Labor Complications

Labor Complications US Medical PG Question 1: A 30-year-old woman, gravida 2, para 1, at 12 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and vaginal delivery of her first child were uncomplicated. Five years ago, she was diagnosed with hypertension but reports that she has been noncompliant with her hypertension regimen. The patient does not smoke or drink alcohol. She does not use illicit drugs. Medications include methyldopa, folic acid, and a multivitamin. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 145/90 mm Hg. Physical examination shows no abnormalities. Laboratory studies, including serum glucose level, and thyroid-stimulating hormone concentration, are within normal limits. The patient is at increased risk of developing which of the following complications?

• A. Placenta previa
• B. Abruptio placentae (Correct Answer)
• C. Spontaneous abortion
• D. Polyhydramnios
• E. Uterine rupture

Labor Complications Explanation: ***Abruptio placentae*** - The patient's history of **chronic hypertension** (145/90 mmHg) and her noncompliance with antihypertensive medication significantly increase her risk for **abruptio placentae**. Hypertension is a major risk factor for this condition. - Abruptio placentae involves the **premature separation of the placenta** from the uterine wall, which can lead to severe maternal hemorrhage, fetal distress, and preterm birth. *Placenta previa* - **Placenta previa** is characterized by the placenta covering the cervical os and is primarily associated with risk factors like **previous C-section**, multiple gestations, or advanced maternal age. - While a serious complication, it is **not directly linked to chronic hypertension** in the same manner as abruptio placentae. *Spontaneous abortion* - **Spontaneous abortion** typically occurs in the **first trimester** and is often due to chromosomal abnormalities, endocrine disorders, or uterine anomalies. - While hypertension could theoretically contribute to some pregnancy complications, it is **not a primary risk factor** for spontaneous abortion at 12 weeks gestation. *Polyhydramnios* - **Polyhydramnios** is an excessive accumulation of amniotic fluid, often associated with **maternal diabetes**, fetal anomalies (e.g., GI obstruction, anencephaly), or multiple gestations. - Maternal hypertension is **not a direct risk factor** for polyhydramnios. *Uterine rupture* - **Uterine rupture** is a rare but catastrophic event, most commonly associated with a **previous uterine scar** (e.g., from a prior C-section or myomectomy). - The patient's history of a prior vaginal delivery and absence of uterine surgery means she is **not at increased risk** for uterine rupture at this stage.

Labor Complications US Medical PG Question 2: A 39-year-old woman, gravida 3, para 2, at 32 weeks' gestation comes to the emergency department 1 hour after the sudden onset of severe abdominal pain and nausea. She has had one episode of nonbloody vomiting. Pregnancy has been uncomplicated, except for a blood pressure measurement of 150/90 mm Hg on her last prenatal visit. Her first child was delivered vaginally; her second child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. She appears anxious and pale. Her temperature is 36.1°C (96°F), pulse is 115/min, and blood pressure is 92/65 mm Hg. Extremities are cool and clammy. Pelvic examination shows a rigid, tender uterus. The cervix is 30% effaced and 1 cm dilated; the vertex is at -1 station. The fetal heart rate is 100/min. Which of the following is the most likely diagnosis?

• A. Ruptured vasa previa
• B. Placenta accreta
• C. Abruptio placentae (Correct Answer)
• D. Ruptured uterus
• E. Placenta previa

Labor Complications Explanation: ***Abruptio placentae*** - The sudden onset of **severe abdominal pain**, **uterine rigidity and tenderness**, maternal hypovolemic shock (tachycardia, hypotension, cool and clammy extremities), and **fetal bradycardia** are classic signs of **abruptio placentae**. - **Hypertension** (150/90 mm Hg) is a risk factor, and a prior **cesarean section** may slightly increase the risk as well, although the primary risk factor here is hypertension. *Ruptured vasa previa* - **Vasa previa** typically presents with **painless vaginal bleeding** when membranes rupture, accompanied by rapid fetal deterioration due to fetal blood loss, and would not cause severe maternal abdominal pain and shock. - The bleeding in vasa previa originates from fetal vessels, leading to a profound impact on fetal heart rate *before* significant maternal symptoms. *Placenta accreta* - **Placenta accreta** is typically diagnosed prenatally via ultrasound or suspected at delivery due to difficulty with placental separation. It does not usually present with acute, severe abdominal pain and hypovolemic shock during pregnancy. - Patients with placenta accreta are at high risk for significant hemorrhage *after* delivery of the fetus, but before placental delivery. *Ruptured uterus* - While a prior **cesarean section** is a risk factor for uterine rupture, the presentation of **rigid and tender uterus** is more characteristic of abruptio placentae. Uterine rupture often involves a **sudden cessation of contractions**, palpable fetal parts outside the uterus, and often severe, sharp pain, but not typically a rigid uterus. - The fetal heart rate in uterine rupture often shows a **sudden, profound deceleration** or absence, but the specific finding of a rigid, tender uterus with ongoing severe pain points away from frank rupture. *Placenta previa* - **Placenta previa** typically presents with **painless vaginal bleeding** in the second or third trimester. - It does not usually cause severe abdominal pain, uterine tenderness, or maternal hypovolemic shock unless accompanied by abruptio placentae, which is the more dominant and acute finding here.

