6. Complications of L&D

Question 1

Prematurity puts infants at increased risk of (4):

Answer 1

• RDS
• Intraventricular hemorrhage
• Sepsis
• Necrotizing enterocolitis

Question 2

Medication used for tocolysis prior to 34 weeks

Goal of using this medication

Answer 2

Betamethasone

Goal: decrease/halt cervical change resulting from contractions… also keep pt hydrated! (dehydrated pt has increased levels of ADH… b/c ADH differs from oxytocin by only one AA, it may bind with oxytocin receptors and lead to contractions)

Question 3

Tocolytics

Answer 3

• Beta-mimetics
  
  • Ritodrine / terbutaline
    
    • Watch out for pulmonary edema!
• Magnesium sulfate (calcium antagonist)
  
  • Watch out for flushing, headaches, fatigue, diplopia!
• CCBs
  
  • ​Nifedipine
• Prostaglandin inhibitors
  
  • ​Indomethacin
    
    • Watch out for premature constriction of ductus arteriosus, pulmonary HTN, and oligohydramnios 2/2 fetal renal failure

Question 4

Most common concern of PROM (premature rupture of membranes)

Answer 4

Chorioamnionitis

Give ampicillin with or without erythromycin

Question 5

Obstetric Emergencies (5)

Answer 5

• Fetal bradycardia
  
  • Anytime the fetal HR is below 100-110 bpm for longer than 2 min
• Shoulder dystocia
  
  • Risk factors: fetal macrosomia (>4,000 g), gestational diabetes, maternal obesity, postterm
• Uterine rupture
• Maternal hypotension
• Seizure

Question 6

Mgmt of pregnant pt with seizures or in status epilepticus

Answer 6

Question 7

How can breech presentations be managed?

Answer 7

External version to vertex

C-section

Trial of labor

Question 8

First-line treatment of patients with seizures in pregnancy

Answer 8

IV or IM magnesium sulfate