6: Complications of L&D Flashcards
(39 cards)
risk factors of preterm labor (PTL)
preterm ROM; chorioamnionitis; multiple gestations; uterine anomalies such as a bicornuate uterus; previous preterm delivery; maternal prepregnancy weight less than 50 kg; placental abruption; maternal disease including preeclampsia, infections, intra-abdominal disease or surgery; and low SES.
prematurity increases risk of
respiratory distress syndrome (RDS) or hyaline membrane disease, intraventricular hemorrhage, sepsis, and necrotizing enterocolitis
only tocolytic FDA approved in the US
ritodrine—a beta-mimetic agent
many others are used
ritodrine and terb doses
Ritodrine is given as continuous IV therapy, whereas terbutaline is usually given as 0.25 mg SC, loaded Q 20 min × 3 dosages, and then Q 3 to 4 h maintenance
how does hydration act as a tocolytic?
decreases levels of ADH, the octapeptide synthesized in the hypothalamus along with oxytocin. Because ADH differs from oxytocin by only one amino acid, it may bind with oxytocin receptors and lead to contractions.
why does terbutaline have a black box warning?
may cause maternal death and cardiac events, including tachycardia, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia
Mg sulfate dosing
loaded as a 6-g bolus over 15 to 30 minutes, and then maintained at a 2- to 3-g/hour continuous infusion. A slower infusion should be used in the case of renal insufficiency because magnesium is cleared via the kidneys.
risks at toxic levels of magnesium (> 10 mg/dL)
respiratory depression, hypoxia, and cardiac arrest, pulmonary edema
risks at magnesium levels less than 10 mg/dl
Deep tendon reflexes (DTRs) are depressed
adverse effects of indomethacin
premature constriction of the ductus arteriosus, pulmonary hypertension, and oligohydramnios secondary to fetal renal failure.
increased risk of necrotizing enterocolitis and intraventricular hemorrhage in extremely premature fetuses that had been exposed to indomethacin within 48 hours of delivery
Oxytocin antagonists can also be used as tocolytics, including
atosiban
preterm ROM vs premature ROM (PROM)
preterm ROM: before week 37
PROM: ROM occurring before the onset of labor
may occur together: PPROM
prolonged rupture of membranes if ROM lasts longer than 18 hours before delivery
most common concern of PROM
chorioamnionitis
test for ROM
pooling, nitrazine test, ferning, U/S, Amnisure test, tampon test
the vault is composed of what 5 bones?
can do what during labor?
two frontal, two parietal, and one occipital
the bones of the vault are not fused and can undergo molding to conform to the maternal pelvis in contrast to the bones of the face and base
factors associated with breech presentation
complications?
previous breech delivery, uterine anomalies, polyhydramnios, oligohydramnios, multiple gestation, PPROM, hydrocephaly, and anencephaly
complications: prolapsed cord, head entrapment
types of breech: frank, complete, incomplete/footling
frank: “folded”; flexed hips and extended knees
complete: “compact”; flexed hips, but one or both knees are flexed as well, with at least one foot near the breech
incomplete/footling: one or both of the hips not flexed so that the foot or knee lies below the breech in the birth canal.
three management options for breech
external cephalic version of the breech (manipulation into a vertex presentation), trial of breech vaginal delivery, and elective cesarean delivery
compound presentation
watch out for ?
tx is different for UE and LE
fetal extremity presenting alongside the vertex or breech
risk of umbilical cord prolapse
UE may be gently reduced
LE is considered footling/incomplete and calls for c section
types of breech: frank, complete, incomplete/footling
frank: “folded”; flexed hips and extended knees
complete: “compact”; flexed hips, but one or both knees are flexed as well, with at least one foot near the breech
incomplete/footling: one or both of the hips not flexed so that the foot or knee lies below the breech in the birth canal.
OP vs OT position, which one more common to deliver vaginally?
While OP position fetuses deliver vaginally in about 50% of cases, OT position fetuses rarely deliver vaginally in the OT position and must rotate to either OA or OP to deliver vaginally.
(may try to rotate manually or operatively with vacuum/forceps, otherwise C section)
etiologies of prolonged FHR decelerations include
preuterine (maternal PE, MI, AFE, seizure, epidural) uteroplacental (abruption, tetanic contraction, rupture) or postplacental (cord prolapse/compression, vasa previa)
prolonged deceleration vs bradycardia
prolonged decel: FHR below 100-110 bpm for >2 minutes
bradycardia: >10 minutes
C section if FHR decelerations are due to
cord prolapse, placenta previa, abruption
