique Lie/Shoulder Presentation

• long axis of fetus and mum are at right angles

• presents as shoulder presentation or cord prolapse

• can lead to uterine rupture

• do not attempt to birth. rapid transport for c-section

Cord Prolapse

• cord lies ahead of the presenting part of the body, baby and mum are at risk

Cord Presenation

• cord is present close to the presenting part of the baby but isn’t at risk

3 Types of Prolapse

• occult/hidden: compressed between the baby and the pelvis, cannot be seen or felt on examination

• cord in front of head: cannot be seen but can be felt on vaginal exam

• complete prolapse: cord is protruding from the vagina

Cord Prolapse Risk Factors

• malpresentation

• high head

• prematurity

• polyhydramnious

• low birth weight

• placental preavia

• fetal congential abnromalities

Cord Prolapse Management NOT IMMINENT

• all fours with head to floor

• walk patient to stretcher and get them back in that position

• oxygen HIGH FLOW

• PIPER & MICA, + pre alert

• transport mum in exaggerated sims position (lying down bum in air to side)

• keep cord warm and moist

• if there is pressure on the cord, push the presenting part away from the cord until at hospital

Cord Prolapse Management IMMINENT

• PIPER + MICA

• O2 15L

• ask mum to push through contractions, NEED TO BIRTH BABY

• pain relief

• assist delivery as per normal

• prepare for neonatal resus

• reassurance +++

• document time of prolapse

Preterm Labour is…

labour prior to 37 weeks

Preterm Labour Risk Factors

• <18 yrs or >35 yrs

• aboriginal, african, south asian

• cigarette smoking

• high levels of psychological stress

• late booking or no pregnancy care

• low socioeconomic status

• bmi <19 or >30

Preterm Labour Medical Conditions that put mothers at higher risk?

• previous preterm birth

• short cervical length

• PPROM

• multiple gestation

• genital tract infections

• urinary tract infections

• uterine anomalies

• etc..

Preterm Birth Management NOT IMMINENT

• reassurance ++

• PIPER + MICA

• EPOMS

• pain relief

• left lateral positioning

• >34 weeks basic support

• <34 weeks consult for GTN patch 50mg on abdomen + notify

Preterm Birth Management IMMINENT

• back up + MICA + PIPER

• prepare for delivery

• PREP FOR RESUS

• keep baby warm (put em in a bag!)

• general care!

Rupture of Membranes

• waters breaking, loss of amniotic fluid

• can be an indication of labour but can also just happen

ROM

rupture of membranes

SROM

spontaneous rupture of membranes

ARM

artificial rupture of membranes

PROM

prelabour rupture of membranes

PPROM

premature prelabour rupture of membranes

Forceps

Metal instruments used to assist delivery of the baby, indicated in prolonged second stage labour, fetal distress, c-section etc.. Can cause PPH, infection, pelvic floor dysfunction, trauma to baby and vagina.

Episiotomy

surgical cut of the perineum from the vaginal fourchette in the right mediolateral direction at an angle of 60 degrees. indicated in fetal distress/dystocia and can result in pain, infection, pph, etc.

Vaccum

vacuum cup used to assist the delivery of the baby, indicated in prolonged second stage/fetal distress. can result in PPH, infection, pelvic floor dysfunction, trauma to baby and vagina.

C-Section

A surgical procedure in which incisions are made through the women’s abdomen to deliver one or more babies. Risks of infection, PPH, organ damage, DVT etc..

Multiple Pregnancy Risk Factors

• IVF

• previous history of twins

• familial history

• multiparity

• maternal age >45

Multiple Pregnancy Complications

• prematurity

• fetal growth restriction

• cerebral palsy

• still birth

• etc..

Management of Multiple Pregnancy

• deliver first baby as per normal guideline

• no not deliver placenta and transport to hospital before secondary delivery

• otherwise deliver as a singleton