Other terms for chorioamnionitis include intra-amniotic infection and amnionitis. 1.Migration of cervicovaginal flora through the cervical canal (common)2.Hematogenous spread as a result of maternal bacteremia Most common risk factorsLonger length of laborProlonged rupture of membranesClinical in momFeverMaternal leukocytosisMaternal tachycardiaFetal tachycardiaUterine tendernessBacteremiaPurulent or malodorous amniotic fluidManagementDelivery Broad-spectrum antibiotics (ampicillin/gentamicin)Fetal Malposition(s)Malposition(s) interfere with fetal descent into the maternal pelvisSeveral malposition(s) can present oOcciptio-posterior oFace presentation oBrow presentationoBreech presentationoShoulder presentationoUnstable lieBrow PresentationsBrow Presentations are the least common of all presentations. C/S is best for deliveryIn a Brow presentation the forehead is the presenting part.
Results in a prolonged labor or secondary arrest of labor. Complications: Extension of episiotomy or lacerationsBirth injuries to fetus: cerebral or neck compression Damage to the trachea and larynx.Infant MortalityBrow Presentations are the least common of all presentations.In a Brow presentation the forehead is the presenting part.Results in a prolonged labor or secondary arrest of labor.Face Presentation(sunny side up)A Mentoanterior position can be delivered vaginally.A Mentoposterior position cannotbe delivered vaginally.Complications of a face presentation: Prolonged laborInfectionC/SFacial TraumaComplications: Extension of episiotomy or lacerationsBirth injuries to fetus: cerebral or neck compression Damage to the trachea and larynx.Infant MortalityBreechFrank BreechFootling BreechA baby in the transverse position is sideways, usually with his shoulders or back over the cervix.Sometimes refereed as a shoulder or oblique position, a transverse position occurs in 1 to 2,500birthsExternal versionis done to promote vaginal birth by changing fetal presentation from a breech or transverse lie to cephalic lie. (Getting an OP to Rotate to OA)Internal versionis sometimes used to change the presentation of the second twin after the birthof the first (2 dr’s and ultrasound) Fetal Mal positionsMonitor labor progressionChange maternal position frequently (hands & knees – roll hips, Lunging on chair, knee-chest, breech tilt exercises)Forceps/ vacuumRisk FactorsMaternal-prolonged labor-ending with C/SFetal-cerebral and neck compressionDamage to the trachea, larynx, facial edema and bruising, excessive moldingCompound PresentationBaby has two or more presenting parts (occiput and fetal hand)Usually resolves spontaneously but may require manipulationNeed to assess movement of extremity, pulse and cap refill. Usually corrects itself.
Shoulder DystociaDelayed or difficult birth of the shoulders may occur as they become impacted above the maternal symphysis pubis. As the head is born, it retracts against the perineum, much like a turtle’s head drawing into its shell.
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- Winter '17
- Deborah Cridor