4.2 part 3 lmao Flashcards
late preterm birth
34-37 weeks
moderate preterm birth
32-34 weeks
very preterm birth
less than 32 weeks
extremely preterm birth
less than 28 weeks
low birth weight
less than 2500 g
very low birth weight
less than 1500 g
extremely low birth weight
less than 1000 g
diffuse atelectasis, alveolar collapse, and pulmonary perfusion without ventilation due to insufficient surfactant production by an immature lung
neonatal respiratory distress syndrome
who does neonatal respiratory distress syndrome predominantly affect
preterm infants
what is the most common cause of death in the first month of life
neonatal respiratory distress syndrome
risk factors for neonatal respiratory distress syndrome
caucasians
males
multiple births
maternal DM
clinical manifestations of neonatal respiratory distress syndrome
tachypnea > 60/min
tachycardia
chest wall retractions
expiratory grunting
nasal flaring
cyanosis
CXR for neonatal respiratory distress syndrome
bilateral diffuse reticular (ground-glass) opacities + air bronchograms
noninvasive management for neonatal respiratory distress syndrome
nasal continuous positive airway pressure or nasal intermittent positive pressure ventilation
CNS disorder with muscle tone, movement, and postural abnormalities due to brain injury during perinatal or prenatal period
cerebral palsy
hallmark of cerebral palsy
spasticity
Diagnosis for cerebral palsy
primarily clinical but MRI required in all patients
PE for cerebral palsy
hyperreflexia
limb-length discrepancies
congenital defects
persistent primitive reflexes
Minimally invasive procedure where a laparoscope is inserted into the uterus to see the fetus and placenta
fetoscopy
Best chance for curing twin-to-twin transfusion syndrome
fetoscopy
abnormal communications in the female reproductive tract between the bladder urethra and ureters
urogenital fistula
when do urogenital fistulas commonly occur
after hysterectomy
painless urinary leakage from the vagina indicates what type of urogenital fistula
uretovaginal fistula
continuous urinary incontinence indicates what type of urogenital fistula
vesicovaginal fistula
Dye testing (PO phenazopyridine) – tampon test: blue staining for urogenital fistula
vesicovaginal fistula
Dye testing (PO phenazopyridine) – tampon test: wetness w/ clear fluid for urogenital fistula
ureterovaginal fistula
most common urogenital fistula
vesicovaginal fistula
synthetic drug that mimics oxytocin
Pitocin
stimulates contraction of uterine smooth muscles and causes cervical dilation
Pitocin
can Pitocin induce labor if cervix isn’t ready?
nope
complete transection of the uterus from the endometrium to the serosa
uterine rupture
complete transection of the uterus from the endometrium to the serosa but the peritoneum remains intact
uterine dehiscence
is uterine rupture life threatening
YES to mother and fetus
risk factors for uterine rupture
previous uterine rupture
prior c section
decreased risk of uterine rupture
prior vaginal delivery before or after prior c section
clinical manifestations of uterine rupture
sudden onset of extreme abdominal pain, decreased or absent uterine contractions
management of uterine rupture
immediate laparotomy and delivery of fetus followed by immediate repair of uterus or hysterectomy
definitive management of uterine rupture
hysterectomy
entrance of meconium containing amniotic fluid into the respiratory tract resulting in respiratory distress, hypoxia, and acidosis
meconium aspiration
meconium aspiration primarily occurs in what population
postterm infants and infants small for gestational age
Clinical manifestations of meconium aspiration
respiratory distress
what color will the umbilical cord be if meconium aspiration is a cause
yellow-green
CXR for meconium aspiration
hyperinflation of lungs (flattened diaphragm and increased AP diameter)
most effective management of meconium aspiration
PREVENTION – prevention of post-term delivery > 41 weeks
indications for operative vaginal delivery
prolonged 2nd stage of labor
suspicion of fetal compromise (abnormal heart rate pattern)
most common surgery performed in US
c section
when should antibiotic prophylaxis be administered before c section
