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What is the association between multifetal gestation and cerebral palsy
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What technique is used to reduce the number of fetuses in a multi-fetal gestation Preterm delivery is a common and serious complication of multiple births What are some methods to predict pre-term delivery How may a multiple gestation pregnancy be prolonged
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How is preterm labor managed in multiple gestation
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Section III: Topics in Obstetrics
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Abnormal Labor and Delivery
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What is dystocia and what is its incidence Abnormal labor; occurs in approximately 25% of nulliparous women Advanced maternal age Non-reassuring fetal heart tracing Epidural anesthesia Macrosomia Occiput posterior position Nulliparity Short stature High station with full dilatation Chorioamnionitis Post-term pregnancy Obesity What are the three major categories of causes of dystocia What is meant by abnormal power What is meant by abnormal passage Problems with the three P s: power, passage, and passenger Inadequate or uncoordinated contractions Abnormal size or shape of maternal pelvis leading to cephalopelvic disproportion (a disproportion between the fetal head and maternal pelvis) Malposition, malpresentation, macrosomia, or multiple gestations Protraction disorders slower than normal progress Arrest disorders complete cessation of progress Name and describe two of the major causes of failure to progress Uterine hypocontractility: the most common cause of failure to progress; refers to uterine activity that is not strong enough or is not coordinated enough to dilate the cervix; quantified as uterine contractions <200 Montevideo units
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What are the risk factors for abnormal labor
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What is meant by abnormal passenger What are the two major categories of failure to progress
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9: Complications of Pregnancy
Epidural anesthesia: leads to an increased duration of the first and second stages of labor and an increased incidence of fetal malposition What are the criteria for the diagnosis of abnormal labor in each of these categories Duration of labor: Protracted dilation: Arrest of descent (with epidural): Arrest of descent (without epidural): When is an arrest of dilation diagnosed Nullipara >247 hours <12 cm/hr >3 hours >2 hours Multipara >188 hours <15 cm/hr >2 hours >1 hour
Cessation of dilation after 4 cm or more despite adequate uterine contractions (>200 Montevideo units for 2 hours or more) With an amniotomy (if membranes are intact) and/or oxytocin (for hypocontractile uterine activity) Cesarean delivery she is in active phase arrest A latent phase (in the first stage of labor) of over 20 hours for a nullipara or 14 hours for a multipara Increased risks of cesarean delivery Newborn requiring NICU admission Thick meconium Depressed apgars
How is poor progression in the first stage of labor managed If protraction persists despite these interventions, how should the patient be managed What is a prolonged latent phase
What are the risks associated with a prolonged latent phase
What are the risk factors for poor progression in the second stage of labor
Nulliparity Diabetes Macrosomia Epidural anesthesia Use of oxytocin Chorioamnionitis
How is poor progression in the second stage of labor managed How is a hypocontractile uterus treated What is assisted vaginal delivery
Fetal surveillance and expectant management or active pushing by the patient With oxytocin Also known as operative vaginal delivery, it involves the use of forceps or a vacuum device
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Section III: Topics in Obstetrics
What fetal position is most associated with abnormal labor How is occiput posterior position managed
Occiput posterior Most spontaneously rotate If it doesn t, it can be managed with manual/instrumental rotation to occiput anterior, operative vaginal delivery, or spontaneous delivery in the occiput posterior position Face (~1/700) Brow (~1/1400) Breech (~1/30) Compound (~1/1500) The fetal neck is sharply extended, causing the face to lead into the birth canal Cephalopelvic disproportion Macrosomia Contracted maternal pelvis Platypelloid pelvis Multiparity Abnormal fetal head (eg, anencephaly)
What types of abnormal presentations are possible and what are the relative incidences of each
Describe face presentation
What are the risk factors for face presentation
What are the three types of breech presentation
Frank breech: fetus has hips flexed and knees extended (feet near head) Complete breech: fetus has hips and knees flexed Footling/incomplete breech: fetus has one or both feet present below the buttocks (see Fig 9-8)
How common is breech presentation
Approximately 3 4% of fetuses at term are breech (increased rates at earlier gestational ages) Uterine shape (fibroids, placenta previa, poly/oligohydramnios, m llerian anomaly, etc) Fetal shape (anomalies such as anencephaly) Fetal mobility (asphyxia, impaired growth, fetal structural malformation, fetal chromosomal anomaly, etc)
What are some of the factors that affect presentation
How is breech presentation diagnosed
With abdominal palpation and ultrasound
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9: Complications of Pregnancy
Frank breech Footling/Incomplete breech
Complete breech
Figure 9-8 Breech presentations
What are the options for management of a breech presentation near term
External cephalic version Cesarean delivery Vaginal delivery (rarely done) A procedure that externally rotates the fetus from the breech presentation to the cephalic presentation After 36 weeks Approximately 65% When the fetus s longitudinal axis is perpendicular to the long axis of the uterus Back down: fetal back facing toward the cervix Back up: fetal back facing away from the cervix
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