Labor Complications US Medical PG Question 3: A 27-year old primigravid woman at 37 weeks' gestation comes to the emergency department because of frequent contractions for 4 hours. Her pregnancy has been complicated by hyperemesis gravidarum which subsided in the second trimester. The contractions occur every 10–15 minutes and have been increasing in intensity and duration since onset. Her temperature is 37.1°C (98.8°F), pulse is 110/min, and blood pressure is 140/85 mm Hg. Uterine contractions are felt on palpation. Pelvic examination shows clear fluid in the vagina. The cervix is 50% effaced and 3 cm dilated. After 4 hours the cervix is 80% effaced and 6 cm dilated. Pelvic examination is inconclusive for the position of the fetal head. The fetal heart rate is reassuring. Which of the following is the most appropriate next step?

• A. Administer oxytocin
• B. Perform external cephalic version
• C. Administer misoprostol
• D. Perform Mauriceau-Smellie-Veit maneuver
• E. Perform ultrasonography (Correct Answer)

Labor Complications Explanation: ***Perform ultrasonography*** - The examination notes that the **pelvic examination is inconclusive for the position of the fetal head**, which is a critical piece of information needed for safe delivery. **Ultrasonography** is the most appropriate next step to ascertain the fetal presentation and position, especially given the dilated cervix. - Determining fetal position is essential to rule out **malpresentation**, such as **breech** or **transverse lie**, which would significantly impact the delivery plan and potentially necessitate a **cesarean section**. *Administer oxytocin* - **Oxytocin** is used to induce or augment labor when contractions are insufficient or labor is prolonged, but in this case, the cervix is progressing well (from 3 cm to 6 cm dilation in 4 hours), indicating **active labor**. - Without knowing the fetal presentation, administering oxytocin could exacerbate issues if there's a **malpresentation**, potentially leading to **fetal distress** or **uterine rupture**. *Perform external cephalic version* - **External cephalic version (ECV)** is performed to change a **breech presentation** to a **cephalic presentation** by external manipulation, typically done before labor onset or early in labor at term. - This patient is already in **active labor** with significant cervical dilation (6 cm), making ECV less likely to be successful and potentially increasing risks like **placental abruption** or **umbilical cord compression**. *Administer misoprostol* - **Misoprostol** is a prostaglandin analog used for **cervical ripening** and **labor induction** in cases where the cervix is unfavorable or labor needs to be initiated. - This patient is already in **active labor** with progressive cervical dilation, making misoprostol unnecessary and potentially harmful due to the risk of **uterine hyperstimulation**. *Perform Mauriceau-Smellie-Veit maneuver* - The **Mauriceau-Smellie-Veit maneuver** is a technique used during a **vaginal breech delivery** to deliver the fetal head, specifically in cases of **frank or complete breech** that are being delivered vaginally. - This maneuver is only performed *during* delivery of a breech baby, and the fetal position is currently unknown. It would be premature and inappropriate to consider this maneuver without first confirming a **breech presentation** and the decision for vaginal delivery.

Labor Complications US Medical PG Question 4: Immediately following prolonged delivery of the placenta at 40 weeks gestation, a 32-year-old multiparous woman develops vaginal bleeding. Other than mild asthma, the patient’s pregnancy has been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. Previous pregnancies were uncomplicated. She has no history of a serious illness. She is currently on intravenous infusion of oxytocin. Her temperature is 37.2°C (99.0°F), blood pressure is 108/60 mm Hg, pulse is 88/min, and respirations are 17/min. Uterine palpation reveals a soft enlarged fundus that extends above the umbilicus. Based on the assessment of the birth canal and placenta, which of the following options is the most appropriate initial step in patient management?

