Labour and DeliveryPostpartum
Lynne McLeodCRAM Course
Which of the following is NOT a fetal presentation?
1. Breech
2. Face
3. Occiput posterior
4. Brow
Which of the following is NOT a fetal presentation?
1. Breech
2. Face
3. Occiput posterior
4. Brow
Presentation Normal presentations
Vertex (cephalic)
MalpresentationsBreech
Frank
Complete
Footling
Malpresentations
Face Brow Shoulder Compound Cord
Position
Occiput ANTERIOROALOAROA
Occiput POSTERIOROPLOPROP
Occiput TRANSVERSELOTROT
Which of the following is NOT part of the Bishop Score?
1. Presentation
2. Cervical dilatation
3. Position
4. Cervical consistency
Which of the following is NOT part of the Bishop Score?
1. Presentation
2. Cervical dilatation
3. Position
4. Cervical consistency
PV Exam-Bishops Score
Factor 0 1 2 3
Dilatation closed 1-2 3-4 > 5Effacement 0-30 40-50 60-70 80+Station -3 -2 -1 +1Consistency firm med softPosition post mid ant
An acceleration in an NST after 32 weeks gestation is defined as?
1. Peak 15 bpm above baseline for > 15 secs
2. Peak 20 bpm above baseline for > 15 secs
3. Peak 20 bpm above baseline for > 20 secs
4. Peak 15 bpm above baseline for > 20 secs
An acceleration in an NST after 32 weeks gestation is defined as?
1. Peak 15 bpm above baseline for > 15 secs
2. Peak 20 bpm above baseline for > 15 secs
3. Peak 20 bpm above baseline for > 20 secs
4. Peak 15 bpm above baseline for > 20 secs
Normal FHR
Early Decelerations
Variable Decelerations
The most appropriate next step in management of this patient at 4 cm in labour is?
1. Reassess FHR in 2 hours
2. Consider internal monitor/scalp pH
3. Immediate C section
4. Intermittent FHR monitoring
The most appropriate next step in management of this patient at 4 cm in labour is?
1. Reassess FHR in 2 hours
2. Consider internal monitor/scalp pH
3. Immediate C section
4. Intermittent FHR monitoring
Late Decelerations
Which of the following is NOT a component of a Biophysical Profile?
1. Amniotic Fluid assessment
2. Fetal movement
3. Fetal presentation
4. Breathing movements
Which of the following is NOT a component of a Biophysical Profile?
1. Amniotic Fluid assessment
2. Fetal movement
3. Fetal presentation
4. Breathing movements
Biophysical Profile (BPP)
Fetal movements FM Fetal tone FT Fetal breathing movements FBM Amniotic fluid volume AFV Non stress test NST**
Score: Normal = 2 Abnormal = 0
Significance
BPP score correlated with: cord pH:
BPP 8-10: pH ~ 7.28BPP 6: pH ~ 7.19BPP 0-4: pH ~ 6.99
perinatal outcomes long term outcomes
Which of the following is a clinical scenario where a vacuum might be an option?
1. G3P2, at 37 weeks, 9 cm, station -1, non-reassuring FHR
2. 34+6 weeks, fully dilated, station +2, FHR 60
3. 40 weeks, fully dilated, station +3, FHR reassuring
4. G1, 41 weeks, fully dilated, FHR 50, station 0
Which of the following is a clinical scenario where a vacuum might be an option?1. G3P2, at 37 weeks, 9 cm, station -1, non-
reassuring FHR
2. 34+6 weeks, fully dilated, station +2, FHR 60
3. 40 weeks, fully dilated, station +3, FHR reassuring
4. G1, 41 weeks, fully dilated, FHR 50, station 0
Vacuum
Assisted vaginal delivery Good option:
Multip Good progress Good maternal effort No epidural Not < 35 weeks
Set Up
In room In OR Empty bladder Fully dilated Know position Analgesia Neonates Ability to do CS
Potential Complications
Pop off Unsuccessful
forceps CS
Hematoma Subgaleal bleed
Which of the following are NOT necessary components of a forceps delivery?
1. Availability to perform a C-section
2. Pediatric resuscitation staff present
3. Epidural analgesia
4. Informed consent
Which of the following are NOT necessary components of a forceps delivery?
1. Availability to perform a C-section
2. Pediatric resuscitation staff present
3. Epidural analgesia
4. Informed consent
Forceps
Assisted vaginal delivery Good option:
Arrest in 2nd stage Multip maternal effort ? ++ Caput Analgesia < 35 weeks
Set Up
In room In OR Empty bladder Fully dilated Know position Analgesia Neonates Ability to do CS
Potential Complications
Unsuccessful CS
Lacerations Malplacement Hematoma Shoulder Dystocia Fracture
The turtle sign is a warning of what potential delivery complication?