60 minutes before
1 g dose cephazolin IV (1 dose)
VBAC
vaginal birth after cesarean
TOLAC
trial of labor after cesarean
what does ACOG recommend for delayed cord clamping
ACOG recommends a delay of at least 30 to 60 s in vigorous term and preterm infants who do not require resuscitation
onset of postpartum blues
2-4 days postpartum
clinical manifestations of postpartum blues
mild depression
concern if she is a good mother
no thoughts of harming baby
when do postpartum blues resolve
1-2 weeks
is treatment needed for postpartum blue
not usually
cognitive behavioral therapy
onset of postpartum depression
2 weeks - 2 months postpartum
clinical manifestations of postpartum depression
loss of interest
crying most days of the week
may have thoughts of harming baby
when does postpartum depression usually resolve
within 3-14 months
treatment for postpartum depression
antidepressants (SSRI)
cognitive behavioral therapy
onset of postpartum psychosis
repeats weekly or biweekly
clinical manifestations of postpartum psychosis
psychotic thoughts and delusions
thoughts of harming baby (baby is in danger)
Management of postpartum psychosis
admit patient and remove children to ensure safety
antidepressants (SSRI) and antipsychotics
cognitive behavioral therapy
how many stages are there in labor
3
stage one includes what phases
latent phase
active phase
latent phase
cervix effacement with gradual dilatin
active phase
rapid cervical dilation usually beginning at 3-4 cm
what phases are included in stage 2 of labor
passive phase
active phase
passive phase
complete cervical dilation to active maternal expulsive efforts
active phase of stage 2 of labor
from active maternal expulsive efforts to delivery of fetus
stage 3 of labor
postpartum until delivery of placenta
0-30 minutes (average is 5 minutes)
3 signs of placental separation
gush of blood
lengthening of umbilical cord
anterior-cephalad movement of the uterine funds (becomes globular and firmer) after the placenta detaches
cardinal movements of labor
engagement
descent
flexion
internal rotation
extension
external rotation
the uterus is at the level of what after delivery
umbilicus
when does the uterus begin to shrink postpartum
2 days
when does the uterus descend into the pelvic cavity postpartum
2 weeks
when is the uterus back to normal size postpartum
6 weeks
pinkish/brown vaginal bleeding postpartum
lochia serosa
when do you see lochia serosa
4-10 days postpartum
what is lochia serosa a result of
decidual tissue
when does lochia serosa resolve
3-4 weeks postpartum
what color is breast milk initially
bluish-white
how long do you have bluish-white milk postpartum
3-5 days
if not breast feeding, when may menses return
6-8 weeks
early postpartum hemorrhage
within 24 hours postpartum
delayed postpartum hemorrhage
> 24 hours up to 8 weeks postpartum
4 T’s associated with postpartum hemorrhage
Tone: uterus unable to contract to stop bleeding
Tissue: retained placental tissue
Trauma: to the cervix, perineum, or vagina, uterine rupture, etc
Thrombin: coagulation abnormalities like hemophilia A or DIC
Most common cause of postpartum hemorrhage
uterine atony - uterus unable to contract to stop bleeding
PE for postpartum hemorrhage
soft flaccid boggy uterus if uterine atony
dilated cervix
management of atony
bimanual uterine massage and compression are first line
first line medication for postpartum hemorrhage
IV oxytocin to increase uterine contractions
if retained products causing postpartum hemorrhage, what’s the treatment
suction and curettage
stimulation of uterine contractions to initiate labor prior to the onset of spontaneous labor
induction of labor
absolute contraindications to induction of labor
transmural myomectomy
placenta previa
prolapsed cord
active genital herpes
transverse fetal lie
uterine scar from c-section
cephalopelvic disproportion
induction of labor for woman with favorable cervix
IV oxytocin
amniotomy - artificially rupturing membranes
pre induction cervical ripening for women with unfavorable cervix (for labor induction)
prostaglandin gel – promotes cervical ripening
balloon catheter or laminaria - dilates the cervix