• A. Intramuscular carboprost
• B. Manual exploration of the uterus
• C. Discontinuing oxytocin
• D. Intravenous methylergonovine
• E. Uterine fundal massage (Correct Answer)

Labor Complications Explanation: ***Uterine fundal massage*** - The patient presents with **postpartum hemorrhage** indicated by vaginal bleeding and a **soft, enlarged fundus** after placental delivery, suggesting **uterine atony**. - **Uterine fundal massage** is the **first-line intervention** to encourage uterine contraction and reduce bleeding by expelling clots and compressing vessels. *Intramuscular carboprost* - **Carboprost** is a **prostaglandin F2 alpha analog** used to treat **uterine atony** when initial measures like uterine massage and oxytocin are insufficient. - It is contraindicated in patients with **asthma** due to its bronchoconstrictive effects, which this patient has. *Manual exploration of the uterus* - **Manual exploration of the uterus** is indicated when there is suspicion of **retained placental fragments** or **uterine rupture**. - While these can cause postpartum hemorrhage, the primary finding of a soft, boggy uterus points more strongly to atony, making massage the immediate priority. *Discontinuing oxytocin* - The patient is already on an **intravenous oxytocin infusion**, which is a uterotonic agent used to prevent and treat uterine atony. - Discontinuing it would worsen **uterine atony** and increase blood loss, directly contradicting the goal of management. *Intravenous methylergonovine* - **Methylergonovine** is an **ergot alkaloid** used to treat **uterine atony**, but it is contraindicated in patients with **hypertension**, which is not explicitly present here, but it is a potent vasoconstrictor and second-line. - It is often used as a **second-line agent** if oxytocin and massage are ineffective and there are no contraindications.

Labor Complications US Medical PG Question 5: A 34-year-old G3P2 is admitted to the hospital after being physically assaulted by her husband. She developed severe vaginal bleeding and abdominal pain. She is at 30 weeks gestation. Her previous pregnancies were uncomplicated, as has been the course of the current pregnancy. The vital signs are as follows: blood pressure, 80/50 mmHg; heart rate, 117/min and irregular; respiratory rate, 20/min; and temperature, 36.2℃ (97.1). The fetal heart rate is 103/min. On physical examination, the patient is pale and lethargic. Abdominal palpation reveals severe uterine tenderness and tetanic contractions. The perineum is grossly bloody. There are no vaginal or cervical lesions. There is active heavy bleeding with blood clots passing through the cervix. An ultrasound shows a retroplacental hematoma with a volume of approximately 400 ml. Laboratory workup shows the following findings: Red blood cells count: 3.0 millions/mL Hb%: 7.2 g/dL Platelet count: 61,000/mm3 Prothrombin time: 310 seconds (control 20 seconds) Partial prothrombin time: 420 seconds Serum fibrinogen: 16 mg/dL Elevated levels of which of the following laboratory markers is characteristic for this patient’s complication?

• A. C-reactive protein
• B. D-dimer (Correct Answer)
• C. Creatinine
• D. Pro-brain natriuretic peptide
• E. Procalcitonin

Labor Complications Explanation: *** **D-dimer*** - This patient's presentation with **severe vaginal bleeding**, **abdominal pain**, **uterine tenderness**, **tetanic contractions**, and **fetal distress** following trauma, along with the ultrasound finding of a **retroplacental hematoma**, is highly suggestive of **abruptio placentae**. - The abnormal coagulation panel (low platelets, prolonged PT/PTT, low fibrinogen) indicates **disseminated intravascular coagulation (DIC)**, a common complication of severe placental abruption due to extensive activation of the coagulation cascade and subsequent breakdown of clots. **D-dimer levels** are characteristically **elevated** in DIC as they are degradation products of **fibrin** from enhanced fibrinolysis. *C-reactive protein* - **C-reactive protein (CRP)** is an **acute-phase reactant** primarily elevated in response to **inflammation** or **infection**. - While trauma could induce some inflammation, very high CRP levels are not specific for **DIC** or the direct complications of **placental abruption** described. *Creatinine* - **Creatinine** is a marker of **renal function**. While severe shock and hypoperfusion from significant bleeding could lead to **acute kidney injury** and elevated creatinine, it is not a direct or characteristic marker of the **coagulopathy** or **DIC** seen in this patient. - The primary issue presented is one of **bleeding and coagulation abnormalities**, not primarily renal dysfunction. *Pro-brain natriuretic peptide* - **Pro-brain natriuretic peptide (pro-BNP)** is a biomarker primarily used to assess **cardiac stretch** and **heart failure**. - There are no clinical signs or symptoms presented that suggest **cardiac dysfunction** as the primary or most characteristic complication in this setting. *Procalcitonin* - **Procalcitonin** is a biomarker that is significantly elevated in **bacterial infections** and **sepsis**. - Although the patient's condition is critical, the clinical picture strongly points towards **hemorrhage** and **DIC** due to **placental abruption** rather than a primary **bacterial infection**.

