labor and delivery complications

umbilical cord prolapse classification

emergency, immediate intervention

umbilical cord prolapse is when

the umbilical precedes or lies alongside presenting part

risk factors for umbilical cord prolapse

• malpresentation

• polyhydramnios

• multiple gestation

• preterm

overt prolapse

palpable/visible

occult prolapse

alongside, not past

what to do with cord prolapse

• elevate present part with gloved hand

• maintain pressure

nuchal cord is

cord looped around fetal neck

loose nuchal cord intervention

slip over head before birth or shoulders

tight cord intervention

clamp and cut before the birth

nuchal cord classified as

usually not harmful, FHR monitored closely

placental abruption is

premature separation of placenta from uterine wall

placental abruption cuases

• htn

• preeclampsia

• trauma

• cocaine/tobacco use

partial placental abruption shows as

• late decelerations

• changes in variability

• some placenta still hanging on

complete placental abruption is

• emergency need

• category 3

• bradycardia

• general anesthesia needed

placental abruption presents as

• painful

• dark red bleeding

• board like abdomen

how can placental abruption be delivered

vaginally if hemodynamically stable

placenta previa presents as

painless bright red bleeding

placenta previa is

• placenta covers os

• c- section required

• avoid digital exam

placenta accreta spectrum is

abnormal invasion of myometrium

accreta is

superficial invasion

increta is

into the muscle, might need hysterectomy

percreta is

• invading organs

• requires multiple surgeons and hysterectomy

uterine rupture indication

pop or sudden relief of pain during labor

uterine rupture risk factors

• prior uterine surgeries

• 5+ deliveries

• oxytocin hyperstimulation

uterine rupture symptoms

• sudden abdominal pain

• loss of FHR

• maternal shock

uterine rupture treatment

stat section, possible hysterectomy

uterine tachysystole is

>5 contractions in 10 mins

uterin hyperstimulation is

hypersystole with adverse FHR changes

uterine tachysystole causes

• oxytocin

• misoprostol

• cervical ripening agents

uterine tachysystole interventions

• stop or reduce oxytocin

• left lateral position

• O2

• IV fluid

• terbutaline 0.25 mg SQ if ordered

uterine inversion is

uterine fundus collapses into uterine cavity thru cervix, rare but life threatening

uterine inversion risk factors

• excessive cord traction

• fundal pressure of uncontrolled uterus

uterine inversion symptoms

• postpartum hemorrhage

• severe pelvic pain

• non palpable fundus

• profound shock

amniotic fluid embolism is

catastrophic entry of amniotic fluid/fetal cells into maternal circulation

amniotic fluid embolism symtpoms

• sudden hypoxia

• hypotension

• altered mentation/coagulopathy

amniotic fluid embolism occurs

• during labor

• delivery

• immediately post partum

amniotic fluid embolism can lead to

• respiratory arrest

• cardiac arrest

• DIC

amniotic fluid embolism is usually due to

induction of labor

A in amniotic fluid embolism treatment

• atropine

• increase contractility of heart

O in amniotic fluid embolism treatment

• ondansetron

• blocks more uptake of amniotic fluid

K in amniotic fluid embolism treatment

• ketorolac

• busts the clots

oligohydramnios can be caused by

• post dates

• IGUR

• ROM

• renal problems

oligohydramnios can cause

cord compression, variable decels

oligohydramnios treated with

amnioinfusion

polyhydramnios can be caused by

• maternal diabetes

• fetal GI obstruction

• twin to twin

polyhydramnios is a what risk

• cord prolapse

• malpresentation

polyhydramnios can cause

• preterm labor

• placental abruption

shoulder dystocia is classified as

fetal hypoxia risk, urgent

shoulder dystocia is

anterior fetal shoulder behind maternal pubis

shoulder dystocia warning signs

• turtle head

• macrosomia, diabetes, prior shoulder, prolonged labor

HELPERR in shoulder dystocia

• H - call for help

• E - evaluate for episiotomy (E)

• L - legs (mcRoberts)

  • supine, legs far back, heels tilting

• P - suprapubic pressure

  • rock on top of shoulder, pubic bone pressure

• E - enter

• R - remove posterior arm

• R - roll patient

intrauterine fetal demise is

fetal death >20 weeks

intrauterine fetal demise causes

• placental abruption

• infection

• hypertension

intrauterine fetal demise diagnosed by

ultrasound, always need confirmation

intrauterine fetal demise delivery

vaginally if stable

intrauterine fetal demise risks

DIC over time after demise

intrauterine fetal demise bereavement care

sit w/ them. verify feelings, offer to call

DIC is

simultaneous clotting and bleeding

DIC causes

• placental abruption

• fetal demise

• sepsis

• AFE

• severe preeclampsia

DIC labs

• decreased fibrinogen

• increase PT/PTT

• increase d-dimer

• decrease PLT

• decrease H/H

tranexamic acid should be given

within 3 hours of delivery, for PPH >500 mL

tranexamic acid is a

antifibrinolytic agent

tranexamic prevents

fibrin degeneration

tranexamic window peak

6-10 hours post delivery

tranexamic dose

1 g IV over 10 mins

tranexamic reduces

blood transfusion need