4.3 Flashcards
What is the leading cause of neonatal death in the US?
Preterm birth
Define preterm, very preterm and extremely preterm
Preterm
Whats the greatest predictor of preterm birth?
Prior PTB
Whats the path process of PTB?
Activation of the maternal or fetal hypothalamic pituitary axis, Infection, Decidual hemorrhage, Pathologic uterine distention.
What are the biochemical and US PTB risk predictors?
Biochemical: Fetal Fibronectin: Glycoprotein in amnion, decidua, cytotrophoblast. High bc inflamm, shear, mvmt. Very good negative predictive value, useless pos.
Ultrasound: Cervical length: smaller, the greater the prob due to increased risk of UTI’s and increasing prostaglandins to expell the baby.
Best use for terbutaline?
Beta adrenergic Receptor Agonist: Purpose is to slow down contractions. But best used for tachysystole.
Contraindication of MgSO4
myasthania gravis, renal fail
Contraindication of CCBs
Left vent dysfunx, CHF
MOA and contraind of indocin
Cyclooxygenase inhibitor that reduces PGE2 production. Contraindications: Platelet or hepatic dysfunction
When are antenatal steroids given?
Preterm labor 24 – 34 weeks OR PPROM 24 – 34 weeks
When is progesterone given?
Given to women with prior PTB women of 24-36wks. Given as injection at 16-20wk and continue until 36wks
What are 5 dx methods for rupture of membs?
Nitrazine test, Fern test, placental alpha microglobulin 1 protien, ultrasound, Indigo-carmine amnioinfusion
Expectant management criteria
means watch and wait. >34wk DELIVER not worth risk of ascend infxn. 24-34 (PPROM)wk: antibiotics, steroids, tocolytics. PreviablePPROM- counsel pt on risks.
What are indications for immediate delivery?
Intrauterine infection,
Abruptio placenta,
Repetitive FHR decelerations,
Cord prolapse.
What’s the clinical dx of preterm labor?
persistent contraction with cervical change (80% effacement/>2cm dil)