Labor Complications US Medical PG Question 6: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Labor Complications Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Labor Complications US Medical PG Question 7: A 32-year-old G2P1 female at 30 weeks gestation presents to the emergency department with complaints of vaginal bleeding and severe abdominal pain. She states that she began feeling poorly yesterday with a stomach-ache, nausea, and vomiting. She first noted a small amount of spotting this morning that progressed to much larger amounts of vaginal bleeding with worsened abdominal pain a few hours later, prompting her to come to the emergency department. Her previous pregnancy was without complications, and the fetus was delivered at 40 weeks by Cesarean section. Fetal heart monitoring shows fetal distress with late decelerations. Which of the following is a risk factor for this patient's presenting condition?

• A. Singleton pregnancy
• B. Hyperlipidemia
• C. Patient age
• D. Hypertension (Correct Answer)
• E. Prior Cesarean section

Labor Complications Explanation: ***Hypertension*** - The presenting symptoms of **vaginal bleeding**, **severe abdominal pain**, and **fetal distress** in a pregnant woman are highly suggestive of **placental abruption**. - **Chronic hypertension** is a well-established and significant risk factor for placental abruption, increasing the risk by two to three times. *Singleton pregnancy* - This is typical for most pregnancies and does not increase the risk of placental abruption. - **Multiple gestations** (twins, triplets) are actually associated with an increased risk of placental abruption, not singleton pregnancies. *Hyperlipidemia* - **Hyperlipidemia** is generally not considered a direct risk factor for placental abruption. - While it can be associated with other cardiovascular issues, its link to placental abruption is not significant in the way hypertension is. *Patient age* - At 32 years old, the patient is not at an extremely advanced maternal age, which typically refers to 35 years or older. - While **advanced maternal age** can be a slight risk factor for some pregnancy complications, it is not as strong a risk factor for placental abruption as hypertension in this context. *Prior Cesarean section* - A **prior Cesarean section** is a risk factor for conditions like **placenta previa** and **placenta accreta**, where the placenta implants abnormally. - It is not a primary risk factor for **placental abruption**, which involves premature separation of a normally implanted placenta.

Labor Complications US Medical PG Question 8: A 25-year-old G2P1001 at 32 weeks gestation presents to the hospital with painless vaginal bleeding. The patient states that she was taking care of laundry at home when she experienced a sudden sensation of her water breaking and saw that her groin was covered in blood. Her prenatal history is unremarkable according to the clinic records, but she has not seen an obstetrician for the past 14 weeks. Her previous delivery was by urgent cesarean section for placenta previa. Her temperature is 95°F (35°C), blood pressure is 125/75 mmHg, pulse is 79/min, respirations are 18/min, and oxygen saturation is 98% on room air. Cervical exam shows gross blood in the vaginal os. The fetal head is not palpable. Fetal heart rate monitoring demonstrates decelerations and bradycardia. Labs are pending. IV fluids are started. What is the best next step in management?

