Blue Prints 5: Antepartum Hemorrhage Flashcards
Define placenta previa?
3 types of previa?
Placenta implants over the internal cervical os.
Complete, partial and marginal
3 placental causes of antepartum bleeding?
1 maternal and 1 fetal cause of antepartum bleeding?
Placenta previa, placenta abruption, vasa previa
Uterine rupture
Fetal vessel rupture
Patient presentation of placenta previa and when does it usually happen?
Painless vaginal bleeding after 28 weeks
When do 50% of abruptions occur?
Before labor and after 30 weeks
What is classic presentation of abruption?
Third trimester vaginal bleeding with severe abdominal pain
What is the difference between cervical insufficiency and preterm labor?
Painful and painless cervical dilation and effacement
What is considered low birth weight?
Less than 2500 grams
Infants who have not grown appropriately for their gestational age have what or are what?
Intrauterine growth restriction or are small for gestational age
4 big time conditions that baby is at risk for if born premature?
RDS, intra ventricular hemorrhage, sepsis, and necrotizing enterocolitis
What is the only FDA approved tocolytic?
Ritodrine
Studies have shown that tocolytics only prolong gestation for how long, which means what is the primary purpose and what med is used for this primary purpose?
48 hours
Allow lungs to mature
Betamethasone
What is the goal of tocolytics?
Decrease cervical change for contractions
Besides tocolytics, what else is used to decrease contractions and why?
Hydration. It decreases the level of ADH which can bind to oxytocin receptors and halt contractions.
Explain big picture what regulates uterine contractions on a molecular level and what turns it on and off?
Myosin light chain kinase.
Calcium + calmodulin turns it on and cAMP turns it off.
How can we increase levels of cAMP and what is the actual effect of cAMP to turn off MLK?
Beta agonists that activate b2 receptors, convert ATP to cAMP. The cAMP causes calcium to go inside the SR which lowers available calcium for contractions.
What are the two beta agonists historically used to prolong pregnancy?
Ritodrine and terbutaline
What effect does magnesium have on contractions and how does it work?
Decreases by being anti calicum
What is the calcium channel blocker mentioned in the book?
Nifedipine
What is the prostaglandin inhibitor mentioned to decrease contractions?
Indomethacin, blocks cyclo oxygenase
How to best make the diagnosis of ROM?
History of leaking vaginal fluid
Pooling, nitrazine test positive and ferning
US shows less fluid
Tampon test via amniocentesis
What drives the management of preterm premature ROM?
At some gestational age, the risk of prematurity and the risk of infection becomes equal between 32 and 36 weeks. Up to 32 weeks, the risk of prematurity is the driving factor in management and after 36 weeks it is infection. Most would say they deliver at 34 weeks.
What two meds are recommended in the setting of preterm premature ROM?
Antibiotics, so ampicillin (+- erythromycin)
And steroids for lungs.
What is the most common concern of premature ROM?
How do we treat?
Chorioamnionitis
Abx and deliver at 34 weeks
How do we define prolonged deceleration and bradycardia in baby?
HR below 100 for over 2 minutes
Longer than 10 minutes is bradycardia
What is the Mc Roberts maneuver for shoulder dystocia, what does it accomplish and what needs to be done along with it?
Sharply flex moms hips to increase AP diameter
Suprapubic pressure above symphysis to get anterior shoulder out
If there is a shoulder out, try to push it toward anterior chest to decrease diameter of baby’s