1. Postpartum hemorrhage
2. Compound presentation
3. Wound infection
4. Shoulder dystocia
The turtle sign is a warning of what potential delivery complication?
1. Postpartum hemorrhage
2. Compound presentation
3. Wound infection
4. Shoulder dystocia
Obstetric emergency Incidence
1-4% term vaginal deliveries Risk Factors
Macrosomia Maternal diabetes Previous shoulder dystocia Older mom Grand multiparity Increased maternal weight Operative vaginal delivery
Shoulder Dystocia
Prepare for Shoulder Dystocia Call for HELP! Maneuvres
Episiotomy McRoberts Suprapubic Pressure Rotate shoulders Woods Screw Posterior Arm Fracture Clavical Symphysiotomy Zavenelli Maneuvre
Management
85-90% relieved with first 1-2 maneuvres
Most SD mild-mod
Maternal Risks Perineal trauma Lacerations Bleeding PPH
Prognosis/Risks
Neonatal Risks Asphyxia Trauma Brachial Plexus injuries Death
Prognosis/Risks
Which of the following is a risk factor for a cord prolapse?
1. Polyhydramnios
2. Oligohydramnios
3. Post dates
4. Previous Classical C-section
Which of the following is a risk factor for a cord prolapse?
1. Polyhydramnios
2. Oligohydramnios
3. Post dates
4. Previous Classical C-section
Cord Prolapse Part of umbilical cord falls in front of the fetal
presenting part
1/300-1/600 deliveries 0.2-0.4% singletons 3% breech ~ 10% transverse
When membranes intact cord presentation
Predisposing Factors
Malpresentation Prematurity Abnormal Fetus Multiple Gestation Polyhydramnios PROM Previa Pelvic Mass Obstetric Procedures version, rotation, forceps
Diagnosis
Sudden appearance of loop of cord at introitus
PV exam feel pulsatile cord
Nonreassuring FHR
Ultrasound
Which stage of pregnancy is the highest risk of developing a venous thromboembolic event?
1. Preconception
2. Antenatal
3. Intrapartum
4. Postpartum
Which stage of pregnancy is the highest risk of developing a venous thromboembolic event?
1. Preconception
2. Antenatal
3. Intrapartum
4. Postpartum
What is the most common etiology of postpartum hemorrhage?
1. Perineal trauma
2. Uterine atony
3. Hematological abnormalities
4. Retained products
What is the most common etiology of postpartum hemorrhage?
1. Perineal trauma
2. Uterine atony
3. Hematological abnormalities
4. Retained products
Which of the following are NOT SAFE to consider in breastfeeding?
HIV + with N CD4 and undetectable viral load
Hepatitis B positive mother
Methadone use in the mother
Warfarin prescription postpartum
Which of the following are NOT SAFE to consider in breastfeeding?
HIV + with N CD4 and undetectable viral load
Hepatitis B positive mother
Methadone use in the mother
Warfarin prescription postpartum
Labour and DeliveryPostpartumWhich of the following is NOT a fetal presentation?Which of the following is NOT a fetal presentation?PresentationMalpresentationsMalpresentationsPositionWhich of the following is NOT part of the Bishop Score?Which of the following is NOT part of the Bishop Score?PV Exam-Bishops ScoreAn acceleration in an NST after 32 weeks gestation is defined as?An acceleration in an NST after 32 weeks gestation is defined as?Normal FHREarly DecelerationsVariable DecelerationsSlide Number 16The most appropriate next step in management of this patient at 4 cm in labour is?The most appropriate next step in management of this patient at 4 cm in labour is?Late DecelerationsWhich of the following is NOT a component of a Biophysical Profile?Which of the following is NOT a component of a Biophysical Profile?Biophysical Profile (BPP)SignificanceWhich of the following is a clinical scenario where a vacuum might be an option?Which of the following is a clinical scenario where a vacuum might be an option?VacuumSet UpPotential ComplicationsWhich of the following are NOT necessary components of a forceps delivery?Which of the following are NOT necessary components of a forceps delivery?ForcepsSet UpPotential ComplicationsThe turtle sign is a warning of what potential delivery complication?The turtle sign is a warning of what potential delivery complication?Slide Number 36Slide Number 37Slide Number 38Slide Number 39Which of the following is a risk factor for a cord prolapse?Which of the following is a risk factor for a cord prolapse?Cord ProlapsePredisposing FactorsDiagnosisWhich stage of pregnancy is the highest risk of developing a venous thromboembolic event?Which stage of pregnancy is the highest risk of developing a venous thromboembolic event?What is the most common etiology of postpartum hemorrhage?What is the most common etiology of postpartum hemorrhage?Which of the following are NOT SAFE to consider in breastfeeding?Which of the following are NOT SAFE to consider in breastfeeding?