• A. Cesarean section (Correct Answer)
• B. Betamethasone
• C. Red blood cell transfusion
• D. Vaginal delivery
• E. Lumbar epidural block

Labor Complications Explanation: ***Cesarean section*** - This patient presents with signs highly suggestive of **placenta previa with possible vasa previa or placental abruption**, with life-threatening complications for both mother and fetus. The presence of **painless vaginal bleeding**, a prior **cesarean section for placenta previa**, and **fetal heart rate decelerations/bradycardia** necessitate immediate delivery via cesarean section to prevent **fetal demise** and severe **maternal hemorrhage**. - The rapid deterioration of the fetal status, indicated by **decelerations and bradycardia**, confirms the urgency. A **cesarean section** is the quickest and safest way to deliver the baby and address the underlying obstetric emergency. *Betamethasone* - **Betamethasone** is administered to promote **fetal lung maturity** in cases of preterm delivery. While this patient is preterm at 32 weeks, the critical nature of the fetal distress and bleeding requires immediate delivery, making the delay for betamethasone administration inappropriate. - The benefits of steroids for lung maturity are outweighed by the **immediate risk of fetal demise** and severe maternal complications if delivery is delayed. *Red blood cell transfusion* - While the patient is actively bleeding and may eventually require a **blood transfusion**, starting IV fluids and proceeding with an **immediate cesarean section** are higher priorities to stabilize the mother and rescue the fetus. - Transfusions are supportive measures once the source of hemorrhage is addressed and vital signs are stabilized during or after surgery. *Vaginal delivery* - Given the patient's history of **placenta previa**, current **painless vaginal bleeding**, and signs of **fetal distress**, a vaginal delivery is contraindicated due to the high risk of **exsanguinating hemorrhage** for the mother and severe fetal compromise. - The prior **cesarean section for placenta previa** also increases the risk of recurrent previa and **placenta accreta spectrum**, further contraindicating vaginal delivery. *Lumbar epidural block* - A **lumbar epidural block** is used for pain management during labor, but in this emergent situation with active bleeding and fetal distress, immediate delivery is paramount. - The time required to safely administer an **epidural**, along with the potential for **hypotension** in a hypovolemic patient, makes it an inappropriate next step.

Labor Complications US Medical PG Question 9: A 31-year-old G6P6 woman with a history of fibroids gives birth to twins via vaginal delivery. Her pregnancy was uneventful, and she reported having good prenatal care. Both placentas are delivered immediately after the birth. The patient continues to bleed significantly over the next 20 minutes. Her temperature is 97.0°F (36.1°C), blood pressure is 124/84 mmHg, pulse is 95/min, respirations are 16/min, and oxygen saturation is 98% on room air. Continued vaginal bleeding is noted. Which of the following is the most appropriate initial step in management?

• A. Oxytocin
• B. Blood product transfusion
• C. Uterine artery embolization
• D. Hysterectomy
• E. Bimanual massage (Correct Answer)

Labor Complications Explanation: ***Bimanual massage*** - The patient is experiencing **postpartum hemorrhage (PPH)**, indicated by significant bleeding post-delivery. **Uterine atony** is the most common cause of PPH, and bimanual massage helps stimulate uterine contractions to reduce bleeding. - This is a **first-line, non-pharmacological intervention** that can be rapidly initiated to manage uterine atony. *Oxytocin* - While **oxytocin** is a uterotonic agent used to treat PPH, the initial step is typically **bimanual massage** to physically stimulate the uterus while preparing for medication administration. - Oxytocin infusion would be administered concurrent with or immediately following bimanual massage, but manual compression is often initiated first. *Blood product transfusion* - Blood product transfusion is indicated for significant blood loss and hemodynamic instability, but it is a **supportive measure** rather than an initial intervention to stop the bleeding. - The patient's current **blood pressure (124/84 mmHg)** and **pulse (95/min)** do not immediately suggest severe hypovolemic shock requiring immediate transfusion as the *first* step before attempting to control the source of bleeding. *Uterine artery embolization* - **Uterine artery embolization** is a highly invasive procedure typically reserved for cases where conservative measures, including uterotonic agents and bimanual compression, have failed to control PPH. - It is not an appropriate initial step, as it requires specialized equipment and personnel and would delay immediate management of active bleeding. *Hysterectomy* - **Hysterectomy** is a last-resort intervention for intractable PPH that cannot be controlled by all other methods, including uterotonics, uterine massage, and other surgical or interventional radiology techniques. - It is a highly invasive procedure with significant morbidity and is not considered an initial management step.

Labor Complications US Medical PG Question 10: A 32-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the emergency department because of vaginal bleeding for the past hour. The patient reports that she felt contractions prior to the onset of the bleeding, but the contractions stopped after the bleeding started. She also has severe abdominal pain. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Her pulse is 110/min, respirations are 17/min, and blood pressure is 90/60 mm Hg. Examination shows diffuse abdominal tenderness with no rebound or guarding; no contractions are felt. The fetal heart rate shows recurrent variable decelerations. Which of the following is the most likely diagnosis?

• A. Uterine inertia
• B. Amniotic fluid embolism
• C. Uterine rupture (Correct Answer)
• D. Vasa previa
• E. Abruptio placentae

Labor Complications Explanation: ***Uterine rupture*** - The patient's history of a prior **cesarean section**, sudden onset of **vaginal bleeding** and **severe abdominal pain**, resolution of contractions, and signs of **hypovolemic shock** (tachycardia, hypotension) coupled with fetal distress (variable decelerations) are highly indicative of uterine rupture. - Diffuse abdominal tenderness without rebound or guarding, and no palpable contractions, are also consistent with rupture. *Uterine inertia* - This condition is characterized by **weak or uncoordinated uterine contractions** leading to prolonged labor, but it does not typically present with acute vaginal bleeding, sudden severe abdominal pain, or hypovolemic shock. - Fetal distress in uterine inertia would more likely be due to prolonged labor rather than acute compromise following a sudden event. *Amniotic fluid embolism* - This is a rare, life-threatening obstetric emergency characterized by sudden **cardiovascular collapse, respiratory distress**, and **coagulopathy**, often occurring during labor or immediately postpartum. - While it can cause fetal distress, vaginal bleeding and severe abdominal pain are not primary presenting symptoms. *Vasa previa* - Characterized by **painless vaginal bleeding** when fetal vessels within the membranes cross the internal cervical os, making them vulnerable to rupture during cervical dilation or amniotomy. - The bleeding is typically fetal blood, and fetal distress occurs rapidly, but the mother would not experience severe abdominal pain or signs of hypovolemic shock unless the bleeding is substantial and prolonged. *Abruptio placentae* - This involves the **premature separation of the placenta**, causing painful vaginal bleeding, uterine tenderness, and frequent, strong contractions. - While it can cause hypovolemic shock and fetal distress, the description of contractions stopping after bleeding started, along with a previous C-section scar, points more specifically to uterine rupture rather than an abruption.

Labor Complications Flashcard 1 of 10

Question: Inflammation of the endometrium due to retained products ofconception, miscarriage, abortion, or foreign body (IUD) is known as _____

Answer: endometritis

Labor Complications Flashcard 2 of 10

Question: Tocolytics are generally used to decrease contraction frequency in _____ labor

Answer: preterm

Labor Complications Flashcard 3 of 10

Question: _____ is a complication of pregnancy that presents with a triad of membrane rupture, painless vaginal bleeding, and fetal bradycardia (< 110 beats/min)

Answer: Vasa previa

Labor Complications Flashcard 4 of 10

Question: A full-thickness disruption of the uterine wall that typically presents with intense, acute abdominal pain, profuse vaginal bleeding, and fetal distress is most likely what condition?_____

Answer: Uterine rupture

Labor Complications Flashcard 5 of 10

Question: leiomyoma (fibroid)

Answer:

Extra Information: asymptomatic, abnormal uterine bleeding, miscarriagewell-demarcated edges, whorled smooth muscle bundlesgood, does NOT progress to leiomyosarcoma20-40 years, black race

Labor Complications Flashcard 6 of 10

Question: endometritis

Answer: retained tissue/foreign body in uterus

Extra Information: infection and inflammation of endometriumgentamycin + clindamycin +/- ampicillin

Labor Complications Flashcard 7 of 10

Question: placenta previa

Answer: placenta attaches near or over internal cervical os

Extra Information: painless vaginal bleeding during any trimestermultiparity, prior C-section

Labor Complications Flashcard 8 of 10

Question: abruptio placentae

Answer:

Extra Information: painful bleeding in 3rd trimesterlife-threatening for fetus and mothersmoking, HTN, cocaineDIC

Labor Complications Flashcard 9 of 10

Question: mittelschmerz

Answer: blood from ruptured follicle causes peritoneal irritation

Extra Information: acute onset abdominal pain mimicing appendicitis

Labor Complications Flashcard 10 of 10

Question: true hermaphroditism

Answer:

Extra Information: both ovarian and testicular tssue present, ambiguous genitalia